If You Become Disabled
Estimates suggest that approximately 25 percent of all people with fibromyalgia are receiving disability payments. But applying for disability benefits can be a long, painstaking process that requires patience and perseverance.
People who become disabled may be eligible for benefits from various agencies. Some of these forms of assistance are temporary and provide short-term help until you find another source of assistance.
If you are laid off from your job, for instance, you may collect unemployment. If your fibromyalgia was triggered by a work-related injury — though this may be tough to prove — you may be eligible for worker's compensation. If your family qualifies, you may be eligible for a program called temporary assistance for needy families. But if you are going to be disabled for a year or longer, you may qualify for Social Security Administration (SSA) disability benefits.
To help more people with disabilities find work and get vocational services, the Social Security Administration offers the voluntary Ticket to Work Program for people receiving Social Security benefits. Recipients take the ticket to any participating employment network or state vocational rehabilitation office.
Applying for Social Security Disability
The SSA offers two types of assistance to people who are disabled. Social Security Disability Insurance provides benefits to workers under age 65 who can no longer work or who have lost income as the result of disability. To qualify, you must have worked for a certain amount of time before applying. The amount you receive will depend on your previous salary.
Supplemental Security Income is a program based on needs for people who are disabled and who have limited income. People who receive SSI need not have worked to receive these benefits.
The SSA considers a person disabled if she is unable to do any kind of work for which she is suited. The disability should also be expected to last at least a year or to result in death.
Applying for disability will require the support and assistance of your primary care doctor, who should advise you of your option to file for SSA disability when it becomes apparent that you won't be able to work for the next year. In addition, you will need a specialist in fibro. That person is usually a rheumatologist, though a neurologist or pain management specialist may be considered acceptable, too.
Do I actually have to be disabled a year to qualify for benefits?
No. According to the SSA, you should apply for benefits as soon as you can. If you are approved, your payments will begin after a five-month waiting period that starts with the month Social Security decides your disability began.
You also need an attorney who has significant experience getting benefits for fibromyalgia patients. Given that doctors can't prove that you don't have fibro, the SSA is very reluctant to blithely hand out benefits. An experienced attorney can help you meet all their expectations and minimize the risk of denial.
On your initial application, you'll need to describe the nature of your condition, provide the name of your health-care provider, and give a description of your work background and history. The SSA will then delve further into your claim. The agency will most likely contact your health-care providers for information about your condition. A physician who is skilled at keeping good records can be of great assistance when it comes to securing disability benefits. The SSA will also try to determine your capacity for lifting, walking, standing, and sitting. In addition, you will undergo a physical exam by a physician hired by the SSA.
Dealing with Rejection
It often takes six to eight months before you get a response, and the odds are high that your initial claim will be denied. In fact, only about a third of all applications are approved at this initial stage, and almost all fibro applicants are initially rejected. A claim may be denied for myriad reasons.
For instance, the SSA may think that you can still perform a different type of job, even if it's the kind of work you have been doing. If your initial claim is denied, you will want to appeal to have your case reconsidered, a process called a request for reconsideration. But it must be done within 60 days of the mailing date of your rejection.
At this point, you may consider hiring an attorney to help with the filing process. The attorneys are generally paid 25 percent of back benefits — monies you would have received if you'd started receiving benefits at the time when you first declared you were unable to work. To find a lawyer, ask your physician for a recommendation or contact the local or state bar association.
Approximately 13 percent of cases are awarded disability at this second stage. If your claim is denied a second time, you may request a hearing. Again, the request must be made with 60 days of the mailing date of the appeal rejection. The hearing is usually held before an administrative law judge. During the hearing, you and your doctor may be called upon to testify. At this stage, approximately 68 percent of the cases are approved.
To help health-care professionals better understand disabling medical conditions, the Social Security Administration publishes a book called Disability Evaluation Under Social Security, also known as the Blue Book. When ruling on a case, the SSA relies in part on this 187-page document. As of now, fibromyalgia is not specifically included on the list. You can download a copy from the Social Security website.
If the judge still determines that you are not disabled, you may take an appeal to the Appeals Council, again within 60 days of the judge's ruling. In most cases, the council's decision typically agrees with the judge's. If you choose, you may file an appeal in U.S. District Court, which may ask for a new hearing.
There's no doubt that the process of getting Social Security benefits can be lengthy and exhausting. But considering that you may be eligible for as much as $1,000 a month, the process is well worth the trouble.
And once you're approved for Social Security payments, you will become eligible for Medicare, the government-sponsored health insurance program. You will receive Medicare benefits after you've gotten disability benefits for twenty-four months. For more information on Social Security, check out their website.
Don't let the daunting nature of applying for benefits deter you. Keep in mind that you did not choose to become disabled and that you are merely trying to attain benefits that are rightfully yours. At the same time, be level headed. Keep good records, and stay cool and calm during any interviews.