Hello, Silent observor here, wife to Ed: Diagnosed with stage IV, Gleason 8, November 2020, with mets to nearby lymph nodes and lungs (of all places). Successfully treated so far with orchiectomy, Zytiga and prednisone with minimum SE. Age 60, living in PNW of US.
Ed is considering an application to go on disability. In addition to SS, he has both ST and LT disability insurance. We are just looking to get started here, and I'm hoping to hear from others about the "real" deal on applications for SSDI for stage IV cancer. My understanding is that a stage IV diagnosis is an automatic qualification, but would like to know if those who have been through the process, actually found it that easy?
With our private insurance, my understanding is that SSDI pays first, then insurance kicks in to bring monthly payment up to 60% of recent salary (up to maximum limits).
Really hoping to learn from all of you about your experiences, and any particular advice to share!
thank you -
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MIkamom
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For me I had to be out of work for a year or very limited work. I applied and was then rejected so hired attorney. I was administered a functional test that I passed with ease but after a telephonic hearing was granted SSDI retroactively to day of filing. Over all process took about a year after getting an attorney. Easy application and over all process, just time consuming
I also live in the PNW. Initially diagnosed Stage 4. Here’s a brief rundown on how it worked for me. First I was put on short term disability and after it ran out onto long term disability all through work. Worst part for me was chasing down medical records for the disability insurance. Once on long term and after a bit they hired a lawyer to take care of all the SSDI stuff. I was approved in less than 30 days. That’s because my work disability deducts the ssdi payment from there monthly 60% payment to me. Once on ssdi there is a 2 year wait to get Medicare bennies. Hope that helps.
Recurrent prostate cancer is on the list for expedited SSDI - took me about a month. Gathering documentation was the hardest part. In Florida the regional center that did the final vetting had access to University of Florida Health electronic records - made it go much faster.
I applied a little less than a year after being dx, and was immediately accepted, they even fast tracked my application. I went in and applied face to face at the local office, it was just after early chemo so I imagine I looked like death warmed over. That was almost 10 years ago. I too have LTD from the company I worked for, so the LTD pays 60% of income, once SSA kicks in they pay the difference between what SSA pays and the amount equal to the 60%. When meeting with them you need to be honest about how your disease and treatment impacts your ability to do your job, no time for being a tough guy here, be brutally honest. Once accepted you still have to wait 2 years for Medicare to kick in, some crazy congressional rule, even the SSA person thought it was nuts. So you’ll have to pay COBRA until then.
All medical records gathered are the most important. I stress ALL. No matter what it pertains to. Every detail on the application filled out. I submitted mine. They gave me a face to face at the social security office. I had to go to their doctor. 3 months later it was approved.
With lung Mets he should be approved. SSA does not consider regional lymph nodes as Mets but definitely lung. That said, there is a huge variance in individual skills and knowledge at SSA so be patient. If you happen to be denied initially, don’t fret you’ll win on appeal and payment is retroactive. I prepared a document summary, along with my medical records. Collect your records and prepare a medical summary with the key points of diagnosis and impacts on him. Good luck, start now, be patient.
Stage IV is NOT an automatic approval. However, as per the SSA's own guide (they call it their blue book) metastasis to the lungs IS an an automatic approval. But don't trust that, get a lawyer. My initial claim was denied even though I had widespread Mets to Bones, Lungs and lymph nodes. Also, without a lawyer, the ssa will try to trip you up with their questions, just looking for a reason to deny your claim. A good disability lawyer can walk you through the process. Some will tell you to try on your own first, but that will ultimately just cost more time.
SSA considers compassionate allowance, which fast tracks certain diseases states. It is not necessarily automatic approval, but makes it way faster. For prostate cancer, "PROSTATE CANCER - HORMONE REFRACTORY DISEASE - OR WITH VISCERAL METASTASES" You just go through the usual application. Do not minimize your symptoms. After converting to mCRPC, I applied and was approved in a few months. Happily, I didn't need a lawyer.
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