If you’re struggling with Lupus, you are able to get disability benefits if you meet both the medical and work requirements outlined for disability by the Social Security Administration (SSA).
Meeting the Blue Book (which is the list of disabilities that qualify for Social Security disability benefits) listing for lupus under Section 14.02 is just one requirement that determines whether you qualify for Social Security disability benefits.
This is because the SSA has other criteria that disability applicants must meet in order to get approved for disability with lupus.
How to Apply for Lupus Disability Benefits
Applying for disability benefits due to lupus can be a daunting task. Lupus is a complex condition with symptoms that vary widely, making it essential to carefully prepare your application. Understanding the process and knowing what the SSA looks for can help you present a strong case.
1. Consider Working with a Disability Attorney
If you’re struggling with lupus and you’re looking to apply for disability benefits, you may want to get connected with a disability lawyer. A disability attorney will help you collect your medical paperwork and make sure it’s all in order, as well as get notes and recommendations from your doctors.
Your disability lawyer will also be able to testify on your behalf and help gather witnesses to help prove your lupus disability case. A disability lawyer will be able to tell you how much disability you can get and can help get your case approved after an appeal if your claim is initially denied
Disability lawyers are only paid if you win your claim. That means that you do not have to pay unless you win your claim.
According to a study from the U.S. Government Accountability Office (GAO), those who used a disability lawyer when applying for disability were 3x more likely to get approved than those who did not use a disability lawyer.
2. Meet the Lupus Disability Criteria
Figuring out which medical conditions qualify for disability comes down to whether or not the condition is listed in their Blue Book. The Blue Book is the SSA’s manual of medical conditions that they see as being severe enough to qualify someone for disability.
Since there is a Blue Book listing for lupus, people can get disability for lupus. The specific Blue Book listing for lupus is in Section 14.02 – Systemic Lupus Erythematosus.
The Blue Book listing for Lupus is as followed:
A. Involvement of two or more organs/body systems, with:
One of the organs/body systems involved to at least a moderate level of severity; and
At least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss).
OR
B. Repeated manifestations of SLE, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level: Limitation of activities of daily living, Limitation in maintaining social functioning. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.
You’ll also have to meet the following work and financial requirements to receive benefits:
- SSDI Work Credits: You must have the required amount of work credits for your age group. Work credits are earned by paying Social Security taxes. You’re able to earn up to 4 work credits per year.
- SSDI Financial Requirements: You must earn under the Substantial Gainful Activity (SGA) limit, which is $1,550 per month in 2024
- SSI Financial Requirements: There are no work requirements for SSI benefits, as the program is needs-based. Financially, you must own under $2,000 in assets for individuals, or under $3,000 for couples.
The medical criteria is very complex and is meant for doctors and lawyers to understand clearly, not the average person. Your disability attorney will be able to help you understand this criteria and whether you’ll be able to meet it or not.
Note: If you don’t medically qualify for lupus benefits, you can still receive benefits through a Residual Functional Capacity (RFC) from your doctor. Your disability attorney will know what this is and can guide you through the process with your healthcare providers to obtain one.
This process is standard for the SSA for any applicant that doesn’t meet or closely match a disability listing. You’ll receive notification in the mail that more information is needed to evaluate your claim.
3. Collect Medical Evidence
To prove you suffer from severe lupus symptoms, you must submit convincing medical evidence. Medical evidence of lupus includes:
- Results of diagnostic tests used to rule out other medical conditions that cause similar symptoms as lupus
- Longitudinal reports from your doctor, reporting symptoms, complications, treatments, and treatment affects over a period of three or more months (12 months is even better)
- Prescription medications used and their effects on your specific symptoms and complications
- Hospitalization and other treatment records, if appropriate
- Test results or lab work reports, showing diagnosis of common complications, like kidney or heart disease, bone loss, seizures, anemia, etc.
You should submit copies of every healthcare receipt, including the cost of prescription medications and the use of an assistive device.
Ask your healthcare provider to submit a statement that describes your prognosis of making a full or partial recovery.
Successful completion of these things can be one of, if not, the most important signs your disability claim will be approved. Your disability attorney will get in contact with your doctors and can assist in collecting the necessary medical evidence you’ll need to get approved for benefits with lupus.
