Expedited Disability Decisions for Terminal Illness Claims

You've probably heard that applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) disability benefits is a long process. The Social Security Administration (SSA) could take several months—even years—to approve your benefits. That can be too long if you're facing a terminal illness.

However, Social Security expedites disability decisions for applicants with terminal illnesses through the TERI program. A disability application will qualify as a TERI case if the applicant has an untreatable medical condition that is expected to result in death.

Social Security requires DDS (Disability Determination Services, the state agency that makes initial disability decisions) to handle these cases quickly and with sensitivity. TERI cases are expedited at every stage of the disability determination process (unless DDS finds that the medical evidence doesn't support the TERI designation).

Whether you're applying for Social Security disability benefits for yourself or for a loved one with a terminal illness, here's what you need to know about getting the claim expedited as a TERI case.

How Does Social Security Identify TERI Cases?

Having your SSDI or SSI disability benefits application designated as a TERI case ensures your claim will process more quickly. Social Security generally identifies TERI cases in one of the following ways:

• You tell Social Security that you have a terminal illness.
• Someone else (like a friend, family member, doctor, or other medical source) tells the SSA or DDS that your condition is terminal.
• A Social Security representative at your local field office or the national SSA phone center flags your file as a potential TERI case.
• A DDS claims examiner finds indicators that your condition is a terminal illness in your application or medical file.

Indicators that can prompt a Social Security representative or DDS staff member to designate your application as a TERI case include learning that you're receiving inpatient or in-home hospice care (for example, in-home nursing care or counseling care) or that you have certain medical diagnoses. (POMS DI 11005.601.)

What Conditions Qualify for TERI?

If you tell Social Security or your medical records indicate that you have a medical condition that can't be treated or reversed and is terminal, your claim qualifies for a TERI designation. Conditions that qualify automatically for TERI treatment can include the following conditions:

• amyotrophic lateral sclerosis (ALS), known as Lou Gehrig's disease
• acquired immune deficiency syndrome, or acquired immunodeficiency syndrome (AIDS)
• being dependent on a cardiopulmonary life-sustaining device
• being a candidate for a heart, lung, liver, or bone marrow transplant (not a kidney or corneal transplant)
• being in a coma for 30 days or more
• chronic pulmonary failure or heart failure with home oxygen and being unable to care for your own personal needs
• advanced cancer that is:
• metastatic (has spread)
• diagnosed as Stage IV
• persistent (recurrent following therapy), or
• inoperable or unresectable
• any of the following cancers, at any stage:
• cancer of the esophagus
• cancer of the liver
• cancer of the pancreas
• cancer of the gallbladder
• mesothelioma (cancer caused by asbestos)
• small cell or oat cell lung cancer
• cancer of the brain, or
• acute lymphocytic leukemia (ALL) or acute myelogenous leukemia (AML).

A disability application for a newborn with a lethal congenital or genetic defect also qualifies to be expedited as a TERI case.

How Does Social Security Handle a TERI Case?

Social Security will prioritize and expedite your SSDI or SSI claim if it has a TERI designation. Faster processing means you'll get a quicker decision and should get your benefits sooner.

Other than processing your claim faster, Social Security treats TERI cases the same as other SSDI and SSI disability cases. So, like all applications for benefits, your TERI case will still have to go through the disability determination process. (20 C.F.R. § 404.1520.) And all of the following requirements still apply:

• You must meet the financial eligibility requirements for disability benefits, such as having enough work credits for SSDI or meeting the SSI income limit.
• You must have a condition that meets the requirements of a medical listing or prevents you from working.
• A medical consultant must review your file before the DDS claims examiner can make disability determination (like all disability claims).

Even with a TERI designation, there's still a five-month waiting period (from your disability onset date) before you're entitled to SSDI benefits, unless you have ALS.

In addition to faster processing, a TERI designation does offer a couple more advantages for SSI. TERI cases can qualify for presumptive disability payments, allowing benefits to start before these claims are decided. Additionally, if you're owed SSI back pay in a TERI case, Social Security will issue it in one lump sum, regardless of the amount—but only if your condition is expected to result in death within 12 months.

Other Expedited Disability Determination Programs

In addition to the TERI designation, Social Security has other programs designed to speed up claims processing for some applicants, including:

• QDD (Quick Disability Determination), and
• CAL (Compassionate Allowance).

QDD and CAL designations don't necessarily mean the applicant has a terminal illness, but they might. Many conditions on the CAL list can also qualify for TERI designation.

These expedited programs can and sometimes do overlap, meaning your claim might fall into two or three fast-track programs. When that happens, you have an even better chance of getting a fast approval from Social Security.

How to Apply for Disability With a Terminal Illness

You can apply for SSDI benefits or start an SSI application online at ssa.gov. If you prefer, call Social Security's national office at 800-772-1213 (TTY 800-325-0778) to make an appointment to apply by phone or in person. Or you can contact your local SSA field office to file your application.

If you think your claim, or the claim of a loved one, might be a TERI case, you should tell Social Security when first applying for disability benefits. That way, the claim will be expedited from the very start.

Even if you don't have a terminal condition and you don't qualify for QDD or CAL, there are things you can do that might lead to a faster disability determination. Learn more about what you can do to speed up your disability claim.