My Spouse had a Massive Heart Attack - What Do I Do?
This is a guide I prepared for a client's spouse who was in need of a plan to help after their loved one suffered a massive heart attack. The information is specific to California, but similar programs for State Disability exist in all states.
Step One: Apply for State Disability for the Injured PartySTEP ONE: APPLY FOR STATE DISABILITY:
State Disability is a cash only benefit for injured people who have worked in CA and paid into a State Program.
All workers pay the State Gov't. a percentage of their paychecks. It is listed as "SDI" on your paystub. EDD, the department that oversees this program, looks at the last 18 months of earnings. How much you earned determines your weekly benefit. State Disability is for workers with a sudden medical disability, such as a motor vehicle accident, mental health issues, pregnancy, PTSD, heart attacks, and denied worker's compensation claims.
It is a temporary benefit, a maximum of 52 weeks (one year) of payments at 2/3rds (66%) of your pre-tax income. If you have not worked in the last 18 months, you will not qualify.
A doctor has to certify that you are unable to work due to a serious medical condition. Doctors and hospitals have Disability Forms available, a link for an on-line application is listed at the end of this section, which may be much easier for those in the hospital.
PRO TIP: The EDD Website is VERY secure. They will ask you to set up complex passwords, select an identifying picture, provide addresses and phone numbers for employers, etc. Make sure you write down your log-in and claim number information, you will need it.
State Disability will process your application and notify you of eligibility. Your first payment would arrive by mail in about three weeks if you qualify. Note that EDD will not send you a notice when benefits are ending, they will basically be "this is your last check" - so make sure you check your claim balance on line regularly to avoid surprises.
Step Two: Apply for Social Security if Condition is Expected to Last Over 12 monthsHeart attacks and strokes vary in severity and intensity. A mild heart attack will not have residual impact on the person's physical impairment, for example. Or the condition may be controlled. This advice is for a massive heart attack which leaves no doubt as to the severity of the condition.
File for Social Security NOW - it will take several months, and you will need to gather information on the medical condition. There are two programs under Social Security that provide support for disabled persons.
When you "apply" for benefits, they check under both programs to see if you qualify.
The two benefits are:
(A) SSDI (Social Security Disability Income) and MEDI-CARE
(B) SSI (Supplemental Security Income) and MEDI-CAL/ MEDICAID
BOTH REQUIRE MEDICAL EVIDENCE OF YOUR INABILITY TO WORK, AND DR"S CERTIFICATION THAT YOUR CONDITION WILL LAST AT LEAST 12 MONTHS. YOU WILL AUTOMATICALLY BE CONSIDERED FOR BOTH PROGRAMS.
Social Security Disability Income (SSDI) - This is the usual benefit people think of receiving when they reach retirement age. The SSDI rate of payment is based on your work history. The medical program for Social Security is called MEDI-CARE. People under 65 can qualify if their condition qualifies and they have worked 5 out of the past 10 years. Rules are stricter for those under age 50. Over 50, and at age 55, the rules are more relaxed.
SSI is a monthly cash benefit paid to you if you don't have enough work history and have a medical condition prevents you from working in any capacity. SSI is for people who do not have enough work credits. (For example, a person disabled from birth). An individual can have a car but must have less than $2,000 in the bank. For couples, the maximum allowance is $3,000 and one car.
If you have ANY drug or alcohol abuse in your medical records, you will be disqualified from receiving SSI or Social Security until you are in an active recovery program. (This has been the law since 1996).
SSI is a set amount per month (California's 2019 SSI rate is $971.32 for a single person).
You can request a Benefit Statement from Social Security to find out how much you qualify for if you continued working until your full retirement age, and if you retired today on disability.
On-Line Application for Social Security Disability : https://secure.ssa.gov/iClaim/dib
Step Three: Contact Employer and Request FMLA Leave For Yourself and ThemFMLA - The Family and Medical Leave Act allows employees to take up to 12 weeks of UNPAID leave in any twelve-month period for the birth/adoption of a child, to care for a family member, or in the event of the employee's own health condition. Leave can be taken as follows:
-- in a continuous block of time / all at once
-- by working on a reduced schedule
-- on an intermittent basis (in some circumstances)
Employers may require the employee to use the sick and vacation leave they have on the job while they are out on FMLA. Whether or not you can use paid leave during this time is up to the Employer's leave policy. PRO TIP: If you have sick or vacation time available and are required to use it, you cannot use it at the same time as SDI / State Disability.
FMLA applies to the following employers and employees:
Private employers with more than 50 employees
All public agencies (federal, state, local government)
All public and private schools
Must have worked for employer at least One Year AND 1,250 hours total
Must work at a location with at least 50 employees within 75 miles
Notify employer of FMLA leave, required to provide 30 days' notice or ASAP if crisis
If you have a family member with a s serious health condition, you can and SHOULD apply for FMLA for yourself and your spouse. FMLA protects your employment for the duration of the leave. Once you have exhausted your FMLA leave, your employer can require you to return to work. A doctor has to certify the condition and your required assistance to the family member.
Serious Health Conditions under the FMLA include, but are not limited to:
- Emphysema and severe respiratory conditions
- Heart attacks and Heart conditions requiring bypass or valve operations
- Back Surgery
- Most Cancers
- Any serious injury caused by an accident or an off the job injury
- Severe Psychiatric Disabilities
- Emotional Distress following a miscarriage, death, severe depression
Even if you don't expect to take the full 12 weeks off, the fact that you have notified your employer of the possibility that you will need additional time off will protect your job at your workplace. The 12 weeks is only within a one year period, so if you anticipate having to take time off for medical appointments, testing, etc, it is not that much time.