Understanding Compassionate Allowances

Welcome to Season 1, Episode 18 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into the complicated topic of "Understanding Compassionate Allowances."

Join host Nancy L. Cavey, an experienced disability attorney, as she unpacks one of the few fast-track options in the Social Security Disability system: the Compassionate Allowances program. Designed for individuals facing serious or terminal conditions, this program can drastically speed up the process of getting benefits - but only if you know how it works. In this episode, Nancy explains what Compassionate Allowances really are, how they fit into the larger Social Security Disability Insurance process, and which medical conditions qualify - including twelve new additions just this year. You’ll learn how the Social Security Administration identifies eligible claims, how to apply the right way, and why legal guidance can make all the difference when time and clarity matter most. If you or someone you love is navigating a life-altering diagnosis, this episode is essential listening. Nancy also shares key tips that can make or break your application - so be sure to stay until the end. Let’s get into it - because when it comes to Compassionate Allowances, knowing how to qualify can bring much-needed relief, faster.

In this episode, we'll cover the following topics:

1 -  What Are Compassionate Allowances?

2 - Twelve New Conditions Added to the Compassionate Allowances List

3 - How to Apply - And Why You Need an Advocate

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

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Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00]:
 Foreign. Welcome back to Winning Isn't Easy, the Social Security Disability Benefit version of our podcast. In this podcast, we break down everything you need to know about navigating the Social Security system. And I'm your host, Social Security Disability and long term disability attorney, Nancy Cavey. Now, before we get started, I've got to give you a legal disclaimer. The Florida Bar association says I have to tell you that this podcast is not legal advice. So I've said it. But nothing will ever prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played during that process, and what you need to know to get the Social Security disability benefits you deserve.
 
 Nancy Cavey [00:00:51]:
 So, off we go. Now, in my last episode, we covered what the Social Security Administration does with the initial application known as the IA Today, we're going to dig into one of the few bright spots in the Social Security disability claims process, the Compassionate Allowance Program. Now, I say bright spot, but in reality, if you or a loved one are facing a serious illness that qualifies for the Compassion Allowance, you're very ill. But let's dive in deeper. Every day without support can feel like a battle when you are disabled and unable to work. And the last thing anything really wants to be dealing with is the Social Security disability claims process. Now, if you have certain medical conditions that qualify under the Compassion Allowances Program, then you, you may get your benefits faster because the claims process is going to be sped up. The Social Security Administration is still going to use that five step sequential evaluation test that we've been talking about.
 
 Nancy Cavey [00:01:58]:
 It's just that you get put in front of the line, if you will. So we're going to talk about what the Compassion Allowance Program is, how the program works, what conditions qualify, including 12 new ones that were just added, and, and how to apply the right way. And lastly, of course, why experienced legal help matters in a Compassion Allowances program. All right, I want you to stick around to the end because we're going to be sharing tips that will make or break your application, and that's something that you really need to know. Right? Okay. So we're going to talk about what are Compassion Allowances? What are the 12 new conditions added to the Compassion Allowance list and how to apply and why you need an advocate on your behalf. Before we get started, let's take a quick break.
 
 Speaker B [00:02:45]:
 Are you considering filing for Social Security Disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to Know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:03:07]:
 Foreign welcome back to Winning Isn't Easy. We're ready to get started. Let's first talk about what are compassionate allowances? Now, I will tell you that the standard Social Security disability claims process feels like it was designed to make people give up. In fact, I, I think that's exactly how it was designed. It's slow, it's full of red tape. Most people will get denied at the initial application stage and have to file an appeal called a request for reconsideration. And worse yet, they can get denied at the second stage, the request for reconsideration stage, and then have to file an appeal asking for a hearing. That's called a request for a hearing.
 
 Nancy Cavey [00:03:55]:
 And right now, this process can take anywhere from just a year to year and a half to get a claims examiner assigned at the initial application stage. And, and depending on where you live in the United States, can take as long as three to four years to get a hearing in front of a Social Security judge if you have to go that far. Now, there is one part of the system designed to work faster and more humanely. That's the Compassion Allowances program. It's not just a policy. I think it's a potential lifeline. But to use it, you need to understand it. So this is a purpose built fast track.
 
