FAST DECISIONS FOR SERIOUS IMPAIRMENTS:

Compassionate Allowances, TERI, Presumptive Disability

1.  Compassionate Allowance Cases

  • If an applicant has a condition that has been designated a Compassionate Allowance, the SSA will approve him or her for disability benefits based on a relatively small amount of information (i.e. a letter from a doctor listing the diagnosis, x-ray or lab results, medical source statements).
  • Because it can take weeks or months for medical providers to send records to SSA, submitting some medical records proving a diagnosis with the initial application can help fast track a decision.
  • An applicant can receive a favorable award decision within as little as 10 days from when they first filed their application.
  • Waiting Period – while Compassionate Allowances allow a decision to be made more quickly, SSDI recipients still have to wait 5 months after the onset date to begin receiving benefits (and 24 months before Medicare benefits begin).
  • Conditions that qualify for Compassionate Allowances include many cancers, ALS, some types of muscular dystrophy (not all), early onset Alzheimer’s disease and a few other illnesses.
  • The complete list of conditions that qualify for Compassionate Allowances can be found at www.ssa.gov/compassionateallowances/conditions.htm

2.  TERI Cases

  • Terminal illness or TERI cases are those that are expected to result in the applicant’s death (generally within 6 months).  Like Compassionate Allowance cases, a TERI designation will result in an expedited approval.
  • The applicant does not have to state that the illness is terminal for it to be expedited under the TERI program.  A claims examiner at the DDB (Disability Determination Bureau) can send a claim to the TERI program if alerted that the illness is expected to result in death or that the applicant is receiving hospice.
  • Common examples of TERI eligible illnesses include: Stage IV cancers, cancers of the esophagus, liver, gallbladder, brain or pancreas, small cell lung cancer, mesothelioma, acute lymphocytic leukemia, chronic heart or pulmonary failure requiring life-sustaining devices, comatose for 30 days or more, and awaiting a liver, lung, heart or bone marrow transplant.

3.  Presumptive Disability

  • Presumptive disability payments are designed to provide the applicant with support while SSA completes its review of the applicant’s disability claim file.
  • SSA has the authority to grant immediate SSI payments if the claimant meets the Presumptive Disability criteria.  The applicant must have limited income according to the non-medical eligibility requirements set by SSA to be eligible for SSI payments due to Presumptive Disability.
  • Monthly presumptive disability SSI payments can last for up to 6 months. Once SSA reaches a final decision regarding the disability claim, the presumptive disability benefits will end. If the SSA has not made a decision within 6 months, the presumptive disability payments will stop. If the SSA denies the disability claim, applicants are not responsible for repaying money received because of the presumptive disability.
  • Conditions that easily qualify as presumptive disabilities are such serious impairments that the applicant is “presumed” to be disabled, such as total deafness or blindness, Down syndrome, or cerebral palsy.
  • The following conditions are eligible for presumptive disability:  AIDS, amputation of two limbs or of one leg at the hip, spinal cord injury with inability to walk without assistive device, stroke more than three months ago with difficulty walking or using a hand or arm, muscular dystrophy, cerebral palsy, severe mental retardation, end-stage renal (kidney) disease requiring chronic dialysis, ALS, terminal illness in hospice with less than 6 months to live.