Social Security Disability
What is Social Security Disability?
Social Security Disability is the federal program, supported by payroll taxes, that pays benefits to people who cannot work due to a medical condition. In order to qualify, you must have a medical condition that meets Social Security's definition of disability and is expected to last at least one year or result in death.
You will be considered disabled if you can provide medical evidence that are unable to do the work that you did before and you cannot adjust to other work because of your medical condition(s). No benefits are payable for partial disability or for short-term disability.
Generally, to be eligible for disability benefits, you must have worked long enough and acquired enough work credits. The number of work credits required will depend on your age when you become disabled. There are different eligibility rules for children under the age of 18.
How Social Security determines if you are disabled
There are five steps along the path to being declared disabled.
Step 1 – Are you working?
If you are working in 2010 and your earnings average more than $1,000 a month, you generally cannot be considered disabled.
Step 2 – Is your condition severe?
Your impairment(s) must significantly limit your ability to do basic work activities, for example walking, sitting, seeing, and remembering.
Step 3 – Is your condition found in the list of disabling condition?
Social Security maintains a Listing of Impairments for each of the major body systems that are so severe they will automatically consider you disabled.
Step 4 – Can you do the work you previously did?
If your condition is severe but not at the same or equal level of severity as a medical condition on the list, then Social Security must determine if your condition interferes with your ability to do the work you did previously.
Step 5 – Can you do any type of work?
If you cannot do the work you did in the past, Social Security will see if you are able to adjust to other work. They consider your medical conditions and your age, education, past work experience and any transferable skills you may have. If you cannot adjust to other work, your claim will be approved.
How to apply
You should apply for disability benefits as soon as you become disabled. You can complete some or all of the forms online at www.socialsecurity.gov/applyfordisability or you may call the Social Security Administration toll-free at 1-800-772-1213 to schedule an appointment. A staff member can assist you either in person or by phone.
Build your case
You must be able to prove, by furnishing medical and other evidence, that you are disabled by lupus (not just that you have lupus) and meet the Social Security definition of disability. Your doctor cannot “declare” that you are disabled. You and your doctor must provide evidence that proves lupus prevents you from engaging in any substantial gainful employment and that this condition is expected to last for a continuous period of at least twelve months, or result in death.
What to expect
It can take between three and five months to obtain an initial decision. Almost two out of three applicants are denied benefits initially, and most people who file a written appeal (called “reconsideration”) also are denied. The third level appeal before an administrative law judge is most successful. More than 60 percent of denials are overturned at this stage. So you must be patient. You can improve your odds of being approved for disability by building a solid case based on appropriate medical evidence.
Medicare is a federal insurance program that pays for medical care for people who qualify. People who have been determined to be disabled and have been receiving disability benefits for at least 24 months qualify for Medicare. People with lupus who need long term dialysis treatment for chronic kidney disease or require a kidney transplant will qualify for Medicare immediately after they are determined to be disabled. In general, Medicare pays 80 percent of reasonable charges.