Some of the topics I spend the most time discussing with patients and their families who are facing the aftermath of stroke have nothing to do with actual medicine. Medical school, residency, and fellowship provide the opportunity for physicians to learn that drug A treats condition B, and that we use drug C because Clinical Trials X and Y suggested it is beneficial. When physicians enter the world of clinical practice, while our patients depend on us to guide them in making decisions that impact their health, they also want to answers that physicians are not formally trained to answer. Personally, the non-medical topic I find myself discussing the most frequently with stroke patients is the process of applying for disability income in the United States.
The first time a patient asked me why she was turned down for social security, I had no idea. She clearly was physically disabled from her stroke. I had completed the appropriate paperwork sent to my office. I could see she was visibly upset at being denied this needed income, and I felt guilty, as if it was my fault in some way, despite having meticulously completed the forms. What happened?
Fast forward to 2015, and I think I have gained more insight into why this scenario occurs. My disclaimer here is that I am not an attorney, employed by the federal government, or a certified account, so what I am sharing is what I have gained watching hundreds of stroke patients navigate the process. Patients frequently do not understand how the system works, and many healthcare providers don’t either. To be perfectly frank, I am naïve to all of the inner-workings of “the system,” but I can boil it down to a few key points that I hope will provide clarity to anyone out there living with neurological deficits after stroke and seeking answers.
Stroke patients in the United States essentially have two options available for long term disability income:
- If a long term disability insurance policy was purchased prior to the stroke from a company such as The Hartford, MetLife, or Liberty Mutual (these are only a handful of carriers out of the many available), then an application can be filed. The patient’s healthcare provider, usually a physician, will be asked to complete paperwork, and copies of relevant medical records will be requested.
- Typically there is a waiting period, which is variable. If a patient has short term disability insurance, income from the short term disability policy can be used for part or all of the waiting period until the long term disability income is available. If there is no short term disability policy in place and no sick leave available, there is usually a lengthy unpaid period as the patient waits.
- If a patient improves over the course of the waiting period, even if a long term disability policy is present, the patient may not be eligible to receive income if the level of disability cannot be verified in the medical records or from the paperwork completed by the healthcare provider.
- Then, there is social security. This has to be one of the most misunderstood systems in the U.S. Patients have so many different ideas of what social security is, how it works, how one receives benefits, and so on. The National Stroke Association does a fantastic job of breaking down social security on its website. Click here if you would like to read more.
- In the example I mentioned above, the reason the patient was denied social security income was not because she was not physically disabled, but because her stroke was less than one year old. Her stroke was too recent. The condition has to be expected to last “at least 12 months.” My advice to stroke patients who have been denied social security income if they applied less than one year after the stroke is to reapply.
- If a patient is already receiving social security income because of his or her age (let’s say – a 70 year old patient who has been receiving social security income for five years), then the patient is already receiving the money! People do not receive double the amount of money for becoming disabled over the age at which they become eligible to receive social security income.
- If an adult has never worked, or worked but somehow never paid into the program, or if a person worked but did not contribute enough to the program while working, then a person is probably not eligible to receive social security income. If there are questions about your personal situation, I recommend contacting an attorney with expertise in this area. It’s important for patients to understand that social security is an annuity, meaning that people pay in to the program as an insurance policy. In return, money is paid out, either when a person becomes disabled or when a person reaches retirement age.