Cancer and Qualifying for SS Disability Benefits

Each year, more than one million people receive a cancer diagnosis. There are more than 200 types of cancer that can affect men, women and children of all races and cultures. Symptoms caused by different cancers can be debilitating, and treatments such as chemotherapy and its side effects can prevent a person from working. If you are suffering from the effects of Cancer you may qualify for disability benefits.

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While some cancers may automatically qualify for Social Security Disability benefits, in other cases it will depend on how far the cancer has progressed.

Even if a person doesn’t automatically qualify, they may be approved if their symptoms and treatment prevent them from doing any type of job.

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There are five main categories of cancer:

•    Carcinomas – cancer that begins in the skin or tissues that line the internal organs
•    Sarcomas – cancer that develops in bone, cartilage, fat, muscle or other connective tissue
•    Central nervous system – cancer that begins in the brain and spinal cord
•    Lymphomas – cancer that begins in the immune system
•    Leukemia – cancer that begins in the blood and bone marrow

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Cancer is caused by changes to genes that control how cells function.

These changes can cause errors in instructions to genes resulting in cancer; as cancer grows, cells undergo additional mutations in DNA. Some genetic changes occur naturally when DNA is replicated during the process of cell division, but others are the result of exposure to chemicals in tobacco smoke, radiation, or ultraviolet rays of the sun. Though there may be no apparent cause of cancer in an individual, major risk factors include smoking, heavy alcohol consumption, poor nutrition, and excess body weight. The most common types of cancer are:

•   Lung cancer
•   Breast cancer
•   Colon cancer
•   Prostate cancer
•   Basal cell cancer
•   Melanoma
•   Leukemia
•   Lymphoma

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There is no cure for cancer currently, but early detection can greatly improve an individual’s prognosis.

Treatment focuses on destroying cancer cells without damaging normal cells and depends on the type of cancer, stage of cancer, if the cancer has spread, and the general health of the patient. The main treatments used are surgery to remove tumors, chemotherapy, and radiation therapy, but other therapies include immunotherapy, targeted therapy and hormone therapy.

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If you are suffering from the effects of Cancer and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!

How do I qualify for SSDI if I have cancer?

Any type or stage of cancer will severely impact a person’s finances and personal life.

If you have cancer and you are no longer able to work, you may be eligible for Social Security Disability benefits. Social Security recognizes cancer as a disabling impairment in its Blue Book under Section 13.0 Cancer and cancers such as lymphoma and those associated with HIV under Section 14.00 Immune System. Not every cancer has a Blue Book listing, but those that do have very specific requirements to receive approval. Any cancer that is Stage IV or terminal will qualify for disability, and a very serious cancer may be eligible for Social Security’s Compassionate Allowance program (CAP). Through CAP, Social Security flags those applications with progressive cancer diagnoses and expedites those claims to receive benefits quickly.

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To qualify for CAP, the cancer must meet one of the following:

•    The cancer is inoperable,
•   The cancer has spread beyond its region of origin, or
•   The cancer is recurrent despite treatment.

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Cancers that automatically qualify for Social Security Disability benefits include inflammatory breast cancer, esophageal cancer, pancreatic cancer, pleural or peritoneal mesothelioma, oat cell lung cancer, primary cancer of the liver, bile ducts, or gall bladder, and certain types of brain or spinal cord cancers.

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In reviewing your case, Social Security will consider the type, location and prognosis of the cancer, as well as how well you respond to treatment.

To qualify for SSDI, you must provide Social Security with specific medical evidence supporting your claim, including:

•    Diagnosis that specifies the type, extent, and site of the primary, recurrent, or metastatic cancer;
•   Medical records;
•   Laboratory and test results;
•   Imaging such as x-rays, MRIs, CT scans;
•   Treatments and side effects;
•   Medications and side effects; and
•   Doctors’ notes detailing symptoms and prognosis.

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You also need to show that you are receiving regular medical treatment and following your doctor’s instructions.

A written statement from your doctor regarding your diagnosis and outlook for your recovery is extremely helpful.

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If your medical condition doesn’t meet the requirements of a Blue Book listing, you may qualify for benefits under a Medical Vocational Allowance.

Complications resulting from cancer and its treatment can affect your ability to do physical work or sedentary work. You may be experiencing difficulty speaking, walking, eating and memory and concentration problems. Social Security will conduct a Residual Functional Capacity (RFC) assessment to evaluate your physical and mental capabilities to determine if there is any job you can do, taking into consideration your age, education and whether or not you can drive. If Social Security decides you cannot do your old job or don’t have the skills to perform a new job, you may be approved for a Medical-Vocational Allowance.

If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.

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You may also be eligible for Social Security Disability benefits if you have another medical condition.

Treatments such as chemotherapy and radiation, as well as various drugs, often have long-lasting damaging effects on different body systems, including the heart, lungs, brain, bones and joints. One disorder alone may not meet the criteria of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.

Social Security also has basic financial requirements.

You must satisfy some basic financial requirements to be eligible for Social Security disability benefits.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,470 per month in 2023 for nonblind applicants and $2,460 per month for blind applicants.

What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.

I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.

How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

Most initial applications are denied, so don’t be discouraged if yours is – you will have the opportunity to appeal. There are four steps to the Social Security appeal process:

1.   File a Request for Reconsideration with the Social Security Administration to completely review the case.
2.   If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI and SSI cases and either uphold or overturn decisions to deny SSDI or SSI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
3.   If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
4.   Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.

Do I need a disability attorney for SSDI or SSI?

If you have cancer and cannot work, it’s likely you will be approved for Social Security Disability benefits, but filing a claim for SSDI or SSI is a complicated process that can be challenging for individuals suffering from cancer and the side effects of treatment.

Your chances for quick approval are increased significantly if you have legal representation. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.

Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.

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If you have any type of cancer, you may be eligible for Social Security Disability benefits.

The attorneys at Bemis, Roach & Reed have wide experience in representing clients at all levels of the Social Security Disability process and in long-term disability insurance cases.

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