Stroke Victims: Qualifying For Calstrs Disability Benefits

If you have suffered a stroke and are wondering if you can qualify for CalSTRS disability benefits, there are a few things to consider. Firstly, it's important to understand the eligibility requirements for CalSTRS disability benefits, which include age, service credit, timeliness of application, and medical documentation. The specific requirements and benefits may vary depending on whether you have Coverage A or Coverage B under the CalSTRS Defined Benefit Program. Additionally, to qualify for disability benefits after a stroke, your medical condition will need to meet certain criteria as outlined by the Social Security Administration (SSA). This typically includes lasting impairment that affects your ability to work and perform your job duties, such as difficulty with communication, mobility, or vision. It's always recommended to seek guidance from a benefits specialist or a social security disability lawyer to understand your specific situation and options.

CalSTRS disability benefit programs: Coverage A and Coverage B

CalSTRS provides disability and survivor benefits under two coverage types: Coverage A and Coverage B. The type of benefits you receive depends on your coverage type.

Coverage A

If you became a member of CalSTRS before October 16, 1992, and did not elect Coverage B before April 1993, you have Coverage A. The disability allowance under this coverage is generally 50% of your final compensation and will be paid as long as you remain disabled or until you turn 60. At 60, your disability benefit will end, and you must apply for service retirement to receive a monthly benefit. However, if you have eligible children and remain disabled, your disability benefit may continue beyond 60.

To qualify for a disability benefit under Coverage A, you must:

• Be less than 60 years old.
• Have five or more years of credited service. (If you were the victim of an unlawful act on the job, you may qualify with one year of service credit).
• Have performed your last five years of credited service in California, with four of those years being for actual performance of creditable service.
• Have earned at least one year of service credit following a service retirement termination or the most recent refund of your accumulated contributions.

Coverage B

If you became a member of CalSTRS on or after October 16, 1992, you have Coverage B. The disability retirement benefit is 50% of your final compensation, which must be determined before your monthly benefit can be calculated. This benefit is not affected by age and will continue as long as you remain disabled. Service credit is not a factor in determining your disability retirement benefit under Coverage B.

To apply for a disability retirement benefit under Coverage B, you must:

• Have five or more years of credited service. (If you were the victim of an unlawful act on the job, you may qualify with one year of service credit).
• Have performed your last five years of credited service in California, with four of those years being for actual performance of creditable service.
• Have earned at least one year of service credit after receiving a disability benefit, service retirement, or the most recent refund of your accumulated contributions.

Eligibility requirements

To qualify for a disability benefit after a stroke, you must meet the eligibility requirements of CalSTRS, which include age, service credit, and timeliness of application and medical documentation.

Coverage A: Disability Allowance

If you became a member before October 16, 1992, and did not elect Coverage B before April 1993, you have Coverage A. Under this coverage, you must meet the following requirements:

• Be less than 60 years old.
• Have five or more years of credited service. An exception is made if you were the victim of an unlawful act on the job, in which case you may qualify with one year of service credit.
• Your last five years of credited service must have been performed in California, with four of those years being for the actual performance of creditable service.
• You must have earned at least one year of service credit following a service retirement termination or the most recent refund of your accumulated contributions.

Coverage B: Disability Retirement

If you became a member of CalSTRS on or after October 16, 1992, you have Coverage B. To qualify for a disability benefit under this coverage, you must meet the following requirements:

• Have five or more years of credited service. Similarly to Coverage A, if you were the victim of an unlawful act on the job, you may qualify with one year of service credit.
• Your last five years of credited service must have been performed in California.
• Four of the five years of credit must be for the actual performance of creditable service.
• At least one year of service credit must be earned after receiving a disability benefit, service retirement, or the most recent refund of your accumulated contributions.

Additional Requirements for Both Coverages

Regardless of which coverage you have, you must meet the definition of "disabled" as established by the California Education Code. This means having a medically determined physical or mental impairment that is permanent or expected to last at least 12 continuous months. This impairment must prevent you from performing your usual duties, even with reasonable modifications from your employer. It must also prevent you from performing comparable duties that you are qualified for or can become qualified for in a reasonable period with education, training, or experience. Finally, it must prevent you from earning at least 66 2/3% of your final compensation.

Social Security Disability Benefits

In addition to CalSTRS disability benefits, you may also qualify for Social Security Disability Benefits if you meet certain criteria after a stroke. To be eligible, you must be unable to work for at least 12 months and provide proof of your stroke as described in the Neurological Impairment section of the Social Security Administration's Blue Book. You must also meet the criteria under one of the following listings:

• Listing 11.04: Central Nervous System Vascular Accidents. This includes partial or complete paralysis or uncontrollable movement of at least two limbs, resulting in difficulty with walking, using your hands, communicating, or understanding speech.
• Listing 2.00: Special Senses and Speech. This includes expressive or sensory aphasia, which affects your ability to speak or write effectively.

