Can You Be on Disability Because of Migraines?


The Impact of Migraines

Every year, nearly 3 million people in the United States experience migraine headaches. Unlike regular headaches, migraines can be truly incapacitating and may severely impact activities of daily living.  According to the Migraine Research Foundation, migraines are the 6th leading cause of disability in the world. If you or a loved one suffer from debilitating migraines, you may be eligible for disability benefits.

Short-Term Disability

This type of disability insurance is often offered by employers as a part of their healthcare benefits package or can be purchased through a variety of insurance agencies.  If your migraines cause you to take frequent or lengthy absences from work, you may qualify for short-term disability benefits.  During your time off, these benefits pay a portion of your salary, typically around 60% of your normal wage.  The money received can be used to cover everyday expenses, medical bills, medications, etc.  Payments begin after a two-week waiting period and, depending on the policy, last between three and nine months.

A typical claim for short-term disability benefits will require information from three major parties: you, your employer, and your attending physician.  You will be required to give your basic demographic information, list your sources of income and give information about the physician you see for your migraines. Your employer will be asked to provide information about your short-term and long-term disability coverage along with details about your employment position and, most importantly, how your migraines impact your ability to successfully perform your job functions.

Lastly, the insurance company will ask for information from your physician to determine the extent of your disability. Your doctor will disclose details of your diagnosis including when the initial diagnosis was made, what treatments you’ve had, how you’ve responded to those treatments and the level of impairment you suffer. With regard to impairment, your doctor will take into account not only your physical disability but any mental and/or emotional impairment as well.  They will also provide the date when they expect you’ll be able to return to work.  If they believe your condition is too debilitating for you to return to work, they will note that instead of giving a date.

Long-Term Disability

Long-term disability insurance, also typically offered by employers, goes into effect once all paid time off has been used and when short-term disability benefits have been completely utilized.  With long term disability, payments are usually between 50% to 60% of your normal wage and lasts until you are able to return to work. If you are unable to return to work, the benefits will remain in effect for the maximum number of years allowed by your specific policy. 

To use long-term disability benefits through your employer, the insurance company will require further documentation.  Most of this information will be very similar to what you submitted for short-term disability. While this can vary from employer to employer, the required documentation will likely include your medical records, a note from your physician, information about your employer and updates after each of your doctor visits.

Social Security Disability Insurance

Once your migraines have lasted for a minimum of one year, you may be eligible to apply for social security benefits. Your case will depend upon the evidence you provide about how your condition effects your ability to work. In order to receive benefits from social security, your condition must meet certain levels of severity that impact your employability or your ability to perform job functions at your current place of employment. 

If you chose to file for social security benefits, make sure the doctor treating you for your migraines is aware of your intentions. They will be asked to provide statements regarding the duration and severity of your condition and an estimate as to when you will be able to return to work. This can often be an involved back-and-forth process between the two parties and, at some offices, may incur fees for time spent doing paperwork.

In the months leading up to filing your claim, keep careful track of your records.  MRIs, CT scans, physical examinations, discharge summaries from hospital stays, and results of blood work can all be useful in building your case.  Some people also find it helpful to keep a diary of their symptoms as a way of documenting the frequency and subjective severity of their migraines. 

When filing your claim for social security benefits, you may do so online, over the phone, in person or via mail. Regardless of which method you chose, you will need to provide demographic information, employer details, tax documentation, proof of citizenship or work status and banking information. The claim form itself is extensive – give yourself adequate time to complete it. Many of the documents required for your claim will need to be the original and not copies. You may mail these to the social security office and have them mailed back to you, or you will need to take them to a social security office. Once you have completed your claim, you will receive a response in the mail regarding the SSA’s decision within three to four months.

Rejections and Appeals

The five most common causes of claim denials include: lack of hard medical evidence, previous denials, your income, failure to comply with treatment, and failure to cooperate. Far and away, a lack of hard medical evidence accounts for most claim denials. For this reason, it is especially important to maintain thorough records and provide ALL necessary documentation when filing your claim. 

If you were previously denied benefits, it may be in your best interest to file an appeal rather than open a new claim for the same problem. When reviewing your new claim, the previous denial can be used to build a case against your current claim, especially if the two were filed in a short time-span. With regard to income, if you are working and making over $880 per month, this alone could be enough for a denial. 

Failure to follow the treatment prescribed by your physician will result in an automatic denial of your claim. Your failure to comply hinders the case examiner’s ability to examine how your condition affects your capacity for work. Similarly, failure to provide all the necessary documentation or missing scheduled doctor’s appointments will also result in denial. 

The information and documentation required to successfully file a claim and be approved for benefits is quite exhaustive. There are a multitude of services that can, for a fee, assist you in filing and, if necessary, appealing your claim for benefits. Appeal decisions take substantially less time than initial claims and are typically resolved within thirty days.

Going Forward

If you or a loved one suffer from migraines and need time away from work to rest, recover or seek treatment, there are options available. Short-term and long-term disability insurance is typically offered by employers and may provide up to 60% of your income while you’re away from work. For lengthier, more severe cases, the Social Security Administration can provide long-term base income if you’re unable to work due to your migraines.