Expedited Claims

LAW FIRM BLOG

Expedited Disability Claims

September 24, 2019

The Social Securty Administration (SSA) has several programs that will expedite processing of your SSDI or SSI claim and disability determination. The main ones are the Compassionate Allowance List (CAL) and Quick Disability Determinations (QDD). CAL and QDD, identify claimants with the most severe disabilities and allow the SSA to expedite their decisions. The former applies to easily identifiable conditions, which are often terminal, whereas the latter, QDD, utilizes a computer program — a predictive model — to identify applications with a high likelihood of being approved and moves them to the front of the cue. These two fast-track processes, CAL and QDD, are separate but can overlap as your case is being decided. If a applicant qualifies for either program, they will often receive a decision in less than thirty days.

Compassionate Allowance List (CAL)
In the not-too-distant-past, all Social Security Disability claims were processed in order of receipt, no matter how serious the condition. In response to long determination delays, the SSA implemented the Compassionate Allowances program in 2008. “Compassionate Allowances” expedite the application process based on severe medical diagnoses. Under the CAL program, the SSA maintains a list of 225 conditions that get you approved for disability almost automatically.

CAL is Expanding
Over the past five years, the SSA has quintupled the number of conditions that qualify.  The SSA consults with the National Institutes of Health (NIH) to periodically expand its ever-growing list of CAL conditions. New CAL diseases and conditions are added to the list each year. There is no backlog for compassionate allowances applications, even though the application rolls grow as additional diseases are approved. About 200,000 people have received benefits through the program since it started. These medical conditions are listed on the Social Security website under the Compassionate Allowance Listings link. (For the list, go to www.ssa.gov/compassionateallowances/conditions.htm.)

According to the SSA, CAL eligible conditions must be so severe that they “obviously meet disability standards.” Their list of conditions includes several categories:
•Cardiovascular conditions;
•Digestive system conditions;
•Endocrine system disorders;
•Genitourinary conditions;
•Hematological disorders;
•Immune system disorders;
•Mental disorders;
•Neurological disorders;and
•Various Cancers.

Additionally, the Compassionate Allowance list also includes many uncommon conditions which are not included in the Listing of Impairments simply because they are so rare.

If your disability falls into one of the diagnoses listed under the CAL program, you will still need to complete your application and submit documentation to prove the extent of your disability. However, nearly 95% of compassionate allowances applications are approved. The other 5% are placed on an expedited appeals process.

No Special Application
Individuals with conditions on the Compassionate Allowances list apply for disability benefits just like other applicants. Social Security reviews all applications to see which ones qualify as compassionate allowances. You don't apply for a Compassionate Allowance specifically and the CAL program does not require a separate application. It can help to note on the top of your application "Compassionate Allowance claim" -- unless you're applying online. When an applicant’s claim is reviewed, the Social Security worker checks the list of Compassionate Allowances. If the paperwork and test results provided show that the applicant has a qualifying disorder or illness, the applicant is selected for fast processing based solely on the allegations of the claimant (applicant) or of a parent of a child claimant. If the allegations fit the SSA's Compassionate Alowance List, that the claim will be able to be approved with minimal objective information (such as a positive biopsy for esophageal cancer). Because minimal objective information is required--proof of the medical condition is sufficient to assume disability--these cases can be approved in much less time.

Not Immediate
Unfortunately, the CAL program can’t provide benefits immediately. Even with the expedited process, several factors, such as the number of other applications, the speed of submitted medical evidence, and further required examinations can delay the decision. However, most applicants receive Compassionate Allowance benefits from a few weeks to 2 months after the application is received.

Medicare
There is no expedited process for receiving Medicare. Just as with regular disability applicants, Medicare is awarded after the normal 24 months waiting period after the disability onset date.

Five-Month Waiting Period
While Compassionate Allowances allows a disability determination to be made more quickly, SSDI beneficiaries still have to wait five months after their disability onset date to begin receiving benefits. The five-month waiting period for SSDI claims is not waived by having a compassionate allowance. There is no such waiting period for SSI payments.

Potential Retroactive Payments
When Social Security deems a person eligible for benefits, they also consider how long the applicant was disabled before their application was received. After subtracting the five-month “waiting period” from the onset of the disability, applicants can receive retroactive pay for the months between when their disability began and when their application was approved. Note that the date your disability started is not always the date you were diagnosed with the medical condition on the compassionate allowance list. If you experienced significant limitations prior to your actual diagnosis, you may be eligible for additional benefits.

