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What if I have no long-term disability insurance of my own or through an employer?
Very often a disabled individual is working at a job without Long-Term Disability (LTD) benefits, or has been out of work and is no longer covered by an LTD policy. Under these circumstances, what benefits are available for financial assistance, medical insurance, and other needed help?
The primary alternative to long-term disability insurance for financial and medical insurance is Social Security Disability Benefits. These benefits are provided through the Federal Social Security Administration. The Massachusetts CFIDS/ME & FM Association has written a comprehensive booklet, MassCFIDS/ME & FM Disability Handbook: How to Obtain Social Security Benefits if You Have Chronic Fatigue Syndrome (CFS/CFIDS) . The content in the booklet also generally applies if you have fibromyalgia (FM), or even multiple chemical sensitivities (MCS). This portion of the web section will outline some major elements of the Social Security program, but the book will provide you with the needed comprehensive information
What are Social Security Disability Benefits?
Social Security provides two financial assistance programs to people who are disabled.
The term "disabled" under Social Security regulations means that: a person is unable to do any work, even part-time, sedentary work on a predictable basis, and this condition has lasted or is expected to last at least a year. This definition is termed "permanently and totally disabled". Under this definition a person is unable to perform any "substantial, gainful activity." (This is a more encompassing standard than many long-term disability policies, which may allow for some level of work.)
The key phrase for many disabled patients is being able to do any work on a "predictable basis". For example, especially in the case of the Chronic Fatigue Syndrome/Chronic Fatigue and Immune Dysfunction Syndrome/Myalgic Encephalopathy (CFS/CFIDS/ME) or fibromyalgia (FM), a person might be able to work 4 hours today on a computer, and 4 hours tomorrow on the phone, but then be unable to work for 3 days due to a relapse. This person would be considered disabled by Social Security. However, if a person could work 5 hours a day, 3 or 4 days a week on an ongoing, predictable schedule week after week, month after month—then the person would not be considered disabled.
To apply for Social Security Disability benefits, you simply call your Social Security office and state that you are disabled and need to apply. You should ask that an application be sent to you in the mail and should also request a date for a telephone interview. You should fill out the application prior to the telephone interview, so that your answers will be well-considered and clear. One date of importance is the date you became disabled—that is you stopped being able "to do any work, even part-time sedentary work, on a predictable basis." You may have been out of work for some period of time. Give the earliest date you fit this definition. You will also be asked when you first became ill. Give the date as requested—this may have been many months or years before you became disabled.
When you are interviewed for your application, make sure you communicate just how ill and disabled you normally are. If you have been having a few good days, you may be feeling hopeful and therefore tend to understate the severity of your illness. Most people want to be working and are ambivalent about being "disabled." As a result, they will express themselves to Social Security as if they are less ill than they actually are. Moreover, some patients go into a job interview mode and "put their best face forward." If you do not communicate to Social Security just how severely and chronically ill you are, then Social Security cannot know—and therefore has no good reason to grant benefits. If truthful, patients should think first of when they are having a bad day or a bad week in order to balance their presentation.
Social Security may have an application online. If possible it's best to fill out paperwork off-line, since then you can take time to consider and answer questions. A formal telephone interview is best, but if you are asked to be interviewed in person, then you must do so, unless you can persuade Social Security otherwise.
There are two Social Security Disability Programs—Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
Both Social Security programs have the same standard of disability outlined above.
However, they differ in their financial eligibility standards and the amount of assistance they each provide.