If you have had to undergone a hip replacement surgery, you have had a major dysfunction of the hip joint. The dysfunction can be caused from congenital defects, degenerative disease such as rheumatoid arthritis or osteoarthritis, injury or accident.
It does not matter how the problem was caused, the surgical procedure requires the removal of part of or all of the hip joint. It is replaced by synthetic components that are made to mimic the functioning of a normal hip. If you have had to undergone hip replacement surgery and you cannot work because of the procedure, you may be eligible to receive Social Security Disability benefits.
The Social Security Administration (SSA) has Social Security Disability Insurance (SSDI) coverage for those individuals who have worked enough to earn sufficient credits and who have paid in enough taxes. If an individual meets the guidelines of full and permanent disability per the SSA, her or she and certain dependents are eligible for SSDI benefits.
Applying for SSDI is a lengthy and extensive process that involves providing the SSA with extensive documentation regarding your disability including doctor’s notes, test documentation, prescription records and evidence of how you are impacted by the condition. The more documentation that you have, the more effective you are at proving your case.
With the SSA, you have to be disabled fully for at least a full year. Thefre are no benefits for partial or short-term disability. The guidelines that determine disability are strict and specific. If your disability does not specifically meet the guidelines, you can still prove your disability through other means.
The Cost of Hip Replacement
According to Cost Helper, the cost of a total hip replacement varies from $31,839 to $44,816. Those price variations do not include x-rays and MRIs to determine the condition of the hip joint, blood tests to check for overall health and sometimes weight management therapy is required to help you lose weight to reduce the stress put on the hip.
After surgery, there will physical therapy and follow-up doctor visits and prescriptions. Sometimes, the patient goes to a rehabilitation center for a while to recover so he or she can live independently after recovering. There are complications that can occur after hip replacement. The odds of these complications are rare, but they can happen and would result in more medical expenses.
So, on average, you can expect the average hip replacement with care before and after the procedure to run about $50,000. With health insurance, you may be paying copays and coinsurance, while without health insurance you may be paying all of the expenses out of pocket.
The SSA Evaluation and Medical Qualifications
If you have undergone hip replacement and you are still unable to work as a result of having undergone the procedure, you may eligible to receive SSDI benefits under the Blue Book listings. There are several different listings that a hip replacement procedure may fall under in the Blue Book.
The two main listings that may apply to hip replacement include:
- Section 1.02 – Major Dysfunction of a Joint: characterized by gross anatomical deformity, chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s)
- Section 1.03 – Reconstructive Surgery or Surgical Arthrodesis of a Major Weight-bearing Joint
While many hip replacements are effective in treating the initial dysfunction of the joint, enabling patients to put weight back on the joint and regain mobility there are some patients who lose the ability to walk for several months, but that condition rarely lasts more than 12 months, which is the minimum for qualifying for SSDI benefits.
In the majority of cases, it is only instances where something has gone wrong with your hip replacement that would make you eligible to apply for SSDI benefits using the listings of 1.02 or 1.03 of the SSA Blue Book.
Meeting Disability Criteria with an RFC
If you don’t meet the criteria of the SSA’s Blue Book listing, you will need to provide medical documentation and other records that will indicate your limitations in performing all activities, including how you are limited in lifting and carrying, sitting in one place for long periods of time, standing for long periods, bending, stooping or squatting.
The residual functioning capacity form (RFC) is used to rate your ability to work and perform your central job functions even with your physical impairment. Regardless of whether your SSDI claim is evaluated under a listed impairment or reviewed using a medical vocational allowance, the SSA will make all efforts to determine if you are able to walk effectively.
You will need to provide documentation that will show you are unable to:
- Walk on surfaces that are rough or uneven
- Climb stairs at all, or at a reasonable pace while using handrails for support
- Walk without using a walker, crutches, or two canes
- Move considerable distances, such as a block or more, at a reasonable pace
It is important that your medical records have detailed statements from your treating physician that show your condition has not shown improvement following hip replacement and that your mobility remains severely limited after physical therapy and rehabilitation.
When the medical vocational allowance is being used, the SSA will also consider work history, work skills, education level, age and if you can transition into some other kind of work position.
Applying Specific Medical Tests to Your Case for Disability
Several scans are used to help determine your condition. These tests include x-rays, CAT scans and MRIs. Documented examinations that show flexibility of hip joints and the range of motion are also necessary to help with the disability determination process.
There should be tests from before the hip replacement procedure as well as after the procedure. These will be used to determine if you are indeed fully disabled and if your description of your injury or condition matches the medical picture.
Despite your medical records being used as evidence in the case, the SSA may request a medical evaluation at their cost for informational purposes to help determine the extent of your condition. Mental evaluations are sometimes ordered to see if depression or anxiety has come into play and is impacting your ability to function.
The SSDI application process is very detailed and lengthy. The more documentation and information you provide, the better it is for your case. If you are unable to work because of hip replacement surgery, visit the SSA website at www.ssa.gov for details and to start the application process.
If you prefer, you may call 1-800-772-1213 for information or to begin the SSDI application process. The phone number has some automated information available 24 hours a day.
You may also want to consider the benefits of seeking assistance from a Social Security advocate or disability attorney when filing your claim in order to ensure your application and substantiating documentation meets the eligibility criteria for SSD benefits.