Compassionate Allowances - Part 2
To prove that a Compassionate Allowance exists, you must have been diagnosed with one of the above conditions by your medical doctor and/or medical specialist. Depending on which Compassionate Allowance you are diagnosed with, a simple statement from your primary care physician is usually not enough to prove that a Compassionate Allowance exists. In most cases, these conditions must be diagnosed and documented through proper medical testing. Once this documentation is provided to the Social Security Administration, your claim is expedited through the process. This means that rather than waiting many months, maybe even years for your claim to be adjudicated, your case will make its way through the system in a matter of a days or just a couple of months.
Beyond Compassionate Allowances cases, another type of case that receives preferential treatment from Social Security is called the TERI (Terminal Illness) case. These cases are termed "critical" by the Social Security Administration and must be handled in an expeditious manner because of their sensitivity. These cases may be identified by the Teleservice Center (TSC), Field Office (FO), or the Disability Determination Services (DDS). There are particular terms and particular situations in which both your Social Security attorney and the Social Security Administration look for when they determine whether or not a case can be classified as a TERI case.
Situations that warrant a claim to be classified as a TERI case are:
- An allegation that a person has an illness that is terminal. This allegation may come from the person trying to get Social Security benefits, a friend of the claimant, a physician or medical source, or even a family friend. The allegations are then reviewed expeditiously to see if the claim, in fact, should be classified as a TERI case.
- A diagnosis of Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig's Disease. If a claimant alleges this diagnosis, that allegation is also reviewed.
- A diagnosis of Acquired Immune Deficiency Syndrome or Acquired Immunodeficiency Syndrome (AIDS). This is not the same as a diagnosis of Human Immunodeficiency Virus (HIV), as HIV has separate criteria to become a payable medical condition.
- Hospice care. If Hospice services are provided either within the confines of a hospital or in a person's home, then the Social Security Administration assumes that the medical condition(s) from which the claimant suffers is terminal, and as such, warrants TERI classification.
There are a multitude of medical conditions that warrant TERI classification. The list is not finite, as any medical condition that has been documented as an "impairment which is untreatable" or a medical condition that "cannot be reversed and is expected to end in death" is classified as a TERI case. However, Social Security does give a list of descriptors to their case workers to use in their process of classifying these types of cases:
- Chronic dependence on a cardiopulmonary life-sustaining device.
- Awaiting a heart, heart/lung, lung, liver, or bone marrow transplant (this excludes kidney and corneal transplants).
- Chronic pulmonary or heart failure requiring continuous home oxygen and an inability to care for personal needs.
- Any malignant neoplasm (cancer) which is:
- Metastatic (has spread);
- Defined as Stage IV;
- Persistent or recurrent following initial therapy; or
- In operable or unresectable.
- An allegation or diagnosis of:
- Cancer of the esophagus;
- Cancer of the liver;
- Cancer of the pancreas;
- Cancer of the gallbladder;
- Small Cell or Oat Cell lung cancer;
- Cancer of the brain; or
- Acute Myelogenous Leukemia (AML) or Acute Lymphocytic Leukemia (ALL).
- Comatose for 30 days or more.
- Newborn with a lethal genetic or congenital defect.
The Social Security Administration usually does an excellent job in identifying cases that should be classified as either TERI cases or Compassionate Allowances. However, this does not guarantee that the case will be paid at the initial application level or reconsideration level. There are cases that should be classified as one of these that are missed, not properly diagnosed, or are unknown at the initial application or reconsideration levels. Unless you have an experienced Social Security attorney, you may still have to wait for a hearing before an Administrative Law Judge before you receive a fully favorable decision. And with these types of cases, each day may be a struggle just to survive; the income and medical benefits that come from receiving Social Security benefits may be necessary to save your life. As soon as the Sellers Law Firm interviews a claimant, the first thing they look for are Compassionate Allowances and/or TERI cases, they then immediately forward that case to an appropriate Social Security Administration worker so that the case can be reviewed immediately.
However, you do not have to have a Compassionate Allowance condition or a TERI case to win your Social Security case. In fact, most cases that are adjudicated favorably by an Administrative Law Judge are neither Compassionate Allowance nor TERI cases. Most cases are won by the combination of impairments that a claimant has. Most single medical issues are not completely and totally disabling, but combining multiple conditions can prove a claimant is completely and totally disabled. That is where an experienced Social Security attorney is most valuable. Attorneys with extensive experience, like the attorneys of the Sellers Law Firm, recognize which conditions can be combined to reach a fully favorable decision. The conditions that are combined and are considered to be the most limiting to your attorney may not be the conditions that you consider most limiting. That is why it is so important to discuss each medical condition you have in detail with your attorney.
If you think you may qualify for Social Security benefits, do not hesitate to call a Social Security law firm like the Sellers Law Firm. Because there is no consultation fee, you have nothing to lose when you call them; but you may gain valuable knowledge that will assist you in deciding whether or not to apply for Social Security benefits. Let our experienced attorneys help you make that decision!