Families caring for children or adults with autism spectrum disorder often have a significant financial burden when it comes to proper care and medical attention for the child. The Harvard School of Public Health estimates that care for children with autism spectrum disorder can range between $67,000 and $72,000 annually for medical and non-medical care. This number can lead to debt and/or financial instability for many.
What disability benefits are available?
For someone seeking Disability Benefits for autism spectrum disorder, it is important to be aware of the different ways to seek benefits. There are three primary options available:
The first option available is Social Security Disability Insurance (SSDI). SSDI may be available to those adults who have earned enough work credits or quarters.
The second option available is Supplemental Security Income (SSI). SSI may be available to either adults or children who have not earned enough work credits to qualify for SSDI and whose families or household incomes meet the financial eligibility requirements for SSI.
There is also a third option available for those seeking benefits. An individual may qualify as a Disabled Adult Child and thus receive Social Security benefits if a parent is receiving SSDI or Social Security retirement.
What must I prove to receive SSDI or SSI benefits for autism spectrum disorder?
Social Security defines Autism Spectrum Disorder as “characterized by qualitative deficits in the development of reciprocal social interaction, verbal and nonverbal communication skills, and symbolic or imaginative play; restricted repetitive and stereotyped patterns of behavior, interests, and activities; and stagnation of development or loss of acquired skills.
Symptoms and signs of Autism Spectrum Disorder may include, but are not limited to:
- Abnormalities and unevenness in the development of cognitive skills
- Unusual responses to sensory stimuli
- Behavioral difficulties, including hyperactivity, short attention span, impulsivity, aggressiveness, or self-injurious actions.”
Examples of disorders in this category include “autism spectrum disorder with or without accompanying intellectual impairment, and autism spectrum disorder with or without accompanying language impairment.” This category does not include the mental disorders that Social Security evaluates under neurocognitive disorders, intellectual disorder, and neurodevelopmental disorders.
Since 2017, Social Security has utilized Listing 12.10 for Autism Spectrum Disorder for Adults and Listing 112.10 for Autism Spectrum Disorder for children. Listings are the “checklists” that Social Security will use to determine whether or not you are eligible for benefits. Social Security Listing 12.10 and Listing 112.10 have the following requirements an individual must prove:
- Medical documentation of both of the following:
- Qualitative deficits in verbal communication, nonverbal communication, and social interaction; and
- Significantly restricted, repetitive patterns of behavior, interests, or activities.
- Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning:
- Understand, remember, or apply information;
- Concentrate, persist, or maintain pace;
- Adapt or manage oneself.
How do I prove autism spectrum disorder?
Although you may feel these requirements are present, it is your responsibility to prove that these requirements have been satisfied; a simple diagnosis of autism spectrum disorder may not be enough to receive benefits.
Some examples of medical evidence to use to support such a claim include:
- School or academic records – These may include information regarding self-contained classes, IEP plans, teacher statements, or other special accommodations the individual received.
- Treating Physician Records – These may discuss how the doctor diagnosed the individual with an autism spectrum disorder. This should include any testing and the results, not simply a diagnosis.
- Case Management Statement/Notes – Sometimes families work with organizations or groups dedicated to providing services for individuals with autism. Having notes or a statement from a case manager or counselor can help support the individual’s claim for benefits.
Even if you think you meet these requirements, having an attorney can help make sure you have the necessary documentation to prove your Social Security claim.
For additional information, Contact Mallary Scheer to learn more about what we can do to help you today.