Minimal Medical Evidence Required, But...
The information that Disability Determination Services (DDS, the state agency that makes disability determinations for the SSA) must have is truly nominal—just enough information to establish the correct diagnosis. However, hospitals or treating doctors may take weeks or months to respond to a DDS request for medical records. Therefore, you can speed processing of your claim by submitting basic medical information along with your application or sending it to the examiner yourself. The type of medical information you need to submit depends on the nature of your condition. For example, if you have a form of cancer, the most important evidence is the biopsy report. Along with a hospital discharge summary or letter from your doctor, that would be enough to get a disability approval through the CAL program.

Conditions Which Qualify for Compassionate Allowances
The conditions that qualify include many cancers, ALS, some types of muscular dystropy and muscular atrophy, genetic disorders, early-onset Alzheimer's disease, and a few other illnesses. For some conditions, like esophageal cancer, ALS, or an organ transplant, a diagnosis alone (with supporting evidence) is enough to qualify you for a compassionate allowance. Other conditions on the list specify criteria for how severe the illness must be; for example, malignant melanoma qualifies only if it has metastasized. Not all severe or potentially fatal illnesses are on the list; for example, AIDs is not a compassionate allowance condition (instead, you must fulfill the complex severity requirements of the HIV/AIDs listing to qualify for benefits).

What Documentation Will I Need to Submit?
The medical documentation that you will need will depend on the condition that you have. For cancer patients, medical records that include positive biopsy reports should be sufficient for a determination. For other conditions, such as a thyroid disorder, you will need to provide documentation for the diagnosis and show that the condition has left you unable to work.

Medical Consultant Imput Needed
DDS will not review your case until they receive your medical records. A medical consultant working with DDS will need to review and assess the documents in the application before the department can issue a CAL approval.

Other Requirements
Even though having a CAL condition will speed the evaluation process, an applicant still needs to meet other basic requirements in order to receive benefits, including the requirement that the condition prevents the applicant from working, as well as financial or legal requirements that need to be met.

Most of the impairments in the Listing of Impairments, however, lay out certain criteria the applicant needs to meet before the condition will qualify as a disability. For instance, for chronic kidney disease to qualify, the patient needs to be undergoing chronic hemodialysis or peritoneal dialysis, and for central blindness to qualify as a disability, the applicant needs to have 20/200 vision or worse in the better eye—with corrective lens. In addition, all mental disabilities require the applicant to have certain severe symptoms and limitations to qualify.

Summary
If you have been diagnosed with a medical condition on the list, the SSA will automatically flag your claim. Medical evidence will be requested from your medical provider(s) documenting the diagnosis. A decision will be rendered shortly after your medical records has confirmed the condition. You don't need a lawyer or advocate to help as long as you have a diagnosis that falls within the category.

Quick Disability Determination (QDD)
QDD claims are not limited to particular types of illnesses or impairments. The QDD process uses a constantly changing automated computer-based predictive model (computer algorithm) to analyze specific medical data contained in an electronic disability file to screen initial applications to identify cases where a favorable determination is highly likely and there is readily available medical evidence to support the allegations . These cases are marked for quicker processing. Applications that are not filed electronically are reviewed by claims examiners, who can also flag them for fast-track status. They then forward these applications to a specific department, which will evaluate and decide on each claim. By identifying QDD claims early in the process, the SSA can prioritize this workload and expedite case processing. The SSA have used QDD nationally since February 2008. The SSA continues to refine the QDD predictive model to reflect the characteristics of the recent applicant population and optimize its ability to identify strong candidates for expedited processing.

Expedited Claims How Are Applications Selected for QDD?
You cannot refer your own claim to the QDD; only the computer’s predictive model can assign cases as QDD. And no worker in the SSA can manually add an application to the fast track. There’s no way to guarantee that your SSDI application enters QDD. However, providing the right kind and amount of medical evidence may help your chances of being selected.

How QDD Claims Are Processed
A disability examiner in the QDD unit should quickly evaluate the file, request medical records if necessary, and decide if the impairment amounts to a disabling condition that prevents the applicant from working. The SSA finalized regulations in 2010 permitting QDD examiners to, unlike the CAL program, allow claims without showing them to a DDS medical consultant, although they can choose to do so if they wish. Importantly, QDD examiners are not allowed to deny a claim without input from a medical consultant.

