Following a stroke, you or a loved one may be left physically or mentally impaired and unable to work. You may be wondering if you qualify for Social Security benefits.
At first, the answer isn’t always clear. It can depend on a myriad of factors that will evolve over the coming months and years.
And the process can take time. Not only does the initial Social Security claim decision take months or possibly longer. The Social Security Administration (SSA) also defers stroke-related disability claims for an additional three months.
This is because it may be unclear initially what a stroke victim’s path to recovery will take and what the lasting medical effects will be for the individual.
The severity of the condition three months after a stroke, and how it affects the sufferer’s ability to function and work, will determine whether the SSA will award benefits or whether they will deny a claim.
This can obviously be extremely frustrating for someone attempting to navigate the Social Security system themselves—or as a caregiver of a loved one—all while being impacted by a neurological disability.
How do you determine where your case falls in this seeming gray area for SSDI or SSI benefits? What happens if your initial claim is denied? Should you consult with a disability attorney?
Let’s take a closer look at some of these crucial questions.
Qualifying for Social Security Benefits After a Stroke
The SSA defines a stroke as a “Vascular Insult to the Brain,” which is caused either by a blockage or hemorrhage to a blood vessel that supplies oxygen to the brain.
In order to qualify for Social Security disability benefits, the person filing a claim must have:
- Impaired speech or ability to write caused by sensory or motor aphasia.
- Disorganization of motor function in two extremities—arms or legs or one of each—resulting in an extreme limitation in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities.
- Limited physical functioning AND limited mental functioning in one of these areas:
- Understanding, remembering, applying information
- Social interactions
- Concentrating, persisting, or maintaining pace
- Adapting or managing oneself
These conditions must persist beyond three months after the person filing suffered the stroke.
More about Applying for SSDI Benefits
It must be determined that this disability prevents you or your loved one from working for at least 12 months. There must be thorough medical documentation to prove the severity of the disability. The onset of the disability must have occurred prior to retirement age. Finally, the person seeking benefits must have worked and paid FICA payroll taxes for five of the past 10 years.
Alternatively, you can call 1-800-772-1213 or TTY 1-800-325-0778 for the deaf or hard of hearing, or you can visit your local social security office.
What Else Should I Know about SSDI Benefits?
Medicare: 24 months after you’re eligible for Social Security disability benefits, you are also eligible for Medicare.
COBRA: SSDI eligibility allows you to potentially extend COBRA coverage by 11 months.
Long-term disability: LTD insurance may require you to apply for SSDI.
Medical-Vocational Allowance: As an alternative to a typical SSDI claim for a stroke-related disability, when seeking a Medical-Vocational Allowance, the SSA will go through a process of determining if your disability causes you to be unable to meet the demands of your work and if you may be eligible for benefits.
SSI: As opposed to SSDI, SSI (Supplemental Security Income) provides benefits for people based on income and need (those who earn less than $1,600 per month), not work history. This may be another avenue you pursue for benefits, depending on your specific situation.
What If I Am Denied Benefits for my Disability?
Roughly 70 percent of Social Security disability claims are initially denied.
For those who’ve been disabled from a stroke, a denied claim may have to do with the medical records and treatments from your doctor for the three-month deferral period, or for various other reasons.
The next step is to appeal the decision. However, your initial appeal will have only a small chance of success.
After this, you will schedule a hearing with an administrative law judge (ALJ). Failing this, you’ll next seek an appeal with the Appeals Council and beyond that, take your case to federal court.
This can be a daunting process that can take anywhere from months to several years, while you await hearing dates and decisions on your claim.
Attorneys experienced in disability law can guide you each step of the way.
How an Attorney Can Help You Win Your Benefits
Considering the additional wait period and uncertainty for a disabled stroke victim seeking benefits, the initial application process in and of itself can feel overwhelming.
Attorneys can keep you abreast of the status of your claim and how to navigate the initial stages of the process.
After an initial claim is denied, navigating the appeals process becomes increasingly complex. Disability attorneys will know how best to guide you through this process.
Local attorneys will be familiar with administrative law judges and other court personnel. They will have insights into expectations and preferences during the process, and they can advocate on behalf of their clients to seek the best possible outcome.
When you retain the services of a Social Security disability attorney, the fee is typically limited to 25 percent of the past-due benefits you are awarded, up to a maximum of $6,000. Note that, in these instances, the attorney will be paid only out of your past-due benefits, or “back pay.” If no back benefits are awarded, the attorney will not receive a fee.
If you or someone you love has suffered a disability caused by a stroke, and you are filing for Social Security Disability Insurance or Supplemental Security Income, Affleck and Gordon can help. We’ve been helping people in Georgia just like you for over 40 years. Sign up for a free case evaluation, or call us (404) 795-4978.