Social Security Disability Benefits for Terminal Illness (TERI) Patients

Because of the urgency involved when handling disability applications for people with terminal illnesses, the Social Security Administration (SSA) has a method to quickly identify and process what the agency calls "TERI cases." The TERI program allows the SSA to award benefits for people with terminal illnesses quickly, and with special sensitivity—for example, the agency doesn't use the words "terminal" or "terminal illness" on any material that's sent to the applicant.

The SSA makes every effort to identify potential TERI cases as early as possible. If you or a loved one is applying for Social Security disability benefits due to a terminal illness, it can be helpful to understand how the agency processes TERI cases and what you can do to get these benefits in a timely manner.

What Does Social Security Consider a TERI Case?

Social Security defines a terminal illness as "a medical condition that is untreatable and expected to result in death." (POMS DI 23020.045). The SSA has a list of factors that will flag a disability application ("claim") for potential expedited processing as a TERI case:

• an allegation from the claimant or third party that the illness is terminal
• an allegation or diagnosis of amyotrophic lateral sclerosis (Lou Gehrig's disease)
• an allegation or diagnosis of acquired immunodeficiency syndrome (AIDS)
• the claimant is receiving in-home palliative or hospice (end-of-life) care
• the claimant has a chronic dependence on a cardiopulmonary life-sustaining device
• the claimant is awaiting a liver, lung, heart, heart and lung, small intestine, or bone marrow transplant
• the claimant has chronic heart or lung failure that requires continuous oxygen and caregivers
• the claimant has stage IV cancer that has metastasized (spread to other parts of the body), keeps coming back despite treatment, and is unable to be removed or reduced
• an allegation or diagnosis of certain cancers (esophagus, liver, pancreas, gallbladder, mesothelioma, brain, small-cell lung, acute myelogenous leukemia, or acute lymphocytic leukemia,
• the claimant has been in a coma for 30 days or more, or
• the disability claim is on behalf of a newborn with a fatal congenital or genetic defect.

The above list isn't all-inclusive—it's meant to provide general guidance in the identification of TERI cases. Before a disability examiner can make a decision on whether a claim qualifies for fast processing as a TERI case, the examiner must first ask a medical consultant (a doctor who provides opinions for Social Security). If the medical condition is untreatable and expected to end in death, the agency should flag it as a TERI case and expedite processing.

How Fast are TERI Cases Decided?

Social Security regulatory policy requires that claims examiners at Disability Determination Services (DDS), the stage agency that handles initial applications for benefits, track TERI cases closely. An examiner should follow up on a TERI case every 10 days until a decision is made, with escalating levels of managerial responsibility at 30 and 60 days. So while there's no hard deadline on TERI cases, the agency aims to have these cases decided within several weeks or two months—much faster than non-expedited disability claims, which can take over a year.

How to Make Sure the SSA Flags a Claim as a TERI Case

Claimants don't have to state on their applications that they have a terminal illness to qualify for expedited processing under the TERI program. Field office representatives or claims examiners can designate an application as a TERI case when a doctor, family member, or friend states that the illness is expected to result in death or when the claimant is receiving inpatient hospice care or home hospice care.

Even though Social Security can flag a potential TERI case based on an allegation or diagnosis of a terminal illness, the agency still needs to see medical documentation of the illness before the claim can be approved. For example, a claim for benefits based on terminal cancer will need to contain medical tests, imaging, and treatment from the claimant's oncologist (cancer specialist). Cases are more likely to be flagged if they have the following medical records:

• clinical notes from both the treating physician and doctors who specialize in the area of medicine covering the terminal illness
• blood work or lab results that support a finding of a terminal illness diagnosis
• X-rays, MRIs, CT scans, or other objective imaging documenting the extent of the illness
• hospital admission and discharge summaries, and
• evidence of surgical interventions.

Keep in mind that it's not just the quantity of the medical records, but the quality as well. And as with every disability application, TERI claimants need to meet the financial eligibility requirements for the type of disability program (SSDI or SSI) they're applying for.

Is There a Social Security Terminal Illness Lump Sum Payment?

Claimants with cases designated as TERI don't get an additional extra payment if their application is approved—the back pay calculations are the same as those for claimants who are awarded without expedited processing. Any past-due benefits you're entitled to will be paid out most likely as one lump sum.

Separate from SSDI or SSI backpay, Social Security can pay eligible surviving spouses who live in the same house as the claimant at the time of death a one-time payment of $255. Children and spouses not living in the same house can also qualify for the $255 if they were already receiving benefits under the claimant's name or became eligible for benefits at the time of death.

What Happens If the SSA Denies a TERI Claim?

If the SSA declines to process a disability application as a TERI claim, that's not the end of the road. Other options for fast review include the Compassionate Allowances program (for cancers that aren't covered under TERI), the Quick Disability Determination program, or the Presumptive Disability program for SSI. Even if the claim doesn't qualify for expedited processing, that doesn't mean that Social Security won't award benefits—just that it will be reviewed the "regular" way, which takes longer.

It's unlikely that you'll need to get an attorney if you file an initial disability claim and the SSA flags it as a TERI case. In those cases, there's little reason to bring a lawyer into the equation. But if the SSA doesn't award your case under TERI and you need to go through the lengthier process, consider getting legal help. An experienced attorney can handle all communications with Social Security, keep on top of appeal deadlines, and represent you at a disability hearing if necessary. (For more information, check out our article on how to find a disability lawyer.)