Can Certain Medical Conditions Get You Approved for Disability Automatically?

by Jun 14, 2017

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Qualifying for Social Security Disability (SSD) benefits is an involved and often lengthy process. Many factors come into play in determining an applicant’s eligibility, including medical history, the nature of their impairment, work history, and daily living activities. According to the Social Security Administration (SSA), the average wait time for an initial determination of eligibility is three to five months, although times vary.

For some applicants, however, qualification for disability benefits is automatic. Under the Compassionate Allowances (CAL) program, the SSA maintains a list of medical conditions that get you approved for disability automatically.

This list of conditions contains specifics for medical impairments that need expedited application processing. The SSA regularly holds hearings to determine what conditions it will add to the CAL program.

What conditions qualify for the CAL program?

This program provides expedited processing for disability claims based on serious medical diagnoses. According to the SSA, eligible conditions must be so severe that they “obviously meet disability standards.” Their list of conditions can include several categories:

  • Cardiovascular conditions;
  • Digestive system conditions;
  • Endocrine system disorders;
  • Genitourinary conditions;
  • Hematological disorders;
  • Immune system disorders;
  • Cancers; and
  • Mental disorders.

How can I apply for the CAL program?

The CAL program does not require a separate application. The SSA reviews all applications to determine who qualifies for expedited processing under this program.

The determination to expedite requires that the disability in question falls under one of the listed conditions. If you are applying in person, you can also write “Compassionate Allowances claim” on your application or discuss your diagnosis with your case worker.

Once the SSA selects your application for expedited review, they will forward your paperwork to Disability Determination Services (DDS). DDS will review whether or not your diagnosis fits one of the conditions covered under the CAL program. This part of the process moves quickly, since DDS simply needs to establish that your diagnosis is accurate and on the list of approved conditions.

Because doctors or medical facilities may take weeks or months to respond to DDS requests, it helps further expedite the process if you request copies of your medical records directly and submit them with your application.

What documentation will I need to submit?

The medical documentation that you will need will depend on the condition that you have. For cancer patients, medical records that include positive biopsy reports should be sufficient for a determination. For other conditions, such as a thyroid disorder, you will need to provide documentation for the diagnosis and show that the condition has left you unable to work.

How long will a CAL application take to process?

While many disability claims take months to review, a CAL claim can receive approval within weeks. However, DDS will not review your case until they receive your medical records. A medical consultant working with DDS will need to review the documents in the application before the department can issue an approval.

What if my diagnosis is not on the list of approved conditions?

The SSA has two other programs that can expedite disability application reviews.

Quick Disability Determination (QDD)

The SSA uses a computer algorithm that selects applicants with a high probability of approval. They then forward these applications to a specific department, which will evaluate and decide on each claim.

Terminal Illness (TERI) Program

This program provides expedited assistance for patients who are suffering from a terminal illness. The TERI program expedites reviews for applicants whose conditions will likely result in death.

An attorney can help you review your application to determine what options are available to you and help you complete your application accurately, minimizing your chances of an initial rejection.

How can I ensure that the SSA processes my CAL application as quickly as possible?

If your disability falls into one of the diagnoses listed under the CAL program, you should be able to qualify for expedited review, but you will still need to carefully complete your application and submit comprehensive documentation to prove the extent of your disability.

This is where a skilled disability attorney can help. At the Disability Advantage Group, we can help you through your application process to ensure that you complete your forms thoroughly and correctly.  We can also help you navigate the appeals process and schedule a hearing with an administrative law judge if the SSA denied your initial claim.

Let us review your case and provide you with counsel to navigate the application process. Call 865-546-1111 today for a free consultation.