Published on: September 25, 2024
Epilepsy is a condition that affects the brain and causes recurring seizures, which can vary in type and severity. For many people, it impacts their ability to work and perform daily activities. The Social Security Administration (SSA) recognizes epilepsy as a potentially disabling condition under certain circumstances. If an individual’s epilepsy meets the SSA’s requirements, they can qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. However, not every case of epilepsy will qualify, as the SSA has strict criteria for determining whether a person’s condition renders them unable to work.
Disability Experts of Florida are highly skilled disability lawyers and advocates dedicated to helping people throughout the country with epilepsy and other disabilities secure the Social Security Disability benefits they deserve. Their knowledge of Social Security law and experience with the disability claims process make them an invaluable resource for individuals seeking assistance in obtaining the benefits they are entitled to. If you have an issue or questions about your Social Security Disability benefits or eligibility, contact Disability Experts of Florida today.
Criteria for Epilepsy to Qualify as a Disability
The SSA evaluates disability claims based on a set of criteria outlined in the SSA’s Blue Book, which lists impairments that qualify for benefits. Epilepsy is included under section 11.02 of the Blue Book, but to meet the SSA’s criteria, an applicant must demonstrate that their condition meets specific medical requirements.
There are two main types of seizures that the SSA considers when evaluating epilepsy:
- Generalized Tonic-Clonic Seizures: These are the more severe form of seizures, often referred to as “grand mal” seizures, and involve convulsions and a loss of consciousness. To qualify for benefits based on these seizures, an individual must have at least one seizure per month despite being compliant with prescribed treatment for at least three consecutive months.
- Dyscognitive Seizures: These seizures, which may also be called “complex partial” seizures, result in a loss of awareness or altered consciousness without convulsions. To meet the SSA’s requirements, the applicant must experience at least one dyscognitive seizure per week for three consecutive months, again while following prescribed treatment.
In addition to meeting these frequency and severity standards, disability benefits claimants must also provide detailed medical documentation. This includes
- a complete medical history of the epilepsy diagnosis,
- reports of the frequency of seizures,
- how the condition affects daily life and work activities,
- and evidence that the applicant has complied with the recommended treatments.
Even if an individual’s epilepsy does not meet the exact criteria of the Blue Book, they may still qualify for SSDI or SSI benefits if their condition prevents them from maintaining substantial gainful activity (SGA).
The SSA will assess the person’s residual functional capacity (RFC), which measures the individual’s remaining ability to work despite the condition. If the government determines that the applicant cannot perform any of their past work or any other work due to their epilepsy, they can still be eligible for benefits.
How Much Is a Disability Check for Epilepsy?
The amount of disability benefits a person with epilepsy can receive depends on the type of benefits for which they qualify, whether SSDI or SSI.
SSDI Benefits for Epilepsy
SSDI benefits are based on the individual’s work history and the amount of Social Security taxes they have paid into the system. To be eligible for SSDI, applicants must have worked and paid Social Security taxes for a specific number of years, which varies based on their age. The amount of SSDI benefits is not determined by the severity of the epilepsy but rather by the applicant’s earnings record.
The SSA calculates the monthly benefit amount by averaging the individual’s indexed monthly earnings over their working life, which is known as the primary insurance amount (PIA). The maximum SSDI benefit someone could receive in 2024 is $3,822 per month, though most recipients will receive a lower amount based on their average earnings. The actual amount of benefits can vary significantly depending on the person’s work history, with many recipients receiving somewhere between $1,000 and $2,000 per month.
It's important to note that individuals receiving SSDI benefits may also be eligible for Medicare coverage after a 24-month waiting period. This coverage can be invaluable for individuals with epilepsy, as it can help cover the cost of medications, treatments, and other medical needs related to managing the condition.
SSI Benefits for Epilepsy
SSI, on the other hand, is a needs-based program designed for people with limited income and resources. Unlike SSDI, SSI benefits do not require a work history. Instead, eligibility is based on financial need, and the benefit amount is capped based on federal and state guidelines.
In 2024, the maximum federal SSI benefit for an individual is $943 per month, while couples can receive up to $1,415. Some states provide additional payments in addition to the federal amount, which can increase the total benefit for recipients living in those states. However, to qualify for SSI, individuals must have no more than $2,000 of financial resources, while couples resources may not exceed $3,000.
It is also worth noting that individuals who qualify for SSI benefits may be eligible for Medicaid coverage, which can assist with the medical expenses associated with epilepsy, including doctor visits, medications, and therapies.
Factors Affecting Benefit Amounts
Several factors can influence the total amount of disability benefits an individual receives for epilepsy, including:
- Other Income: For SSI recipients, any other income, including earnings, pensions, or other disability benefits, may reduce the SSI payment. SSDI benefits, however, are not affected by unearned income, although earned income above a certain threshold could affect eligibility.
- Cost-of-Living Adjustments (COLA): Each year, the SSA makes adjustments to benefit amounts to account for inflation, which can result in increases in SSDI and SSI payments.
- State Supplements: Some states provide additional payments to SSI recipients, which can increase the total benefit amount. These supplements vary from state to state.
Applying for Disability Benefits for Epilepsy
Applying for SSDI or SSI benefits due to epilepsy can be a complex process, requiring detailed medical documentation and a thorough understanding of Social Security rules. Working with the experienced disability lawyers at Disability Experts of Florida can significantly improve the likelihood of a successful application. Disability Experts of Florida helps you gather the necessary medical records, complete the required paperwork, and represent you throughout the process, including at hearings if needed.
Contact Us