 Nancy Cavey [00:04:29]:
 The Compassion Allowances program, often called calculated cal not cow, was introduced by the Social Security Administration to address a very specific need. What happens when someone with a clearly disabling condition that's severe and potentially terminal applies for benefits? People who have severe, often terminal illnesses just don't have time. They don't have time to go through the, the bureaucratic process. They don't have time to wait for the year or more time frame in which it takes to get a claims examiner assigned. They don't have time to go through potential consultative examinations, appeals, and potentially having a hearing in front of a judge. So this program exists to make sure that those who qualify aren't left waiting. It will fast track the application for individuals who have a disease or condition that Social Security has determined almost always meets its very strict disability standards. Now speed matters, and here's how fast it can go.
 
 Nancy Cavey [00:05:37]:
 Typically it will take three to six months just to sort of get this process rolling. Well, what do I mean by that? You've got to file an initial application. I like to submit requests, residual functional capacity forms that will help address the person's functional capacity in the Tampa Bay Area, it's taking a year to get a person assigned to a claims examiner. I suspect with the resignations in the layoffs, it's going to take longer. So when you make that decision to apply for benefits, hopefully you've made it just as the time you realize you have stopped working or can't work anymore and you are consulting with an experienced lawyer. We want to get this initial application filed as quickly as possible. And some people will dilly dally around. We've had people who've taken that three to six months just to get the application back to so we can file it.
 
 Nancy Cavey [00:06:35]:
 This is like a train. If you don't get on the train, you're not going to get there. So we don't want to dilly dally. We want to get going here. Now, if your case qualifies for a Compassion Allowance, you might get a decision in two to eight weeks again because that's because your claim gets jumped in front of everybody else. The Social Security reviewers through the DDS office, which is where the initial applications are reviewed, know what to look for. And they aren't going to ask necessarily whether or not you meet the five step sequential evaluation they know that you do based on the diagnosis and the severity of the diagnosis. So what types of conditions will qualify? Well, the Compassion Allowance program lists focuses on rare diseases, terminal cancers, severe neurological impairments and genetic disorders.
 
 Nancy Cavey [00:07:26]:
 Conditions like als, pancreatic cancer, childhood leukemia were some of the earliest Compassion Allowance medical conditions recognized for this potential process. Now, over time, Social Security has expanded the list to reflect medical advances and the advocacy from patients and families. And as of 2024, there are 266 qualifying conditions and that number is growing. Now, people get excited when they hear about this, excited because they may be fast tracked, not obviously very happy about their diagnosis. But what this is is just a fast tracking. It's not, hey, you meet the five step sequential evaluation test. So it's not automatic. And this is why it matters.
 
 Nancy Cavey [00:08:14]:
 Just because you have a diagnosis that's on the list doesn't mean that your claim is going to be automatically processed under the Compassion Allowance Program. Here's what can go wrong, and I see this all the time. One, your paperwork doesn't clearly state the condition number. Two, Social Security's automated system doesn't always catch the name of the illness or your representative doesn't flag it as a CAL case. And that's why we think it's essential to use precise medical language. If possible, work with an attorney who knows how to make sure that Social Security doesn't miss the fact that you qualify and isn't following up with the local Social Security office to say, hey, you know, we flagged it. We want you to take a look at this and agree that it should be flagged for consideration. Got it.
 
 Nancy Cavey [00:09:01]:
 Let's take a break. Welcome back to Winning Isn't Easy. What about the new conditions that have been added to the Compassion Allowance list? Now that you get the purpose of the program, let's talk about what's new. Now, in 2024, the Social Security Administration announced the addition of 12 new medical conditions, which brings this list to 266 that can qualify for an expedited review. Now, I think that the importance of this addition is that in part it's addressing medical advances. But there are many times that support groups and advocacy groups and the relatives of patients with these diseases have become very, very vocal and that has resulted in the addition of these conditions to the Compassion Allowance list. So if you're a member of a support group, I would urge you to consult with your support group or the actual any nationwide or international programs that address this disease and talk about how you might be able to get these particular conditions on the list of Compassion Allowance conditions. So the newest 12 conditions number 1 Angioimmunoblastic T cell lymphoma 2.
 
