Only a slim proportion of stroke patients go back to work in their former occupation. The primary reasons for this are not just the permanent effects of brain injury, but the national policy concerning disability insurance--a "Catch-22" policy that discourages people from resuming their careers.

When you are disabled by a stroke or some other long-term illness, your family must concentrate first on meeting the catastrophic medical bills. Meanwhile, most employers can be counted upon to calculate how much time you have accrued in vacation and sick leave and guarantee your salary and employee benefits through that time. Then, if you have a short-term disability policy, it kicks in for 30, 60 or 90 days, depending upon the richness of your insurance policy.

You must then apply for long-term disability insurance benefits, also known as "permanent disability." Workers of all ages are well advised to consider maximizing their long-term benefits, because a career-ending event can occur at literally any moment and getting off permanent disability after a stroke is virtually impossible.

Most permanent disability policies are set up to guarantee a fixed proportion of your base salary (60 percent is common) at the time you were stricken. However, in most cases that funding responsibility is shared between the insurance company and Social Security Disability Insurance (SSDI). You must apply for both. And you must qualify for both.

Let's suppose that you were earning $100,000 a year in base salary. Your long-term disability guarantees $60,000, or $5,000 per month. That $5,000 is typically divided between SSDI at, say, $1,300, and your insurance company at $3,700 per month. You will get two separate checks and as long as you maintain qualifications for both, they will continue until your 65th birthday. (You will be required to pay taxes on your long-term disability benefits if your policy was paid for by your employer.)

The difficulty is that the checks come from two independent sources with vastly differing standards for what is permissible to keep you qualified.

The insurance companies are fairly consistent in not penalizing you for your work and income as long as you cannot assume a job in your old field with similar responsibilities.

SSDI is much more complicated. The amount you are able to earn while retaining benefits is determined by Social Security and can vary greatly. Exceeding this amount would trigger a review of your case and could cause a reduction or elimination of your benefits. If that happens, your insurance company would be notified, and officials there would want to know what has happened. In most cases they will remind you that you must continue to qualify for SSDI in order to keep their benefits coming.

Therefore, since you are probably depending on your disability income for your living expenses, you are hesitant to risk losing your monthly payment even if your ability level would permit you to resume earning a salary. That's the "Catch-22" of disability income policy. Recovering stroke patients should review their private insurance benefits and coordinate with SSDI prior to considering a return to employment.

Darlene Williamson, a speech pathologist in private practice in Fairfax, specializes in rehabilitation of communicatively impaired individuals.