Epilepsy Qualifies for Disability Benefits. Here’s How.
Are you unable to work because of epilepsy? If so, there's a good chance you qualify for monthly payments and free health insurance from the U.S. government. We’ll help you figure out whether you qualify and what to do next.
Tens of thousands of epileptics— rich and poor alike — get benefits from Social Security Disability. For patients and their families, this help can be life-changing. But not everyone with epilepsy is eligible, and government rules can make qualifying a nightmare. At Atticus, we help people cut through the red tape and get the benefits they need. We’ll explain clearly how this program work for people with epilepsy, then tell you what to do if you want to qualify.
What is Social Security Disability?
Social Security Disability Insurance (“SSDI”) is a government program that supports Americans who are medically unable to work. When someone says they’re “on disability” for a long period, they usually mean that they’re getting payments from Social Security Disability.
The program is huge: About 10 million Americans receive SSDI today, and about 2% of every U.S. paycheck goes to fund the program via taxes.
What do recipients get?
People who qualify for Social Security Disability get two big benefits:
- A monthly check (usually between $700 and $3,000)
- Free health insurance through Medicare or Medicaid (sometimes after a waiting period)
They also get other benefits, including extra money for young kids, forgiveness of student loan debt, an easier time qualifying for other programs, and higher Social Security Retirement payments later in life. There's no downside to receiving benefits, and it’s free to apply.
Who is eligible?
In order to qualify for SSDI, six things usually have to be true:
- You’re under 66 years old
- You’re getting treatment for a serious medical condition
- Because of your medical condition, you can’t realistically hold a job
- You're not currently working (or if you are, it's part-time and very low-paid)
- You’re not expected to recover (or be able to work) within a year
- Before getting sick, you worked and paid taxes for years*
* If you didn’t work previously, but you and your family have very little money, you can still qualify for a related program called Supplemental Security Income (“SSI”), and the rest of this article will still largely apply to you.
Qualifying is never easy: The government treats claims with suspicion, and rejects most applicants. But if you meet the criteria above, you can likely get benefits with the right help.
What is epilepsy?
Epilepsy is a medical condition that causes repeated seizures. About 3 million Americans have it. Epilepsy varies from person to person, causing different types of seizures with varying frequency.
Many people with epilepsy live normal lives: once they get proper medical treatment they have seizures only rarely, and they can hold most jobs.
But a large minority of epileptics suffer regular seizures that can’t be controlled with medication. Severe epilepsy often makes it difficult or impossible to hold a job:
- Absence (dyscognitive or petit mal) seizures can cause sudden, unpredictable lapses in attention or consciousness
- Convulsive (tonic-clonic or grand mal) seizures can cause violent sudden muscle contractions and sometimes loss of bowel control
- Medication to prevent seizures can cause serious side effects, including cognitive impairment
- Frequent headaches during or after seizures can make it impossible to concentrate
- Precautions to prevent seizures — or to avoid injury when they occur — can require remaining at home, or staying near a loved one at all times
Because of these symptoms, many people with epilepsy lose their jobs and find themselves unable to earn a living.
Can epilepsy qualify for disability benefits?
Yes. As a general rule, if you have regular seizures despite seeing a doctor and taking medication, you’ll qualify as disabled. If you don’t have regular seizures or you’re not on medication, you probably won't qualify.
Some quick background: Under government rules, some medical conditions – like needing a kidney transplant or losing both your legs – always qualify a patient as disabled. Others - like pregnancy - are never enough. Epilepsy is somewhere in between: You can qualify due to epilepsy, but just being diagnosed isn't enough. Instead, it depends on how far along your illness has progressed and how your condition and treatment impact you.
Epilepsy usually qualifies you for benefits if two things are true:
- You’re seeing a doctor regularly and following the treatment they prescribe. For example, you see a neurologist or general practitioner every few months, and take an anti-seizure medication every day. (Why is this required? Because if you’re not seeing a doctor, the government will assume that you could recover and go back to work if only you got proper treatment — so they won’t consider you disabled.)
- Despite treatment, you still have seizures often enough that they interfere with your daily life. The government’s official guidelines say that if you have convulsive (tonic-clonic or grand mal) seizures at least once per month, or absence (dyscognitive or petit mal) seizures at least once per week, you definitely qualify as disabled. But you can have seizures less often and still be eligible, if the broader impact on your life is severe.
The formal guidelines are complicated, but it boils down to this: If you can’t work because of your condition despite trying to overcome it, and as a result you just can’t hold a job, you’ll probably qualify as disabled with proper help.
I have epilepsy. Should I apply for benefits?