Applying for a disability benefit

If you have suffered a stroke and are considering applying for a disability benefit, there are a few important things to keep in mind. Firstly, you need to determine if you meet the eligibility criteria for disability benefits. This includes assessing the severity and duration of your impairment, as well as your income and ability to work. Here is a step-by-step guide to help you through the process:

Understand the Eligibility Criteria:

To qualify for disability benefits after a stroke, you must meet certain criteria. The specific requirements may vary depending on your location and the type of benefit you are applying for. However, in general, you need to provide proof of your stroke and demonstrate that it has resulted in a significant impairment that affects your ability to work.

In the United States, the Social Security Administration (SSA) offers disability benefits for those who meet their eligibility criteria. The SSA's Blue Book lists strokes within the category of neurological conditions in Section 11.04. To qualify under this listing, you must have suffered from certain effects for more than three months after your stroke, such as partial or complete paralysis, uncontrollable movement of limbs, difficulty walking or using your hands, or difficulty communicating verbally or in writing.

Alternatively, you may qualify under Listing 2.00: Special Senses and Speech if you have experienced vision loss or other physical impairments as a result of the stroke. It's important to review the specific criteria outlined by the relevant organization in your location.

Gather Medical Documentation:

To apply for disability benefits, you will need to provide medical documentation as proof of your stroke and its impact on your functioning. This includes medical records and treatment reports that detail the overall impact of the stroke on your physical and mental abilities. It's important to note that you don't need to delay submitting your application while waiting for medical documents, as they can be submitted after your initial application.

Assess Your Ability to Work:

Disability benefits typically require that your impairment significantly affects your ability to work. This could mean that you are unable to work at all or that your earning capacity has been reduced due to the stroke. The SSA, for example, requires that you earn $1,040 or less per month to qualify for disability benefits. Additionally, your symptoms must be persistent and expected to last for at least 12 months after your stroke.

Contact a Benefits Specialist:

Before submitting your application, it is recommended to schedule a disability benefits planning session with a benefits specialist. They can help you understand the specific requirements, guide you through the application process, and improve your chances of a successful application.

Submit Your Application:

Once you have gathered the necessary documentation and information, it's time to submit your application. You can typically do this in person, by fax, or by mail. Remember that the date the organization receives your application can affect your eligibility and the effective date of your benefit, so don't delay the submission.

Provide Additional Information:

After submitting your application, the reviewing organization may request additional medical or other required documents. They may also notify you if an independent medical examination or vocational evaluation needs to be scheduled. It's important to respond to these requests promptly to ensure the timely processing of your application.

Await the Decision:

Once you have provided all the necessary information and documentation, the reviewing organization will determine your eligibility for disability benefits. They will notify you in writing of their decision. If approved, your disability benefit will typically go into effect from the first day of the month in which they receive your completed application or the day after your last day of compensation, whichever is later.

Remember that the process of applying for disability benefits can be challenging, and it may take months or even years to receive a decision. Seeking guidance from a qualified lawyer or benefits specialist can be helpful throughout this process.

Disability benefits for stroke victims

If you have suffered a stroke, you may be eligible for disability benefits. The Social Security Administration (SSA) considers strokes to be disabling under certain circumstances. To qualify for disability benefits, you must meet the SSA's definition of a disability and the specific criteria for a stroke as outlined in the SSA's Blue Book.

SSA's Definition of Disability

According to the SSA, a disability is defined as a physical or mental impairment that prevents an individual from engaging in any substantial gainful activity. The condition must be expected to last for at least 12 months or result in death.

Blue Book Criteria for Stroke

The Blue Book is the SSA's list of conditions that qualify for Social Security disability benefits. Strokes are evaluated under Section 11.04, vascular insult to the brain. To meet the listing for a stroke, you must meet one of the following criteria:

• Severe impairment or loss of the ability to speak or write
• Pronounced issues with controlling or coordinating movements with at least two extremities (arms or legs)

Even if you don't meet the criteria under Section 11.04, there are other disability listings that may apply, such as Sections 2.02, 2.03, or 2.04 for vision impairment or Section 2.10 for hearing loss.

If your stroke has caused cognitive losses or permanent brain damage, you may also meet the criteria for a mental disorder under Section 12.00.

Medical Vocational Allowance

If you don't meet the specific criteria in the Blue Book but are still unable to work due to your stroke, you may be eligible for benefits through a Medical Vocational Allowance. For this, your doctor must describe your limitations on a Residual Functional Capacity evaluation form. The SSA will then examine your evaluation form, work history, and skills to determine if there is any work you are capable of doing. If they cannot identify suitable work, you will be eligible for benefits.

