5 New Conditions Covered under SSA’s CAL Program

5 New Conditions Covered under SSA’s CAL Program

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Medical records analysis is indispensable when reviewing applications for CAL programs. Now 5 more conditions are covered under this program.

Millions of Americans are affected by disability in one form or another. Social security disability benefits provide financial support to such individuals based on certain strict criteria for meeting the SSA (Social Security Administration)’s definition of disability. People who cannot do work they did before; those who cannot adjust to other work because of their medical condition (s); and those whose disability has lasted/is expected to last for at least one year or to result in death, are considered disabled. Medical records analysis is a necessary step taken to understand the applicant’s current medical condition and determine whether he/she is eligible for disability benefits. Often, there are long delays for disability determination and to address this issue, the SSA offers a Compassionate Allowances program for disabled workers who have applied for SSDI (Social Security Disability Insurance) or SSI (Supplemental Security Income) benefits. The Compassionate Allowances program helps the SSA to quickly identify diseases and other medical conditions that meet their standards for disability benefits. Conditions considered eligible for this program include among others certain cancers, adult brain disorders, and rare disorders that affect children.

The Compassionate Allowance initiative was launched in 2008 and mandated that SS programs should be made immediately available to applicants whose conditions automatically qualify for social security disability benefits. This enables many applicants to receive approval in a few days rather than wait for the typical 3 months to a year waiting period. This program initially covered 50 diseases, including mostly rare diseases and aggressive forms of cancer.

38 more conditions such as several types of cancer, various types of dementia including earlyonset Alzheimer’s disease and schizophrenia were included in the list in the year 2010. The SSA website provides the complete listing of covered conditions.

Applications for Compassionate Allowance are automatically screened by the SSA’s computer systems for the qualifying conditions based on: 

Medical conditions, including alternate names for qualifying conditions

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Work history, age, and other relevant personal information

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Medications that indicate the potential for a qualifying condition

The SSA announced the addition of five other conditions to the Compassionate Allowance program on August 20. These are: 

MMIHS (Megacystis Microcolon Intestinal Hypoperistalsis Syndrome)

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Fibrolamellar cancer

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Megalencephaly Capillary Malformation Syndrome (MCAP)

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Superficial Siderosis of the Central Nervous System

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Tetrasomy 18p

Here are some useful facts to know about the Compassionate Allowance Program: 

You don’t have to put in extra work on the application. The Social Security disability application requires extensive documentation regarding the applicant’s life, health and history. No extra work is required when applying for a Compassionate Allowance.

When an applicant’s claim is reviewed, the office staff start with the medical disability and consults the list of Compassionate Allowances. If the paperwork and test results demonstrate that the applicant has a qualifying disorder, he/she will begin to receive payments quickly.

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Applicants can receive Medicare after the normal waiting period: Medicare processing is not expedited, and Compassionate Allowance recipientscan receive Medicare benefits 24 months after the disability onset date.

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Payments may not be immediate: Even though the program is an expedited one, various factors such as the number of other applicants, the speed of submitted medical evidence, further required examinations and so on may slow down the process. However, most applicants receive Compassionate Allowance within a few weeks to 2 months after the application is received by the SSA.

The NORD (National Organization for Rare Disorders) estimates that 30 million Americans (1 in 10 people) are living with a rare disease. Many of them face serious medical and financial challenges. For them, the Compassionate Allowances program helps to ensure fast review of their claims and speedy granting of benefits. As a medical review company assisting social security disability attorneys, we understand that it is best to consult an attorney when applying for compassionate allowance. Attorneys can help applicants fill out the applications, manage paperwork and keep it organized, and also provide valuable support in case an appeals process is necessary.

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918-221-7791