The Social Security Administration provides disability benefits for a wide range of medical conditions included in its Listing of Impairments. But you may wonder whether someone who is on the waitlist for an organ transplant can receive benefits.
You can claim disability while waiting for an organ transplant. All you need to do is provide the Social Security Administration with proof that you’re on the organ transplant waitlist. You may also qualify due to the underlying condition for which you need the transplant (kidney disease, liver failure, etc.).
Read below to find out more about how you can claim benefits while waiting for an organ transplant.
What is Organ Transplantation?
A transplant is a surgical process in which an organ or organs, tissue, or a set of cells is surgically extracted from a single person (the donor) and physically transplanted into someone else (the recipient) or transferred from one site to another on the same person.
Donating and transplanting organs and tissue saves lives and can restore function to enhance one’s standard of living. For example, the cornea, the transparent covering of the eye, can be transplanted to restore vision, although it is not essential to survival.
Organ and tissue transplantation is a challenging area in health care since an individual’s immune system may reject and destroy the newly transplanted organ or tissue. To prevent this, the recipient must take immunosuppressant drugs.
The treatments that are used can change based on the type of tissue or organ that is being transplanted, the degree of compatibility that exists between the donor and the recipient, and various other aspects of the procedure.
Social Security Disability Benefits
Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are two of the programs run by the Social Security Administration that aim to provide financial assistance to people who are disabled. The specifics of your situation will determine which of these programs is best for you.
Social Security Disability Insurance
People who are disabled and unable to work owing to a medical condition for one year or longer are eligible to receive payments under this program every month. To qualify for this benefit, you will need to demonstrate that you have paid sufficient Social Security taxes on earnings from employment.
SSDI may also provide benefits to your spouse, whether you’re still married or not, your young children, and your adult children who were disabled before the age of 22.
Supplemental Security Income
Individuals of any age who are diagnosed with a qualifying disability may be eligible for SSI. The applicants’ previous employment is not taken into consideration throughout the application process for this program.
Having said that, you are only allowed a certain amount of money and assets in your possession.
In addition to monthly cash benefits, both SSDI and SSI provide medical coverage for eligible recipients.
In most states, receiving SSI entitles a person to free Medicaid health insurance. In contrast, Medicare enrollment for most people receiving SSDI is not possible until 24 months after they have received benefits. The only people who can get Medicare right away are those who have amyotrophic lateral sclerosis (ALS).
Who Qualifies for Social Security Disability Payments?
Before we can move on to the requirements that are unique to organ transplants, we have to look at the prerequisites that are standard for people who are requesting disability benefits.
To be eligible, you must satisfy the following conditions.
Your income must be below the Substantial Gainful Activity (SGA) threshold. The Social Security Administration will reject your application if they believe that your monthly income is high enough to support yourself without assistance.
Your disability must also be long-term. There are three ways to define a long-term disability:
- Your disability has lasted for at least 12 months.
- Your disability is expected to last for 12 months.
- Your medical condition is very likely to result in death.
You will be required to provide medical documentation, such as X-rays, CT scans, or MRI scans, to demonstrate that your disease meets the criteria for being classified as seriously debilitating.
A lack of supporting evidence may result in a claim denial. Make sure the Social Security Administration has all the documentation it needs by staying in touch with your doctor.
The Social Security Administration often rejects disability claims because the claimant does not suffer from a severe enough medical condition to warrant receiving benefits.
Can I Claim Disability While Waiting for an Organ Transplant?
The period for how long someone could wait for an organ differs from person to person based on their specific circumstances. It is not unheard of to have to wait for several months or years. Most of the time, people who are on the list find themselves unable to work due to some kind of medical problem.
People who are currently on a transplant waiting list are eligible to apply for Social Security disability payments, and in most cases, all that is required of them to be approved for such benefits is to confirm that they are on the transplant waiting list. Those on the transplant waiting list may be eligible for assistance if they meet any of the following criteria:
- Cystic Fibrosis
- COPD
- Heart failure
- Kidney disease
- Leukemia
- Liver disease
- Lung cancer
- Lymphoma
Consult your doctor if you have any doubts about your eligibility or what kind of medical evidence you should include with your application.
Medical Criteria for SSDI Benefits
Medical professionals working for the Social Security Administration compare claimants’ symptoms to those included in a database known as the Listing of Impairments. It should be noted that the Listing of Impairments for minors is completely separate.
The criteria for organ transplants are straightforward. People who have had an organ transplant within the past year should generally be eligible, depending on the applicable section of the Listing.
There is no specific section for organ transplants in the Listing of Impairments. Instead, each entry for a transplant can be found under the heading for the listing that pertains to the relevant body system. The listing for heart transplants, for instance, can be found in Section 4.00, which covers cardiovascular illnesses.
