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Some Illnesses Automatically Qualify for Social Security Disability Benefits

The Compassionate Allowance program identifies medical conditions that meet its criteria for disability, reducing the wait for disability determination.

 
 

The Social Security Administration has a list of the most serious medical conditions that will be fast-tracked for approval for financial assistance.


Applying for Social Security Disability can be a long and rigorous process, but did you know that some disorders are so severe they almost automatically qualify for benefits?


Compassionate Allowances

The Compassionate Allowance program identifies medical conditions that meet its criteria for disability, reducing the waiting time for disability determination.

The Social Security Administration’s definition of disability – “the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” is applied to all impairments in its Blue Book.

The Compassionate Allowance program (CAL) identifies diseases and medical conditions that meet its criteria for disability, reducing the waiting time to reach a disability determination. As a result, the Social Security Administration is able to provide assistance on an expedited basis to applicants with the most serious disorders.


Compassionate allowance diseases and medical conditions include advanced and aggressive cancers, brain disorders, chromosomal abnormalities and rare pediatric diseases.
Some examples of compassionate allowance conditions are:

  •   Stage IV breast cancer
  •   Lou Gehrig’s disease (ALS)
  •   Acute Leukemia
  •   Gallbladder cancer
  •   Small cell lung cancer
  •   Pancreatic cancer
  •   Adult non-Hodgkin Lymphoma
  •   Adult brain disorders
  •   Early-onset Alzheimer’s disease
  •   Heart transplant failures and wait list


Social Security updates its list of compassionate allowance conditions regularly using input from the public, counsel from medical experts, research from the National Institutes of Health, the Social Security and Disability Determination Service communities and information from public outreach hearings.

For a full list of conditions considered under the CAL program see: https://www.ssa.gov/compassionateallowances/conditions.htm.


If you have been denied disability don’t give up! Contact a Disability lawyer at 512-454-4000 for a free consultation and get the benefits you deserve.


The process for applying for a Compassionate Allowance is the same as applying for Social Security Disability or Social Security Income; there is no separate application.

First, check the Compassionate Allowance condition list on the Social Security Administration’s website to confirm that your disorder is included. Clearly state the illness on your claim and note on your application “Compassionate Allowance Claim.” Social Security will flag the claim automatically and process it within weeks instead of months.


As with other SSDI claims, you will need to fill out the application carefully and thoroughly. Social Security will want to see the following medical evidence:

  •   Reports from medical providers confirming the diagnosis
  •   Exam results
  •   Bloodwork
  •   Surgery reports
  •   Biopsy results
  •   X-rays, CATs, MRIs
  •   Cognitive test results (for Alzheimer’s)
  •   Treatments and therapies implemented, such as chemotherapy and radiation)


The Social Security Administration also considers an applicant’s financial situation, so if you earn above Substantial Gainful Activity (SGA), which in 2019 is $2040 for statutorily blind individuals and $1220 for non-blind individuals, your claim will be denied.

If a medical condition is not included under CAL, the Social Security Administration allows applicants to propose their condition as a new listing for consideration.

To suggest a disease or condition for addition to the Compassionate Allowance list you will need to submit:

  •   Your contact information
  •   Name of the medical condition
  •   Alternate names for the condition
  •   Description of the condition
  •   Diagnostic testing, physical findings and ICD-10-CM coding (International Classification of Diseases) if available
  •   Onset date of disease
  •   Progression of disease
  •   Treatment


Claiming a Compassionate Allowance is almost always enough to qualify for a disability determination.

An applicant may receive an award decision in as little as 10 days, but the average time for Social Security to process a compassionate allowance application was 19 days in 2018. Even though applicants receive a decision quickly and most receive Compassionate Allowance benefits from a few weeks to 2 months after the application is received, applicants will still have to wait five months after their disability onset date to receive retroactive benefits.


If you do not qualify for a Compassionate Allowance, Social Security has two other programs to fast-track applications.

  1.   Quick Disability Determinations (QDD).
  2. In this program, the Social Security Administration uses special computer software to analyze and identify applications with a high chance of approval for benefits. QDD determinations can be reached in a few days, but are made internally so applicants cannot apply themselves. However, SSA examiners can inform applicants whether or not their application has been referred to QDD.


  3.   Terminal Illness Program (TERI).
  4. Terminal illness cases are those that are expected to result in the death of the applicant. TERI cases are handled on an expedited basis with special consideration for the emotional state of the claimant. An application does not need to state that an illness is terminal, but a Social Security claims examiner can refer an application to the TERI program when a doctor, family member, or friend states that the applicant’s illness is terminal, or if the applicant is in hospice care. Also, if an individual applies for disability with ALS (Lou Gehrig’s Disease), or AIDS, their application is processed under the TERI program.


If you have a serious illness or medical disorder listed under the Compassionate Allowance program, a qualified disability attorney can provide valuable assistance in filing your claim.
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Disability benefits are an important source of income for those who are unable to work. If you not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.


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