Schizophrenia is a disease that affects approximately 2.8 million adults in the U.S. While there is no cure for schizophrenia, research has led to safer and more innovative treatments. Still, even with treatment, many people with this diagnosis struggle to find gainful employment.
Fortunately, the Social Security Administration (SSA) does consider schizophrenia a disability, making millions eligible to receive disability benefits when they are unable to work.
Keep reading to learn how to get disability benefits for schizophrenia and what to do if your application has already been denied.
In this Article:
- Is Schizophrenia a Disability?
- Social Security Disability Criteria
- Applying for Disability Benefits for Schizophrenia
- Schizophrenia Disability Approval Rate
- Challenges in Accessing Benefits for Schizophrenia
- What if You’re Denied Disability Benefits?
Is Schizophrenia a Disability?
Schizophrenia is a mental illness that impacts a person’s ability to think, feel, and behave clearly. This condition can cause disruptions in a person’s perception of reality, thought processes, social interactions, and mood. It is often characterized by psychotic symptoms such as hallucinations and delusions as well as negative symptoms such as low energy and limited facial expressions.
Schizophrenia can be debilitating and prevent a person from functioning in their daily life. As such, schizophrenia is a disability according to the Social Security Administration (SSA), which means a person with schizophrenia can qualify for disability benefits if they also meet the SSA’s income requirements.
Social Security Disability Criteria
To qualify for disability benefits with schizophrenia, Social Security will need to determine your residual functional capacity (RFC) by reviewing your medical records and daily activities. If your RFC shows that your symptoms make it impossible to perform basic work tasks, you may be able to receive disability benefits. Limitations may include:
- difficulty concentrating on tasks
- trouble interacting with others
- responding poorly to stress on the job
- missing several days of work
- requiring additional supervision
Schizophrenia in the Blue Book
The 12.03 listing in the SSA’s Blue Book pertains to the schizophrenia spectrum and other psychotic disorders. To qualify for disability benefits under this listing, an individual must meet specific criteria that demonstrate the severity of their condition.
To meet the criteria for disability benefits for schizophrenia, the SSA requires you to present evidence of criteria (A) PLUS criteria (B) or (C):
A. This requires documentation of the presence of at least one of the following:
- Delusions or hallucinations.
- Disorganized thinking (speech).
- Grossly disorganized or abnormal motor behavior.
- Negative symptoms (such as diminished emotional expression or abolition).
AND
B. The condition must result in an extreme limitation of at least one, or marked limitation of two, of the following areas:
- Understanding, remembering, or applying information.
- Interacting with others.
- Concentrating, persisting, or maintaining pace.
- Adapting or managing oneself.
OR
C. Your mental disorder falls within this category as “serious and persistent,” meaning you have a well-documented medical history of the condition spanning at least two years. Additionally, there is evidence of both:
- Ongoing medical treatment, mental health therapy, psychosocial support, or a highly structured environment that continues to alleviate the symptoms and signs of your mental disorder; and
- Marginal adjustment, indicating you have limited ability to adapt to changes in your environment or to new demands outside of your daily routine.
Even if you do not meet all the requirements in the Blue Book, you may still be able to receive benefits for schizophrenia. However, this may require the expertise of an experienced disability lawyer who can identify ways schizophrenia affects your ability to work.
Applying for Disability Benefits for Schizophrenia
To get benefits for schizophrenia, you must complete an application for Social Security Disability Insurance (SSDI) benefits and/or Social Security Income (SSI) benefits. You can get benefits for SSDI if you meet the SSA’s disability, income, and work requirements (40 work credits). However, for SSI, the applicant only needs to meet the disability and income requirements.
You can apply online, over the phone, or through your local Social Security office. Before applying, consider gathering all the information you will need including:
- social security number
- birth certificate
- medical records
- doctor, hospital, and clinic information
- list of medications and dosage
- summary of where you have worked and the type of work
- recent w-2 forms
Medication Compliance
It is vital that you take your medication as prescribed as your compliance will play a critical role in the SSA’s decision to approve or deny a benefits application. Your application will most likely be denied if you are not as it will leave the SSA wondering if you would be able to work if you were taking your medication properly.
If your symptoms are well under control with proper use of your medication, there’s a chance your SSDI or SSI application will be denied. However, the SSA will consider the impact that side effects symptoms from medication can have on a person’s ability to work, so you still may be able to receive disability benefits for schizophrenia.
Schizophrenia Disability Approval Rate
The approval rate for disability claims related to schizophrenia is notably high compared to other mental health conditions. Under the Social Security Administration’s (SSA) current disability determination process, approximately 80% of applications in the “Schizophrenia/Paranoid Functional Disorders” category are approved.
This rate is significantly higher than the overall approval rate for SSDI/SSI applications, which hovers around 50%. Additionally, the approval rates tend to increase substantially after an appeal, which may indicate that the presence of legal counsel can improve a person’s odds of being approved for disability for schizophrenia.
Challenges in Accessing Disability Benefits for Schizophrenia
While the disability approval rate for schizophrenia is higher than average, the nature of this mental illness often presents significant challenges in accessing disability benefits. People with schizophrenia can often face substantial barriers to securing essential resources such as adequate housing, medical treatment, and public benefits like Social Security.
Moreover, the high prevalence of schizophrenia among homeless and unhoused people means that some applicants may have fragmented treatment histories, often scattered across various locations and healthcare providers, making it difficult to gather the necessary evidence for an applicant. Given these formidable obstacles, it may be helpful to contact a disability lawyer experienced in handling schizophrenia cases as early as possible.
An attorney can help navigate potential roadblocks, alleviate the stress associated with the application process, and ensure that strict deadlines are met.
What If You’re Denied Disability Benefits?
Even if you are denied disability benefits for schizophrenia, you are not out of luck. You will always have the opportunity to appeal a denied SSDI or SSI claim. Any experienced disability lawyer will know just how to navigate the complex appeal process so you don’t have to.
In fact, at Disparti Law Group, our team of Social Security lawyers has a hearing approval rating 25% higher than the national rating. That means we are experts in turning a “denied” into an “approved. We will always fight to the bitter end to get our clients the compensation they deserve,
For a FREE case review, contact us today at (312) 600-6000 and find out why thousands say… Larry wins!
