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Applying for Disability on Behalf of Someone in a Coma

Disability benefits ensure an income, even when a person is in a coma or persistent vegetative state (PVS). This income, which may be paid through Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI), can help cover medical expenses.

Your loved one may still have every day bills, even while receiving dedicated, round the clock medical care. Disability can help cover these bills too, which may include things like the rent or mortgage and utility bills, among others.

Medically Qualifying for Disability for a Coma

The Social Security Administration (SSA) recognizes the inherent severity of a coma, and therefore has a standard disability listing for this condition. The listing appears in 11.20 of the Blue Book, the manual used for determining whether an applicant qualifies medically for benefits.

Any person who slips into a coma, regardless of the reason, can qualify under this listing, provided the coma lasts at least a month. Individuals who are in a PVS automatically medically qualify under this listing too, as long as the condition meets the one-month minimum duration.

If your loved one has recently awoken from a coma and experiences pronounced physical and/or mental deficits, then the SSA may need to consult other disability listings when evaluating the claim you submit. This is particularly true if the coma was caused by another medical condition, like a traumatic brain injury or a stroke, for example.

Medical Evidence Necessary for a Coma Disability Claim

When you apply for benefits on behalf of someone in a coma, the SSA needs to see certain medical records. These records are outlined in the introductory paragraphs of Section 11.00 and include:

  • A medical history report, including the underlying or concurrent medical condition that caused the coma
  • Physician reports or notes from physical and neurological examinations
  • Any lab results that are relevant to the applicant’s condition
  • Imaging results, which may include x-rays, CT scans, MRIs, or EEGs, among others

In addition to medical evidence, the SSA must examine the functional capacity or residual effects of an applicant’s medical condition before deciding eligibility. When a coma or PVS is the reason for filing, the SSA can immediately see the person is disabled.

When you apply on behalf of someone that has recently awoken from a coma however, the SSA must review the physical and/or mental limitations the person faces, as well as any physical, occupational, speech, or other therapy your loved one will require in an effort to regain functional abilities.

Filing for Benefits and Getting Help with Your Claim

Undertaking a disability application on someone else’s behalf can be an intimidating prospect, but you don’t have to go through the process alone. A Social Security disability advocate or attorney can assist you from start to finish. He or she can help you gain access to the appropriate medical and other records and can also act as intermediary between you, your loved one’s doctors, and the SSA, if necessary.

You may decide to file online for SSDI benefits, in which case the SSA can use this application as the start of your loved one’s SSI claim too. To finalize the SSI application though, you’ll need to complete a phone or in-person interview with an SSA representative. Applications can be completed at the local office or by calling 1-800-772-1213, in some cases.