Disability Benefits and Organ Transplant Surgery

August 16, 2013

If you are waiting for or have recently undergone an organ transplant surgery, it is likely that you have been out of work for some time. The resulting loss of income and lack of medical insurance can be financially devastating. Fortunately, the Social Security Administration (SSA) offers disability benefits to many individuals who cannot work due to injury or illness.

If you or a loved one requires organ transplant surgery, Social Security Disability benefits can be used to offset medical expenses and lost wages. The following article will give you a brief overview of the Social Security Disability benefit programs and will provide you with the information needed to begin the application process.

Social Security Disability Programs

The SSA governs and distributes two different types of Social Security Disability benefits. These are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each of these programs has its own set of technical eligibility requirements. These are as follows:

SSDI- Social Security Disability Insurance is offered to disabled workers and their families. Eligibility for SSDI is dependent on an applicant’s employment history and past Social Security tax contributions. To qualify, applicants are required to have earned a certain amount of “work credits”. To learn more about work credits and SSDI, visit the following page: http://www.disability-benefits-help.org/glossary/social-security-disabil....

Individuals who qualify for SSDI are automatically eligible for Medicare coverage after a two year waiting period. If you suffer from end stage renal failure, the two year waiting period is waived.

SSI- Supplemental Security Income is a needs-based benefit program that offers financial assistance to blind, disabled, and elderly individuals who earn very little income. Eligibility for SSI is based solely on strict financial limitations set in place by the SSA. Individuals who exceed these limitations will not qualify for SSI. To learn more about SSI financial requirements, visit the following page: http://www.disability-benefits-help.org/glossary/supplemental-security-i....

Individuals who qualify for SSI automatically become eligible for Medicaid coverage.

In some circumstances, individuals who qualify for SSDI but still fall within the SSI financial limits may qualify for both SSDI and SSI benefits.

Medical Eligibility

To evaluate the severity of an applicant’s condition, the SSA consults a publication—or blue book—containing information regarding many potentially disabling conditions. Each listing contains specific medical criteria an applicant must meet in order to qualify. The SSA will review your application and all supporting medical documentation against the criteria that appear in the related blue book listing. Organ transplants are listed in the following sections:

  • Section 3.11 – Lung Transplant
  • Section 4.09 – Heart Transplant
  • Section 5.09 – Liver Transplant
  • Section 6.00.E.2 – Kidney Transplant
  • Section 7.17 – Bone Marrow or Stem Cell Transplant

Unlike most blue book listings which vary significantly from listing to listing, all organ transplant listings contain the same basic information. Essentially, all transplant listings state that, after undergoing transplant surgery, an applicant will be considered disabled for 12 months following the surgery. As long as an applicant meets the technical eligibility requirements, they will likely receive benefits for those 12 months. After 12 months have passed, the SSA will review any residual impairment under an appropriate blue book listing and decide whether to continue or terminate benefits.

Applying for Social Security Disability Benefits

Prior to beginning the Social Security Disability application process, you will need to collect the necessary medical and non-medical documentation to support your claim. You can find a complete list of these documents on the SSA’s Adult Disability Checklist. (http://www.socialsecurity.gov/disability/Documents/Checklist%20-%20Adult...)

The actual application is made up of several different forms. These forms can be filled out at the SSA’s website or in person at your local Social Security field office. All paperwork should be completed with as much detail as possible. Any missing or incomplete information could result in the denial of your claim.

If you have already undergone transplant surgery or will soon undergo transplant surgery, you may receive a decision within two months of submitting your application. If you are still awaiting transplant surgery, your wait may be a little longer.

If you are approved for benefits, you will begin receiving monthly payments shortly after your notice of approval arrives in the mail. If your initial application is denied, you have 60 days in which to appeal the SSA’s decision. Although a denial can be discouraging and overwhelming, it is important that you remain persistent in your efforts. Many more applicants are approved during the appeals processes than during the initial application.

For more information on organ transplantation and Social Security Disability benefits, visit Social Security Disability Help (http://www.disability-benefits-help.org/blog) or contact Molly Clarke at mac@ssd-help.org.