Qualifying for Disability Benefits on Behalf of a Child with Cancer
When adults have cancer, they often only qualify for disability if the disease is advanced, aggressive, or untreatable. The same can be said for children. In fact, it’s often much easier for children to medically qualify for Social Security benefits than it is for adults.
There’s more to qualifying for benefits than medical eligibility though. Familiarizing yourself with the eligibility requirements, review processes, and application procedures can potentially increase your chances of getting a child with cancer approved for disability benefits.
Medical Eligibility for Benefits
Any type of cancer that develops in childhood and affects a child’s ability to participate in age-appropriate activities may qualify for disability benefits. It’s crucial to understand that a diagnosis of cancer alone is not enough to get approved though.
Instead, a child must have medical records to back up his or her disability claim and those records must either meet exactly or closely match a disability listing in Section 113.00 of the SSA’s Blue Book. The Blue Book is a medical guide that lists exactly how advanced a type of cancer must be to be approved for benefits. Listings for more than a dozen of the most common forms of pediatric cancer appear in this section, including lymphoma, leukemia, Neuroblastoma, and retinoblastoma, among others.
Another basic element of medically qualifying for benefits is the concept of disability duration. Social Security benefits are only available to applicants that have a long-term need. In other words, a child’s cancer must be expected to affect his or her daily life for at least a year (12 months), or the condition must be terminal.
Because the entire Blue Book is available online, you can review it with your child’s oncologist to determine if his or her cancer meets the SSA’s eligibility requirements.
Terminal, aggressive, treatment resistant, and rare forms of cancer that can affect children usually qualify automatically, as far as medical eligibility goes. These types of cancer are sent for expedited review under the SSA’s Compassionate Allowances (CAL) program.
The SSA flags any application filed for one of these CAL conditions and then pushes the application through the review process as quickly as possible. Children may have a disability decision through CAL in as few as 10 days.
Medical Evidence You’ll Need
Whether a child’s cancer qualifies through CAL or must meet or match a Blue Book disability listing, the SSA needs to see certain medical records, including:
- Reports, including biopsies, operative notes, or pathology results, documenting the diagnosis and the origin of the cancer, if possible
- The progression or extent of the disease, including any locations of any metastatic tumors or lesions
- Treatment protocols, including treatment type, frequency, duration, and the effects
- Residual effects of anti-cancer treatments, including any side effects, whether they are short-term, long-term, or expected to be permanent
Imaging results, including MRIs, CAT scans, and even x-rays, can be helpful documentation in a child’s medical files. Although these kinds of records aren’t always necessary, they can sometimes strengthen a child’s claim for benefits. You will not need to physically mail in any medical records, as the SSA will gather them on your behalf. Just be sure to speak with your child’s doctor to ensure all of his or her medical records are easily accessible and your child has all of the tests he or she will need to medically qualify.
Supplemental Security Income
Children typically receive their benefits through the Supplemental Security Income (SSI) program. SSI is need-based, meaning it has financial eligibility rules. If you or your spouse is learning a decent wage, it’s possible your child will not qualify due to your household income.
Your family’s unique income limit will vary depending on how many children you have, and whether you have a spouse. For example, a single parent with one child couldn’t qualify while making more than $38,000 per year. A family of five could make nearly $60,000 per year. You can view a chart online to determine your family’s exact income limit.
Income is the #1 reason why children with cancer are denied disability benefits. If your family’s claim is denied due to financial reasons, it’s not advisable to pursue the claim until your child turns 18. At age 18 parents’ income no longer counts against a child, even if your son or daughter is still living at home.
Applying for SSI on Behalf of a Child
When you apply for benefits on behalf of a child, you must go through a personal interview process with an SSA representative. This interview most commonly takes place that the local SSA office. You can schedule an appointment in advance, by calling 1-800-772-1213, or just stop by the local branch.
During the application appointment, the SSA representative will collect information from you, including verbal answers and copies of financial records. He or she will use this information to fill out the SSI application for you, which is then forwarded on to Disability Determination Services (DDS) for the medical eligibility review.
You can submit copies of medical records during your SSI interview, but you don’t have to. You’ll sign release forms that give the DDS permission to contact your child’s doctors directly. Before going to the interview appointment though, you may want to review the Child Disability Starter Kit. This can help you gather the information and documents you’ll need for filing the SSI application.
Once approved, you can focus on what’s important: Your child’s health.
Section 113 of the Blue Book: http://www.socialsecurity.gov/disability/professionals/bluebook/113.00-NeoplasticDiseases-Malignant-Childhood.htm
Compassionate Allowances List: http://www.ssa.gov/compassionateallowances/
Family’s Income Limit: https://www.ssa.gov/ssi/text-child-ussi.htm
SSA Office Locations: http://www.disability-benefits-help.org/social-security-disability-locations
Childhood Disability Starter Kit: https://www.ssa.gov/disability/disability_starter_kits_child_eng.htm