A person living with multiple sclerosis (MS) may experience symptoms severe enough to qualify for disability benefits. They can receive different kinds of disability benefits depending on their employment and health status.
MS can cause several symptoms that range in severity. For some people, living with MS will eventually make it difficult to continue to perform their job. If this occurs, they may apply for disability benefits.
Although an employer may offer short- and long-term disability benefits, a person may need to consider applying for Social Security Disability Insurance (SSDI).
This article sets out information about short- and long-term disability benefits, SSDI, and what a person needs to know when applying for coverage.
MS is a chronic condition that affects the central nervous system. Many people
The condition can cause many symptoms, from numbness and fatigue to paralysis and blindness. How MS affects a person varies, which means some people living with MS may qualify for disability benefits while others may not.
Disability benefits may come from:
- privately purchased insurance
- an employer’s benefits package
- the federal government
A person living with MS may qualify for one of the following benefits programs due to their symptoms:
Short-term disability benefits
Short-term disability benefits can replace some or all of a person’s salary when they have a temporary disability that requires them to miss work. A person can purchase the plans on their own, or they may be able to get them through their employer.
When an employer offers short-term disability benefits, the person often has to go through a short waiting period before receiving them.
Often, the benefits cover a portion of the person’s base pay. Coverage typically lasts only a few weeks, although this can vary according to the company a person works for and its insurance plans.
For example, Johns Hopkins Medicine offers its employees 60% of their base pay for up to 25 weeks for union workers.
According to the National Compensation Survey by the U.S. Bureau of Labor Statistics, employees contribute 13–42% of the cost, depending on the industry they work in and their specific employer.
People in the service industry tend to have to contribute the most. The median length of short-term disability is 26 weeks.
A person should check with their employer to see how much and how long their short-term disability will cover. Short-term disability does not guarantee a person will be able to return to their job. In other words, an employer can terminate an employee while they receive short-term disability benefits.
Long-term disability benefits
Long-term disability benefits often work in conjunction with short-term disability benefits. Several employers offer long-term disability benefits that typically start once short-term benefits end.
Some considerations for long-term disability benefits include:
- There may be a waiting period of 3–26 weeks.
- Plans may have a lifetime cap of coverage.
- They do not provide job security.
Sometimes, a person may receive long-term disability benefits while they wait for approval to receive SSDI.
SSDI
A person living with MS typically needs to go through the Social Security Administration (SSA) to apply for SSDI, which provides long-term disability benefits.
To qualify for SSDI, a person must fulfill the following criteria:
- Symptoms meet the SSA definition of qualifying impairment.
- Impairment is expected to exceed or has already exceeded 12 months.
- The person is over the age of 18. If not, a caregiver or parent can file for benefits on behalf of their child.
People living with MS who do not meet the criteria for long-term disability benefits may be able to receive short-term disability benefits through their employer.
How the SSA defines qualifying MS impairment
The SSA defines the criteria needed to apply for long-term disability benefits for various health conditions, including MS. It includes these criteria in a document known as the Listing of Impairments or the Listing.
According to the Listing, a person living with MS can qualify for SSDI if they experience at least one of the two criteria.
First, a person must have extreme motor impairment in two extremities, limiting their ability to stand up, balance, or use their arms.
The second criterion states that a person needs to have a definite limitation in physical functioning along with at least one of the following:
- trouble interacting with others
- difficulty remembering, understanding, or applying information
- trouble managing themselves
- issues with concentrating
The National MS Society (NMSS) further notes that while MS has a Listing under number 11.09, a person’s symptoms may qualify under two additional listings. These are:
- 2.00 Special Senses and Speech: A person may use this if their MS causes visual impairments or issues with speech.
- 12.00 Mental Disorders: A person can use this if their MS causes mood or cognitive disorders.
Some additional symptoms that may help qualify a person for SSDI include:
- trouble seeing
- difficulty walking
- impairments affecting speech, swallowing, or breathing
- extreme fatigue that limits the ability to think or perform physical tasks for long periods of time
- persistent, severe pain
Disabilities come in several different forms. According to the
- ability to move, think, learn, communicate, remember facts, or maintain social relationships
- vision
- hearing
- mental health
They further define “disability” as having three parts. These are:
- limitation on activities due to impairments in movement, hearing, vision, or thinking abilities
- impairment to vision, movement, or mental capacities
- inability to participate in social, work, or recreational activities
A person living with MS may fit into one or more types of disability because the condition can affect their movement, vision, mental cognition, and health.