4. File & Submit Application
Once your medical evidence is gathered, it’s time to file and submit your disability application. The application requires detailed information about your lupus, including how it impacts your daily life and work capacity.
Be thorough and detailed in your descriptions and make sure that all relevant medical documents are included. When you’re ready to apply and submit your application, you can do so by applying online through the SSA website, by phone, or in person at your local Social Security office.
It’s crucial that you and your lawyer read through your application again and double check for accuracy before submission. This can help avoid delays and increase your chances of approval.
5. Tracking Your Application
Staying on top of your application progress once it’s submitted is critical. The easiest way to monitor the status of your application is through the SSA website. Your lawyer will also be closely monitoring your claim to be proactive for next steps.
Regularly checking in allows you to address any additional information requests or steps needed to keep your application moving forward. To prevent any delays or even denial, you need to stay on top of your claim and ensure nothing goes unnoticed from the SSA.
6. Appealing Upon Denial
If your initial application for lupus disability benefits is denied, don't lose hope. About 70% of initial claims are denied, so this is very common.
The appeals process is an opportunity to have your case reconsidered. Start by requesting a reconsideration, where a new examiner will review your case. Your attorney will know exactly how to submit the request.
If the reconsideration doesn't get approved, you’ll want to request a hearing before an administrative law judge (ALJ). This hearing allows you to present new evidence or clarify any points that may have been overlooked.
Having a disability attorney during this phase is important, as they can help you strengthen your case and significantly improve your chances of securing the benefits you need.
Can You Work With Lupus & Receive Benefits?
Some individuals with lupus can work, but the ability to work depends on the severity of your symptoms and the type of job you have. Some people with lupus may experience periods of remission where symptoms are minimal and may be able to work full-time or part-time without significant difficulty.
However, if you’re looking to receive disability benefits for lupus, you must demonstrate you have missed work for 12 consecutive months in order to get disability for lupus. The timekeeping records maintained by your employer, as well as the copies of bank statements, act as evidence of missed time from work.
If you feel you are unable to work, you can receive work credits for having lupus. The SSA requires applicants to have worked long enough prior to their development of their disabling medical condition.
The SSA measures work history based on applicants' accumulation of work credits. This is because, for every year that an individual works, they earn a certain amount of work credits. You can earn as many as four work credits each year.
FAQs Lupus Disability Benefits
How Much Can Having Lupus Cost You?
Living with lupus can lead to substantial medical costs. The Lupus Foundation of America reports that the average annual direct medical costs are $12,643 per patient. Managing lupus requires multiple medications, frequent doctor visits, and possible prescription adjustments, which can drive monthly costs into the hundreds or even thousands of dollars.
On top of that, the loss of income due to reduced work hours or inability to work entirely adds to the financial stress, with an average annual income loss of $8,659 per person. In such cases, Social Security disability benefits can provide crucial financial support.
How Much Can You Get For Disability For Lupus?
The maximum amount you get for disability with lupus is $3,882 per month, with the average check being about $1,500 in 2024. The amount you will receive in disability benefits after you have been diagnosed with lupus will depend on your situation, including your age, education, and average lifetime earnings before you became disabled.
How Long Does it Take to Get Disability for Lupus?
It takes between 3-5 months to receive an initial decision from the SSA regarding your lupus disability claim. However, 2 out every 3 of applicants are denied at the initial stage.
You have the option of appealing the SSA’s decision regarding your lupus disability claim, which will delay the process of you receiving disability. A disability attorney can help increase your chances of winning your disability claim, which can help speed up the process.
Next Steps to Take - Connect with a Disability Lawyer Today
If you have lupus and you believe you will be out of work for at least 12 months or more, then you should apply for disability. A disability lawyer for lupus can help increase your chances of getting approved for disability. To get connected to an attorney who can take a case in your area, fill out our free disability evaluation today.
Our Social Security benefits calculator can help you determine how much you’ll receive from the SSA before you file for disability.
When you’re ready to start your application, you can visit the SSA’s website to apply for SSDI, or you can go to the local Social Security office to apply for SSI and/or SSDI benefits.
