The Financial Impact of TBI's
Parents of a child with brain injury often spend their time and energy on keeping their child comfortable, happy, and healthy. Unfortunately, expensive medical treatment combined with time spent away from work can cause significant financial distress on the family. In a situation where the parents are struggling to maintain financial stability while caring for their child, they may be eligible to receive Supplemental Security Income (SSI) benefits on behalf of the injured child. These benefits can help cover everything from medical expenses to the expenses associated with daily living.
Supplemental Security Income (SSI) is a disability benefit program offered by the Social Security Administration (SSA). SSI is intended to provide benefits to disabled individuals who earn very little income. To qualify, applicants must fall within very strict financial limits – because children do not earn income and are not responsible for their personal finances, child applicants will be evaluated based on a portion of their parents’ income and resources.
Applicants who qualify for SSI benefits also automatically qualify for Medicaid. Even if the SSA eventually determines the family’s income no longer meets the parameters required for SSI benefits, the child may be able to retain Medicaid coverage.
In addition to SSI technical criteria, applicants must also meet certain medical criteria. These criteria are found in the SSA’s Guidebook of Medical Conditions and Requirements, commonly referred to as the Blue Book. Brain injuries fall under Blue Book listing 111 – Neurological Disorders. In most cases, benefits are awarded with medical confirmation of the child’s brain injury, or impaired neurological functioning. This may include convulsive or non-convulsive epilepsy, motor dysfunction, and communication impairment. Additionally, the child may qualify under Blue Book Listing 112.00 – Mental Disorders if his or her brain injury has resulted in intellectual disability, mood disorder, or other mental impairment.
For child applicants under the age of 18, the application process consists of several forms and a mandatory interview with an SSA representative. Although a portion of the paperwork can be completed online, many parents prefer to complete all forms during their child’s interview.
Applying for Benefits
It is imperative to call the SSA immediately to schedule an interview as soon as possible after the brain injury. While waiting, it is important to use the time to prepare for the interview, which may include collecting all of the required medical and non-medical documentation that will be used to support the claim, preparing records of medical appointments, physical examinations, mental examinations, records of diagnoses, treatment results, and statements from clinicians and educators who interacted with the child on a regular basis. If any or all of this information is not available, it is still worthwhile and important to attend the interview. While missing information may cause delays, the SSA will help collect any documents that were missed or unavailable.
If the child qualifies for Compassionate Allowance processing, parents may receive a decision in as little as ten days. If the child’s condition does not qualify for Compassionate Allowance processing, the decision may take several months. If the initial application is denied, it is important to not panic or give up. Although being denied can be discouraging, it is certainly not the end of the road. Each and every applicant has the right to appeal the decision within 60 days of receiving the notice of denial and, interestingly, applicants have a better chance of receiving approval during the appeals process than during the initial application.
This booklet gives an overview of the special benefits available for children with disabilities.
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