When people receive short- or long-term disability insurance from work, they should talk with their human resources (HR) department. The HR department should have information on the steps a person needs to take to activate their short-term disability benefits.
Before applying
A person living with MS should talk with a doctor about their condition. Their doctor may recommend starting the process of applying for SSDI if they suspect or have documented that the symptoms could last longer than 12 months.
A person should also talk with their doctor about the application process. To help with the application process, a person should make sure they know the following:
- contact and demographic information about their doctor
- dates and results of tests
- current medications, their intended use, and the doctor who prescribed them
The SSA also offers a list of information people should gather before applying. A person can access the list here. In addition to answering several medical questions and providing test results as the SSA requires, the application will ask about the following:
- employment history
- personal information such as date of birth, children, spouse, and military service
- direct deposit information
- highest levels of education and job training
If financially feasible, hiring a disability lawyer can help get a person through the application process and increase their chances of acceptance.
A person can make a personal reference to find a lawyer, or they can search in local directories or in wider directories such as www.lawyers.com/find-a-lawyer or www.avvo.com/find-a-lawyer.
Application process
The first step is to gather all the necessary documentation to determine whether a person is eligible for the benefits. Then a person should take the following steps:
- Review the SSA’s Blue Book to determine eligibility.
- Apply online on the SSA’s website. Applying online can reduce the time a person will need to spend interviewing with a social security representative.
- Submit any additional medical records that can bolster the application.
Following the application process, a person should be prepared to supply any additional information that the SSA requests. A person should also print copies of the application and gather all the required documents to bring to their appointment at the social security office.
During the application process, a person should not return to work. The SSA lists returning to work as one of several potential reasons a person may not receive benefits.
Once a person submits all necessary forms and documentation to the SSA office, a staff member will review the application.
Primarily, an applicant needs to show the following:
- an impairment that has lasted or could last for 12 months or longer
- physical or mental impairments that limit a person’s ability to work, which can include:
- vision issues
- fatigue
- trouble walking
- other severe symptoms of MS
As part of the process, the SSA may contact the person for more information to help it decide.
The SSA will send a notification of its decision through the mail.
The SSA does not qualify everyone living with MS to receive SSDI. According to its own data, the SSA denies an average of 64% of first-time applicants.
If the SSA denies their application, a person typically has 60 days to appeal the decision. There are four levels of appeal:
- reconsideration
- hearing by an administrative law judge
- review by the Appeals Council
- Federal Court review
It also notes that a person should check their denial letter. The letter will contain information on which level they should appeal their case. A person can find the SSA appeal forms on its website or file online using the appropriate link on its site.
The SSA‘s common reasons for denying a person’s eligibility for SSDI include:
- The impairment is not severe enough.
- The person can continue working at their current job or another profession.
- The impairment is not expected to last 12 months.
- The person provided insufficient medical records, does not follow treatment plans, has impairments due to alcohol or drug use, or has returned to substantial work.
Talking with an employer about living with MS can be a challenging decision. According to the NMSS, people may not want to talk with certain people at their company, including their boss and coworkers.
However, it notes that a person may find talking with someone in HR helpful for the following reasons:
- Unlike a boss or coworkers, HR legally cannot disclose the information to others.
- HR can help a person get accommodations for their work.
- HR may be a good resource when a person is considering applying for disability benefits.
The Rocky Mountain MS Center also notes that the Americans with Disabilities Act (ADA) provides some protections to people disclosing their condition. Also, the ADA requires larger employers to provide reasonable accommodations so long as this does not substantially burden their business.
If a person living with MS believes they can no longer perform their job duties, they should talk with their doctor. Their doctor can then advise whether applying for disability benefits would be a good idea and may be able to help start the process.
A person living with MS may qualify for short-term or long-term disability benefits or SSDI. Some employers offer short- and long-term disability benefits, or a person can apply for them privately.
People may be able to use these benefits as they await a decision about SSDI eligibility from the SSA. To qualify for SSDI, someone needs to have a substantial impairment due to their MS and evidence that the impairment will last for 12 months or longer.
A person should work with their doctor to gather all medical information regarding their qualifications for disability benefits.