If you can’t work because of epilepsy and despite getting medication, you should probably apply for benefits. It’s free and the help can be life-changing. But applying does take time and effort, and not everyone qualifies — so it’s only worthwhile if you have a chance of success. Here’s our advice:
Apply now if:
- You’ve been seeing a doctor for epilepsy and taking the medication they prescribe, AND
- You’re still unable to work because of symptoms from your condition (seizures, headaches, medication side effects, etc.), AND
- You’re not making any money from work (or, if you’re working, it’s part-time and low-paying and you couldn’t possibly work more)
Consider waiting and applying later if
- You just got diagnosed with epilepsy or just started taking medication (within the last few months) and there’s still a chance treatment will fully eliminate your seizures, OR
- You haven’t yet stopped working (even if you worry you’ll need to soon)
Probably don't apply if:
- Your epilepsy doesn’t have a serious impact on your daily life, OR
- You're working (earning more than about $1,300 per month) and don't plan to stop
Whether you decide to apply now or later, the best thing you can do in the meantime is to get as much medical care as possible. Get in to see a neurologist (brain specialist), try the treatment they recommend, and go back for follow-up visits. This will help build the paper trail you need to get benefits. And more importantly, it’s critical for your health.
I want to apply. What should I do next?
Atticus exists to help to people navigating this process — so the easiest thing to do is get free advice tailored to your situation via our online tools or caring staff. (People love us, and we don’t charge anything for our help.)
Applying for disability takes preparation. You can win, but this system doesn’t make it easy. So it’s worth taking some time to understand how things work.
The first step is to make a choice: Do you want to (a) Apply on your own, or (b) Get a professional to handle the process for you? Most successful applicants hire a professional — and for epileptics in particular, that’s generally the right call. But not everyone needs to, and not everyone who wants to can. We’ll explain both paths and help you decide.
How the process works
The government fears that people will exaggerate their medical problems in order to get free money. So it puts every applicant under a microscope. To win, you have to prove — beyond a doubt — that your medical condition is severe and disabling.
There are two major stages in the process, and most people will need to go through both:
Initial Application: You submit a lengthy written application, details on past work and treatment, and copies of your medical records. A government staffer reads your file and makes a decision. (Only 20% of people win at this stage; the large majority are denied.)
Appeals: If you lose, you appeal your denial and eventually get a hearing with a judge. At the hearing, you get to submit additional evidence, speak to the judge directly, and cross-examine government experts. (Among people who make it to this stage, about 50% win. If you lose, there are several more stages of appeal.)
Unfortunately, the process takes time: 3-6 months to get an initial decision, and 1-2 years (or more) to get a hearing. Even a small mistake or omission (like a doctor failing to send in records, or bad answer on a form) can doom an application. The good news is that once you win – even if it takes a long time and several appeals – you get “back pay” (retroactive benefits) for the time you should have been getting benefits.
Why most people seek professional help
Because the process is so complicated, most successful applicants get a lawyer (or trained non-lawyer representative) to help. Lawyers will pull together your medical records, write your application, advise you on getting proper medical treatment, submit all the paperwork, and (if needed) argue your case before a judge.
There are two big upsides to hiring a lawyer: (1) They do almost all the work for you and hold your hand through the process. (2) They increase your chance of winning. (Government studies show that at the appeal stage, people with a lawyer are three times as likely to qualify.)
The only downside is cost. Lawyers aren’t allowed to charge any up-front fee so it doesn’t matter if you can afford one right now. If they win your case, they get 25% of any back pay (retroactive benefits) that they win for you. This is worth it for almost everyone — you only pay if you win (if you lose, you pay nothing), you only pay once, and the cost pales in comparison to the amount you get.
Should I hire a professional?
Almost every applicant that applies because of epilepsy should hire a lawyer or other professional. (We don’t say this to everyone — see, for example, our articles on Huntington’s disease or pancreatic cancer.)
Why? This process can be particularly unfair for epileptics. Since it’s hard to diagnose (there’s no official test for it) and isn’t usually disabling, the government treats epileptics with suspicion and requires detailed proof. Having assistance from an expert can make all the difference.
There are only a handful of situations where we tell epileptics to consider applying on their own:
- If your epilepsy is so severe that no one — not even the most skeptical judge — would believe you could hold a job. (This is the case if you’re seeing a neurologist regularly and taking medication, you still have intense seizures daily or weekly, and you haven’t worked in years.) If this is the case you can likely win on your own, as long as you feel comfortable with government paperwork (about the same as filing your taxes) and requesting medical records.
- If you can’t convince a lawyer to take your case. Sadly, this can happen; if your case is quite hard to win, it can be difficult to find a lawyer to represent you. (Though we recommend trying our service before you give up!) In this case, you can apply on your own, and then try again to find a lawyer once you’ve been denied once — at which point it’s often easier. For more information, see our full article: How to apply for disability on your own.
How Atticus can help
Atticus is a new kind of law firm that helps you navigate the early stages of a disability claim. We help you choose the right approach, hire the right lawyer, and get on with your life. We won’t charge you a dime for our services, so there’s no cost to you.