If medical problems have caused you to require a liver transplant, you may be eligible for Social Security Disability benefits. On average, there are more than 17,000 people throughout the United States waiting for a liver transplant. These individuals are usually suffering from debilitating medical conditions that help them qualify for Social Security Disability benefits.
In order to qualify for benefits, you must meet the Social Security Administration’s (SSA) guidelines for being permanently and completely disabled. To be eligible for benefits, you will be required to have worked long enough to have earned enough credits and to have paid in enough taxes to cover Social Security Disability Insurance (SSDI).
The liver is the human body’s largest internal organ, which does numerous functions. The liver metabolizes nutrients, produces proteins, stores minerals and vitamins, produces bile and removes toxins, and helps fight off infection by the removal of bacteria from the blood. If your liver is not functioning properly, you can face life-threatening consequences with liver failure.
Many medical conditions or diseases can result in liver problems, and ultimately, require a liver transplant. If you are applying for disability benefits because of a liver transplant, you will have to supply the SSA with a lot of documentation and give them access to your medical records. You can qualify for benefits if you have to undergo a liver transplant.
Financial Expenses Related to a Liver Transplant
Any kind of organ transplant is very expensive. As you can expect, there are plenty of doctor visits and hospital stays that go along with the transplant process, not to mention prescription copays and any treatments that are needed.
While most health insurance plans do cover transplants, many of them don’t cover the entire cost of the procedure. Transplant Living, explains that the cost of a transplant includes insurance deductibles, insurance co-pays, pre-transplant evaluation and testing, surgery, fees for the recovery of the organ from the donor, follow-up care and testing, additional hospital stays required because of complications, fees for surgeons, doctors, radiologists, anesthesiologists, and lab tests. Also, there are expenses associated with rehabilitation and anti-rejection drugs.
There are non-medical costs, which include food, lodging and transportation to the transplant center both before and after the transplant. According to the organization’s calculations, the total cost for a liver transplant is $577,100 on average.
The SSA Evaluation and Medical Qualifications
There are strict guidelines set forth by the SSA in order to determine whether an individual is completely and permanently disabled per their guidelines. They do not pay benefits for partial disability or short-term disability. The individual has to be unable to work for a minimum of a year. The first six months of the disability are not payable, according to their regulations.
The Disability Determination Services will go through all documentation regarding your condition and scan through your medical records to determine why you needed the transplant, such as underlying medical conditions, and how the transplant and your medical problems impact your ability to function and continue your normal work.
In the Blue Book, which is the guide for SSA disability listings, liver transplants are covered under Section 5.09. The guidelines state that once an individual has undergone a liver transplant, he or she will be entitled to Social Security Disability benefits for a year. After that one-year timeframe, your case will be reviewed and the determination team will check your progress and your ability to work.
If the outcome indicates you are still unable to work, your SSDI benefits will continue. On the other hand, if the outcome indicates you should be able to return to work, your benefits will end and you will no longer be eligible. To determine whether you can work a year after a transplant, several things will be considered, such as whether anti-viral therapy is needed after the transplant and if you have experienced complications or organ rejection episodes.
Qualifying for Disability Without a Blue Book Listing Using RFC
If a year has passed since your liver transplant took place and you are still disabled, your physician may need to complete a residual functioning capacity (RFC) form. These detailed forms will explain why you are unable to work and how your life has been impacted by the medical conditions and liver transplant.
As an example, if you have had episodes of organ rejection that required additional treatment, the doctor will note that and explain that because of those treatments you were too weak and fatigued to function and that your immune system was suppressed making it unsafe for you to work around the public or other individuals.
If the underlying conditions cause you to be weak and unable to work a full shift, that will also be indicated in the documentation. The doctor will also note how the transplant and any underlying conditions limit your ability to lift, reach, grasp and bend. Also, he or she will note if you require frequent repositioning because your ability to stand or sit for long periods of time have been impacted by the procedure and your conditions.
A detailed RFC can significantly impact the outcome of a SSDI case. Many cases have been approved by the RFC alone because it provides the detailed information that is needed for the decision making process. If your case is about to be reviewed and you are still experiencing problems, you should ask your doctor to include an RFC in your medical file.
How to Apply Specific Medical Tests
Several medical tests are involved when a liver transplant is required. Among those tests are lab work, including liver enzyme counts and blood tests. Liver functioning tests and scans may also be necessary. During the review process a year after your transplant, the SSA may send you for a medical evaluation at their expense.
This examination by a licensed physician is for informational purposes and not medical treatment. It is to verify how you are impacted by your condition and whether the physician believes you are able to return to work or not. This evaluation may involve simple laboratory testing as well.
In some cases, a mental evaluation is ordered to determine if your medical conditions have impacted your mindset by causing anxiety or depression. Sometimes these additional mental conditions can play a major role in your ability to work. These evaluations may be ordered regardless of the complexity and details of your medical records supplied to the SSA.
A Liver Transplant and Your Social Security Disability Case
If, after the twelve-month eligibility period, you are still unable to work and the SSA wants to discontinue your disability benefits, you may need the help of a Social Security Disability attorney or advocate. This professional can gather the medical evidence that will be needed to prove your case to the Social Security Administration. Statistics show that your chances of retaining your benefits are significantly higher with the help of a qualified disability advocate or attorney.