Social Security Disability Insurance (SSDI)

SSDI is a federal insurance program funded by payroll taxes. It provides income for individuals who are unable to work due to a disability. To be eligible for SSDI, you must meet certain requirements:

• Be unable to work due to a physical or mental impairment
• Have worked and paid into the program (through payroll taxes) for at least five of the past ten years
• Be a citizen of the United States
• Be under the full retirement age of 65 to 67

SSDI benefits include regular monthly income, with annual cost-of-living increases, and access to Medicare benefits after 24 months.

Supplemental Security Income (SSI)

SSI is another program offered by the SSA that provides monthly benefits to individuals with disabilities. SSI is typically for those who have not worked or earned an income prior to their disability.

To qualify for SSI, your stroke must result in long-term or permanent impairments that prevent you from earning a gainful living. SSI benefits are based on financial need, and there are specific income and resource limits that must be met to qualify.

Application Process

You can start the application process for Social Security disability benefits right away, but the SSA won't process your claim for a minimum of three months after your stroke to ensure that your impairment is long-term. You can file a claim online or schedule an appointment at your local SSA office for assistance.

It's important to note that medical evidence is a critical component of your disability claim. You will need to provide various medical records and diagnostic test results to support your application. Consulting with a doctor or a Social Security advocate/attorney can help you gather the necessary evidence and navigate the application process.

CalSTRS disability application process

CalSTRS offers disability protection under two coverage plans: Coverage A and Coverage B. The type of coverage you have depends on when you became a member of CalSTRS.

Coverage A

If you became a member before October 16, 1992, and did not elect Coverage B before April 1993, you have Coverage A. The disability allowance under this plan is generally 50% of your final compensation and will be paid as long as you remain disabled or until you turn 60. At 60, your disability benefit will end, and you must apply for service retirement to receive a monthly benefit. Your disability benefit may continue beyond 60 only if you have eligible children and remain disabled.

To qualify for a disability benefit under Coverage A, you must:

• Be less than 60 years old.
• Have five or more years of credited service. (If you were the victim of an unlawful act on the job, you may qualify with one year of service credit.)
• Have performed your last five years of credited service in California, with four years of credit for actual performance of creditable service.
• Have earned at least one year of service credit following a service retirement termination or the most recent refund of your accumulated contributions.

Coverage B

If you became a member of CalSTRS on or after October 16, 1992, you have Coverage B. The disability retirement benefit is 50% of your final compensation. Your final compensation must be determined before your monthly benefit can be calculated and may be reduced for periods of part-time employment. Service credit is not a factor in determining your disability retirement benefit.

Your benefit will continue to be paid as long as you remain disabled, without respect to age. If CalSTRS determines that you are no longer disabled, your disability retirement will be terminated.

To apply for a disability retirement benefit under Coverage B, you must:

• Have five or more years of credited service. (If you were the victim of an unlawful act on the job, you may qualify with one year of service credit.)
• Have performed your last five years of credited service in California, with four years of credit for actual performance of creditable service.
• Have earned at least one year of service credit after receiving a disability benefit, service retirement, or the most recent refund of your accumulated contributions.

The CalSTRS website recommends applying for a disability benefit before you exhaust other benefits available to you. If approved, your disability benefit will go into effect on the first day of the month in which they receive your application or the day after your last day of compensation, including sick leave and subdifferential pay.

• Schedule a disability benefits planning session to talk with a CalSTRS benefits specialist. Sessions are typically scheduled six weeks out. However, even if you cannot schedule a session right away, or if you prefer not to meet with a benefits specialist, do not delay in submitting your application.
• Request the "Your Disability Benefits Guide" booklet, which includes the Disability Benefits Application.
• Submit your completed application and any pertinent documents to CalSTRS in person, by fax, or by mail.
• CalSTRS receives and acknowledges your disability application.
• CalSTRS reviews your application and eligibility and mails requests for medical and other required documents.
• CalSTRS receives your information and sends follow-up requests for missing or additional documents.
• CalSTRS verifies the employment information you provided in your completed application.
• CalSTRS notifies you if an independent medical examination or an independent vocational evaluation must be scheduled.
• CalSTRS reviews all the information submitted and determines if you qualify for a disability benefit.
• CalSTRS sends you written notification of their decision on your application.

The date CalSTRS receives your application may establish your benefit effective date, so it is important not to delay submitting your application. You may talk to a benefits specialist at any time during the process and withdraw your application later if you choose to do so.

Frequently asked questions