Long COVID: How the Social Security Administration Is Handling SSDI Claims
Social Security Disability Insurance (SSDI) helps people of limited means who can’t work because of a disability. Qualifying for SSDI was always notoriously difficult, but the pandemic created a new disability that’s swamping the Social Security Administration (SSA) with applications: long COVID.
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Some people who contract the coronavirus suffer from debilitating symptoms for months or even years after diagnosis, and many of them have found that battling the SSA for disability benefits can be as trying as battling the virus.
Long COVID Is a Disability, but SSDI Is No Guarantee
In July 2021, the Department of Health and Human Services (HHS) declared long COVID a disability under the Americans With Disabilities Act (ADA), but only “if it substantially limits one or more major life activities.”
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That statement, however, is qualified with this footnote: “This guidance only addresses the definition of disability under these Federal civil rights laws. It does not cover other definitions of disability or eligibility requirements such as those necessary to qualify for Federal benefit programs under Social Security.”
In short, long COVID is a disability, but whether you’re eligible for SSDI is between you and the SSA.
“Technically, consumers suffering from long COVID can qualify for SSDI,” said Colin Nabity, CEO and co-founder of Breeze, an insurtech that provides disability and other kinds of insurance. “But the application and approval process for the government benefit is notoriously complicated. To qualify for SSDI, you must meet the government’s definition of disability, which is much stricter than it is for private disability insurance companies.
“For SSDI, the applicant must be significantly limited in their ability to do basic work, like walking and remembering. Further, the condition must be so severe that it’s expected to last at least 12 months and/or result in death. And on top of this, if you are still working and make more than $1,220 a month, you generally cannot be considered disabled by SSDI standards.”
Long COVID Is Especially Hard To Prove
The SSA denied 66% of disability claims between 2008 and 2019. The Government Accountability Office found that between 2014 and 2019, 48,000 people — 1.3% of applicants — went bankrupt while waiting for decisions on their disability appeals. Nearly 110,000 people died waiting for a decision between 2008 and 2019.
In 2021, The New York Times reported that the agency was already dealing with a large backlog of disability claims before the virus swamped it with a sudden influx of long COVID applications, a poorly understood condition that’s difficult to prove.
“Long COVID sufferers are indeed applying for disability benefits, but many are being denied due to the general lack of understanding of the complex and somewhat mysterious symptoms that arise from long COVID,” said Rick W. Fleming, a Social Security disability law specialist and partner at the Law Offices of James Scott Farrin. “In cases where benefits are awarded, it is typically some other impairment that leads to benefits or a combination of other factors that result in the claimant being unable to perform work. Long COVID on its own is rarely the only impairment in a winning case.”
Long COVID Has a Short History, Which Is Bad News for Applicants
Murky diagnosis criteria are only one reason that long COVID claims face such a steep uphill battle. Another is that the ailment is just so new — and SSDI claims follow long timelines.
“The issue with long COVID for most people is that not enough time has passed since the condition has become medically recognized,” said Fausto Bucheli Jr., president of the Cheap Insurance Agency. “SSDI requires that the disability affects you for at least a year or that you have credible reason to believe that it will last this long.”
Bucheli explained that while long Covid can include symptoms that typically qualify for SSDI, like chronic fatigue and heart palpitations, “The issue here is that there’s no telling and no consensus within the medical community about how long a case of long COVID really is.”
Long COVID at the Intersection of SSDI and Medicare
In February, doctors and advocates petitioned Congress to make it easier for the most vulnerable long COVID sufferers to get their Medicare benefits through the Stop the Wait Act.
Anyone who is approved for SSDI automatically qualifies for Medicare — but Medicare benefits don’t kick in until after a mandatory two-year waiting period. According to Bloomberg Law, it’s actually five months longer because the waiting period starts when the applicant is approved, not when the applicant is declared disabled.
Considering the population that SSDI serves, 24 months can be a grueling delay.
The Stop the Wait Act would amend the Social Security Act to give anyone approved for SSDI immediate access to Medicare benefits. It also would phase out the five-month waiting period between SSDI approval and the distribution of benefits.
Democratic lawmakers initially proposed the bill in 2019, but it stalled. It was the influx of long COVID disability claims that rejuvenated the effort in February of this year. Again, however, the measure has stalled and has not left the preliminary committee stages.
So, Can the SSA Handle the Pressure?
The SSA is struggling with an avalanche of long COVID applications and applicants are stymied by the agency’s murky qualifying criteria. Will the SSA be able to manage the pressure?
That depends whom you ask.
“The system can handle the intake of all new disability claims but the process to get a determination is slower and taking longer due to the number of claims being filed,” said K. Merritt-Grant, operations supervisor with the Social Security Administration in Chicago. “The development of the medical information takes the longest.”
The lawyers who work with frustrated applicants every day aren’t so optimistic.
“The SSA has been grossly underfunded and ignored by Congress for far too long, and the amount of claims being filed versus the staff and decision-makers required to adjudicate the claims is in a horrible state of imbalance,” Fleming said. “In fact, Congress has cut SSA’s core operating budget by 17% since 2010 after adjusting for inflation, according to recent studies, while claims have risen by 21%.”
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This article originally appeared on GOBankingRates.com: Long COVID: How the Social Security Administration Is Handling SSDI Claims