 Nancy Cavey [00:10:28]:
 Blastic Plasma Steroid Dendrite cell neoplasm 3. Gerstman Strossler Schneicher disease 4. Microvillus Inclusion Disease Child 5 Mowat Wilson syndrome 6. Myelodyplastic Syndrome with excess blasts 7. Nuts Carcinoma 8. Pfeiffer Syndrome, Types 2 and 39 Pontocerebral Hypoplasia 10 Posterior Cortical Atrophy, 11 Renal Amyloidosis and 12 Sarcomatoid Mesolithymia. Now, each of these conditions meet the Social Security Administration's criteria for being severe, debilitating and generally fatal or producing profound disability. Now let's think about what these conditions have in common.
 
 Nancy Cavey [00:11:25]:
 They have an aggressive progression and many of these diseases progress rapidly, leaving little time for intervention and little time for this Social Security disability claims process. Unfortunately, there is a high mortality rate and several are considered to be terminal just shortly after diagnosis. Thirdly, some of these have a childhood onset. Some, like the microvillus inclusion disease in the Moatt syndrome, the Moatt Wilson syndrome affect children from birth. And then lastly, they can be extremely rare. They aren't common illnesses that you necessarily hear about every day, and they often require genetic testing or specialized treatment. In other words, These aren't gray area conditions like a herniated disc with radiculopathy that could be disabling but may not be disabling under the Social Security Administration's five step sequential evaluation test. These are really clear cut cases where waiting six months, even up to four years for a decision can be devastating.
 
 Nancy Cavey [00:12:25]:
 Now why do these conditions matter? I think that as Social Security expands this list, it does tell us that they're listening. They're listening to public input. Medical research, patient advocacy groups all play a role in getting new conditions recognized. And families affected by these rare disorders often spend years trying to get attention and, and when they succeed, it benefits everybody who comes after them. It's also a signal and a sign that the Social Security Administration is trying to improve slowly by responding to the real world suffering of folks who are diagnosed with these conditions with more efficiency and with compassion. So what should you do if your list is on the list? Get out that list of the conditions. And what you first should be doing is getting your documentation in order. You need test results, doctor's notes, and official diagnosis statements.
 
 Nancy Cavey [00:13:24]:
 Secondly, you should be using the right language. Your doctor and your attorney should refer to the condition exactly as it is listed on the Social Security list. Third, that application should be flagged. That's often missed. And we want you to mark that claim as a Compassion Allowances case. The next thing you should be doing is talking to a lawyer. A qualified Social Security disability attorney knows how to make this system work for you and how to avoid mistakes that delay your claim. We try to present this information to the Social Security Administration in a fashion that they understand with the documentation sort of taking the forefront, if you will.
 
 Nancy Cavey [00:14:05]:
 In this application, we want them to see the appropriate test results, doctor's notes, and official diagnosis statements first to get it in their head that this is a Compassion Allowances program. Got it? Let's take a break.
 
 Speaker B [00:14:19]:
 Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.
 
 Nancy Cavey [00:14:57]:
 Welcome back to Winning isn't easy. Let's talk about how to apply and why you need an advocate. Even if your condition qualifies under the Compassion Allowances program, the process is not automatic and it's far from simple. Just like any Social Security disability claim you need to follow the rules. You have to have the right evidence, and you have to avoid the traps that could slow your case down. So let's walk through what it takes to apply correctly and why you shouldn't try to do this alone. Step 1 Preparing your medical evidence. Even with a Compassion Allowance listing condition, you have to have the right kind of proof.
 
 Nancy Cavey [00:15:38]:
 That means clinical notes from your doctor, pathology reports, imaging results, MRIs like CT scans, hospital discharge summaries, and a letter from your doctor saying you qualify isn't going to cut it. Social Security wants the objective medical evidence. They don't want a diagnosis code. They don't want a letter from your doctor if the evidence isn't there or it doesn't match the Social Security Administration's definition qualifications for this Compassion Allowance listing, your case could be delayed or denied even with a qualifying condition. So we try to get our ducks in a row, if you will, as quickly as possible, because generally we want to get the attention of that claims examiner and get it once with all of the right information. But you also have to file an application. So let's talk about step two, filling out the application the right way. The disability application is going to ask you for your full medical history, your work history, and a detailed explanation of how your condition prevents you from working.
 
