Lupus is an auto-immune disorder which when particularly severe may be irreversible and prevent you from living a normal healthy life and earning a livable income. You may be able to obtain a benefit from the Social Security Administration (SSA) if you can show that your symptoms meet their criteria for approving a social security disability benefit.
Initial benefit applications are often rejected and you may need to persevere with an appeal. There are four stages of appeal and it is possible that you could overturn a denied benefit decision at any of these stages.
The four stages of appeal in the appropriate sequence are as follows:
- request a reconsideration of the benefit application decision;
- request a hearing with an administrative law judge (ALJ);
- take the case to an appeals council review;
- take the case to the federal district court for adjudication.
The Initial Application for a Disability Benefit for Lupus
Although there are an estimated 1.5 million lupus sufferers in the U.S., symptoms can vary significantly. The disease is listed in the SSA’s Blue Book under “immune systems disorders” and the listing gives definitive criteria for symptoms of lupus to be present for the condition to be accepted as serious enough for benefit approval.
Once the application for a benefit has been received, the SSA’s Disability determination services assessors will examine the medical evidence available and match this against the Blue Book listing criteria. A lot depends on how you complete the medical record you provide. Assessors take into consideration whether two or more organ systems have been compromised and whether your symptoms prevent you from doing normal things like bathing and cooking as well as working.
To add to the medical evidence you can provide, you can also request your doctor to provide a residual functional capacity (RFC) assessment. This is a series of physical activity tests which show what sort of work you can and cannot do because of your condition.
In Case of a Denial
The appeal process may result in a denied claim being reversed. Your chances of success are improved if you use a disability benefit lawyer for legal help with your claim appeal.
The four stages of the appeal process are described briefly below. A denied claim decision could be reversed at any of the four stages, but is most likely at the first two.
Step 1 is to ask the SSA to reconsider the decision to deny your benefit application. The SSA will look at the whole application again. If you have any more supporting evidence, then this is the time to provide it.
Step 2 is to request a hearing with an administrative law judge (ALJ). The ALJ will examine the material available and ask questions about your condition and how it affects your ability to work and function normally. Your lawyer can attend at this hearing and the SSA may also send medical experts to ask questions about your lupus.
Step 3, if either the first 2 steps fail, is to take the claim to an appeals council review. The last step if all else fails is to take the case to a federal district court.