A transplant of any of the following organs may make you eligible for disability benefits:
Heart Transplants
An individual who has recently undergone a heart transplant is regarded as having a disability for the first year after surgery. After one year has passed, the claimant will be examined “under the appropriate listing” (such as ischemic heart disease, recurrent arrhythmias, and aortic aneurysm), among other conditions.
Kidney Transplants
For the first year following surgery, kidney transplant recipients are classified as disabled. After a full year, they will be reviewed under the related listing. The Social Security Administration will consider post-transplant function, rejection episodes, complications in other parts of the body, and any adverse effects related to ongoing treatment.
Liver Transplants
An individual who has recently undergone a liver transplant is regarded as having a disability during the first year after surgery. There will be a review of the “residual impairment(s)” after one year. Problems with liver rejection, antiviral treatment, and comorbid (coexisting) diseases could be among the possible disabilities.
Lung Transplants
An individual who has recently undergone a lung transplant is regarded as having a disability for the first year after surgery. It is standard practice to reevaluate a claimant for “residual impairments” such as rejection, adverse reactions to immunosuppressive medicines, or other respiratory issues after a year has passed.
Conditions like asthma, cystic fibrosis, and chronic pulmonary insufficiency are also covered by Section 3.00.
Other types of transplants do not entail the transfer of organs. You may also be eligible for benefits if you have received a transplant of bone marrow or stem cells as a treatment for cancer, an immune system condition, or a hematological disease (commonly known as a blood disease).
Technical Criteria for SSDI
Although receiving an organ from a donor does qualify you medically for SSDI, you also need to satisfy the following technical rules.
To qualify for SSDI, you must have worked and paid into the Social Security system. A person typically needs between twenty and forty available credits. The average worker earns four of these credits per year of service.
Medicare coverage can begin for SSDI claimants after two years of disability. This typically means beginning your countdown not just from the day you have the transplant but also from the point in time when you began to develop organ failure.
If you want to qualify for SSI, you need to have a low income and a few assets, but you don’t need to have worked or have a job history.
The need-based requirements for SSI are stringent, but the Social Security Administration only considers a portion of an applicant’s income and assets when determining eligibility for the program. Beneficiaries of SSI are typically enrolled in Medicaid on an automatic basis.
Will an Organ Transplant Automatically Qualify for Disability?
The Social Security Administration will review your medical records and compare them to the conditions stated in the Blue Book to determine whether or not to grant your request for expedited processing of a claim for an organ transplant.
In some cases, your disability claim may be automatically approved if you have a condition that is included in the Blue Book and that condition caused you to need an organ transplant. If you can show that you are on an organ transplant waiting list, you can get your disability claim approved quickly even if the underlying medical condition that led to your organ failure is not included in the Blue Book.
After undergoing an organ transplant procedure, you are eligible for disability payments for 12 months. You will be required to go through a review of your eligibility for disability benefits after one year has passed.
Benefits Through the Compassionate Allowance Program
It can be quite discouraging for a person who has had an organ transplant to go through the typical Social Security disability claim process. The Social Security Administration can take months to deliver a decision on a disability claim, and that decision could be negative.
Most disability claims are denied by the Social Security Administration for various reasons, such as the applicant failing to meet the Blue Book’s medical requirements for an organ transplant. If you are unable to work after receiving an organ transplant, you may be eligible for the Compassionate Allowance program.
The Compassionate Allowance program prioritizes the processing of claims for certain medical emergencies. The majority of Compassionate Allowance Program-eligible medical conditions are extremely critical, if not terminal.
If you want to apply for the Compassionate Allowance program, you’ll need to provide very strong evidence, including the findings of any diagnostic tests as well as a comprehensive account of your time spent participating in physical therapy. If you’ve recently had an organ transplant, for instance, you should inquire about receiving a prognosis statement from your doctor that details the chances of your full or partial recovery.
Applying for Benefits While Waiting for an Organ Transplant
Even if you meet the medical requirements for disability benefits, you still need to go through the formal application process. You can apply for SSDI online or at any Social Security Administration field office.
When you apply for SSI, you are required to visit the office in your area. To make an appointment with the Social Security Administration, dial 1-800-772-1213. The SSI application process includes a face-to-face meeting. Interviews are often conducted in person at the local office, although in exceptional cases, they may be conducted over the phone.
When applying to the Social Security Administration for any disability program, you should have the following information ready:
- Details of your education and career
- Details about your finances, including income and assets
- Your complete list of healthcare providers and their contact information
- All medical record copies you possess
Conclusion
In conclusion, you can apply for disability benefits if you’re currently on an organ transplant waitlist. You will need to complete an application and provide documentation to the Social Security Administration. To avoid unnecessary delays, you should consult with a Social Security Disability lawyer for help with the process.