 Nancy Cavey [00:16:48]:
 I think of it as symptoms and functionality. What are the symptoms that would make you unable to do your past work, the lightest job you did in the five years before you stopped work, and why you couldn't do even a sedentary job, sitting down all day, meeting the pace production and attendance requirements. So we want to think backwards, if you will. Now, this process still applies. You just can't skip it. And you just can't write I qualify. Your paperwork has to clearly demonstrate that you meet both the medical and the technical qualifications for Social Security. Step 3 Understanding the Social Security Administration system.
 
 Nancy Cavey [00:17:31]:
 Now, the Social Security Administration uses automated tools to identify Compassion Allowance cases. These systems are looking for specific phrases, diagnostic codes and keywords. And here is where things often go wrong. If your condition is listed as something similar but not exact, the system may not flag it. For example, if the documents say brain atrophy, it's probably not going to get flagged because posterior cortical atrophy will. Same thing, but you're using the terms that Social Security wants you to use so that it can correctly identify your condition as being one that would qualify for a review under the Compassion Allowance program. That's why precise language matters. And that's where a disability Attorney can make all the difference.
 
 Nancy Cavey [00:18:25]:
 Step four, Getting the right legal help. Now, even in Compassion Allowance Program cases, I think the experienced representation gives you an edge. Why? Well, a good Social Security disability attorney is going to be looking at your medical records to make sure that your condition is presented properly and qualifies. So if there's something missing in the documentation that's required, this lawyer is going to be contacting you or your family members saying, we need this report or that report, because as we present this, we want to make sure all of our ducks, all of our documentation is in a row, if you will. Now, obviously, an attorney can contact your doctors for the right documentation. I will tell you that there are certain organizations that we deal with in the Tampa Bay area that are incredibly responsive. When we ask, we get. And they know why we're asking because they understand of the claims process.
 
 Nancy Cavey [00:19:26]:
 There are some doctors who don't necessarily get it or whose offices are slow. And in that instance, I actually ask my client or my client's family to get the documentation and we give them a list of what it is we need. Now, what happens, of course, is once this application is filed, ostensibly it is, you know, the Compassion Allowance check box is checked and it's flagged, hopefully as a Compassion Allowance claim. But what happens is we, for example, call. We call our local office and say on X date we submitted this case. We believe it qualifies under the Compassion Allowance listing. We flagged it, but can you pull it? And then we follow up with them to see, in fact, if they've flagged it. We also follow up to see if they are looking for additional documentation because we want to make sure that what would otherwise qualify under the Compassion Allowance Program slips through the cracks.
 
 Nancy Cavey [00:20:27]:
 Because either the application hasn't been submitted properly, the condition hasn't been presented properly with the supporting medical evidence, and it wasn't really properly reviewed. So a Social Security disability attorney is there to follow up, to make sure that this gets fast tracked. You can see that you really have to have an advocate. The process is complex, the stakes are high, and winning isn't easy. But with the right help, it's possible to get your Social Security disability benefits on an expedited basis under the Compassion Allowances Program. Got it. Well, that's a wrap for today's episode. We've covered what the Compassion Allowances are, what new conditions qualify, and what steps you need or your relatives need to take to apply properly and get the Social Security benefits you deserve.
 
 Nancy Cavey [00:21:20]:
 Now, if you or someone you know is dealing with a serious illness. Please don't go through this process alone. Consult with an experienced Social Security disability attorney who understands the system and knows how to win. If you found this episode helpful, please take a moment to like our page, leave a review, and share it with your family and friends. And better yet, subscribe to this podcast so you'll be notified when a new episode drops, and we'd love to hear from you. At the beginning of each episode description, you'll find a link where you can send us your questions or comments, and I may even feature them in a future episode because your questions are important to me and I want to make sure your questions get answered. So please join us next week for another insightful discussion with where we're going to be talking about the Appeals Council. Thanks for listening.