Patients Unable to Work May Qualify for Disability Benefits

Photo courtesy of Deanna Power

Deanna Power is the community outreach manager for Social Security Disability Help. [Photo courtesy of Deanna Power]

Two Types of Benefits Available

Chemotherapy, radiation and other cancer treatments can easily take anyone out of work. If you’ve been diagnosed with cancer, cannot work due to your symptoms and expect to remain in that situation for more than 12 months, the Social Security Administration (SSA) may be able to offer you disability benefits.The SSA offers two forms of disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Each program uses its own criteria to determine who is qualified.

SSDI is for people age 18 years or older with disabilities who have worked throughout their lives. A work history is necessary because SSDI is funded by FICA (income) taxes, and only those who have paid into the system are eligible.

SSI is for people of all ages who have never worked, or who haven’t worked recently, such as a parent who took time off to raise a family. To qualify for SSI, an applicant must have low income and assets. The SSA will not include a primary home and one car when evaluating assets, but will look at cash, stocks, a second car and life insurance. Through a supplemental program, some states will automatically give SSI recipients additional benefits on top of what the SSA pays.

If approved for either federal program, you will be paid (retroactively, or even posthumously, if necessary) starting in your sixth full month from the time Social Security determines that your disability began.

Who Is Qualified to Receive Disability Benefits?

If you receive SSDI, the amount of your monthly payments will be based on your lifetime average taxed earnings, replacing approximately 58 percent of an income below $100,000 per year and up to 30 percent of an income higher than $100,000. If you receive SSI, your benefits will be calculated based on the severity of your disability, the state in which you reside and the people with whom you live.When evaluating applications, the SSA uses a medical guide called the Blue Book, which lists hundreds of conditions and the symptoms that must be present for an applicant to qualify. Multiple forms of cancer are listed in Section 13 — Malignant Neoplastic Diseases.

Every cancer diagnosis will qualify differently for benefits. Breast cancer will need to either have advanced carcinoma to the skin and distant metastases, or to be recurrent despite treatment. On the other hand, a diagnosis of esophageal cancer will automatically medically qualify for disability benefits, even if the cancer hasn’t metastasized.

If your cancer is not listed, the SSA will evaluate your claim based on how your symptoms affect your ability to work. Considered will be health issues caused by cancer or its treatments, including fatigue, pain and nausea.

If you are receiving long-term disability benefits from a private employer, this will not affect your eligibility for SSDI benefits, but if you are receiving such benefits from a government employer, Social Security will subtract that income from the total amount it has agreed to pay you. The rules under SSI are the same, but with more stringent financial restrictions.

Compassionate Allowances

Those receiving short-term disability payments from an employer are not expected to remain disabled for more than a year, and thus are not likely to be eligible for SSDI or SSI.The average applicant who secures disability income from the SSA waits a year and a half to get approved. But for those with serious and clearly disabling conditions, the SSA may approve benefits in as few as 10 days via a Compassionate Allowance, or CAL.

Nearly any form of cancer can qualify for a CAL if it is advanced. Cancer of most organs qualifies if it meets one of the following conditions:

• It has metastasized
• It is inoperable
• It is recurring despite treatment

Applying for Benefits

Whether you are seeking SSDI or SSI benefits, you may be eligible for this program, but you don’t need to request inclusion when applying; Social Security workers will consider your eligibility automatically.You can fill out the application for SSDI entirely online. List every hospital and doctor you’ve seen for treatment, so that the SSA can gather records, although the process may move more quickly if you obtain those records yourself and submit them with the application. The more medical records you have proving the severity of your cancer, the stronger your chances are of approval.

SSI applicants can start the application online, but must finish applying with an in-person interview at their local SSA office.

Facing a Denial

To begin the application process, file paperwork online at www.ssa.gov, or schedule an appointment with the SSA by calling 1-800-772-1213.Unfortunately, nearly 70 percent of cases are initially denied. However, an appeals process is available.

The first step is filing for reconsideration, which can be done within 60 days on the SSA’s website. This is fairly easy to complete, but more than 80 percent of applicants are denied again during reconsideration.

The next step would be presenting your case in front of a judge at what’s called an ALJ hearing. This is where the majority of disability cases are approved. Acceptance rates vary depending on the state you live in, but nationwide, nearly 50 percent of applicants are approved at ALJ hearings. If you are denied at your ALJ hearing, you can appeal this decision, as well. Finally, if your ALJ appeal is denied, you can take the claim to federal court.