When Do QDD Claims Get Approved or Denied?
If your claim is fairly straightforward, your medical records are submitted quickly to the QDD, and you didn't state in your application that your disability started a long time ago, you have a good chance of getting a disability decision within a month. However, your claim will be sent out of the QDD process and into the regular process for disability determinations if: the QDD unit doesn’t recommend your claim for approval, the QDD unit doesn't agree with your alleged onset, or the disability examiner and the medical consultant don't agree on whether your claim should be approved. If that happens, your case will start over at DDS, and you will get an initial decision in several months.

Medical Consultant Not Needed
When the predictive model determines an application has a high chance of being approved for benefits, it sends the application to designated employees within the Disabity Determination Bureau (DDB) who have the experience, skill, and training necessary to process the quick turnaround. This means that the QDD bypasses a major, time-consuming step in disability applications: review by a medical professional. Because the SSA relies on experts to review and interpret normal, non-expedited applications, this is a major factor in the amount of time it takes to approve or deny a claim. Cases that include lots of relevant medical records may have a better chance of being approved, but it will take time for doctors or other professionals to evaluate the evidence and make a final decision. With QDD, no medical professional is required to approve a claim. Once a worker reviews a QDD case, they can decide to remove it from the workflow, but only if it lacks evidence, contains false claims, or further evaluation is required.  

Other Fast-Track Disability Benefits Programs
Even if your claim is not referred to the SSA’s QDD unit, you may be eligible for expedited claims processing through alternative fast-track programs, such as the Terminal Illness (TERI) program. The TERI program expedites reviews for applicants whose conditions will likely result in death. Disability cases that involve terminal conditions are flagged and Social Security makes every effort to process these cases expeditiously so that claimants can receive disability decisions in less than a month.

What Medical Conditions Are Eligible for TERI?
The following medical conditions are eligible for TERI treatment, but this list is not exhaustive; any terminal illness can qualify for TERI expedited processing.
•Cancer that is metastatic, Stage IV, recurrent following therapy, or inoperable.
•Cancer of the esophagus, liver, pancreas, gallbladder, or brain.
•Small cell or oat cell lung cancer.
•Mesothelioma.
•Acute myelogenous leukemia (AML) or acute lymphocytic leukemia (ALL).
•Dependence on a cardiopulmonary life-sustaining device.
•Chronic heart failure or pulmonary failure, requiring continuous oxygen and caregivers.
•Comatose for 30 days or more.
•Newborn with a fatal genetic or congenital defect.
•Awaiting a liver transplant, lung transplant, heart transplant, or bone marrow transplant.

Can an Attorney Expedite my Disability Case?
If you have representation on your Social Security disability claim, your attorney can attempt to speed the scheduling of your case before an Administrative Law Judge (ALJ), or even eliminate the need for a hearing altogether. Generally, this would be possible in several ways.

On-The-Record Review (OTR)
Getting an approval based on an on-the-record review eliminates the need for a hearing. An OTR review is requested when your attorney believes that the medical evidence supporting your case is very strong, that is there is no question that you should qualify for disability benefits based on your records. An on-the-record review, of course, will only be requested if your attorney believes that the case is strong enough to be approved without the need for presentation and argument at a formal hearing. Whether or not the request for the review will result in an on-the-record approval will depend on the merits of the case and whatever material may have been submitted by the attorney.

Dire Need
If a claimant is in danger of losing their residence (due to eviction or foreclosure), or losing their access to needed medical treatment or prescribed medications, they may be able to request that the hearing office expedite the scheduling of their disability hearing. If a dire need situation exists, a claimant's attorney can formally submit the dire need request to either the hearing office director or the assigned ALJ. With the dire need request, the lawyer should attach documentation regarding the claimant's situation (such as a statement from the claimant's treating physician regarding the deteriorating condition or need for prescription medicine, or copies of foreclosure or eviction notices). Sending supporting documentation will substantially improve one's chances of having their hearing expedited.

Congressional Inquiry
A claimant, or their attorney, can always contact the office of their congressional representative to have that office conduct a formal inquiry. Congressional inquiries are done at all levels of the disability system. However, at the application and reconsideration levels, it is generally unproductive to do this since the inquiry request is generally just put into the claimant's disability file with no discernable effect on the case (which is actually logical since at those levels, the case will simply move at whatever speed it can move regardless of who inquiries into it). At the hearing level, however, where cases can wait for 1-2 years before being scheduled, an inquiry from the office of a congressperson can potentialally get a case scheduled many months faster than it would ordinarily have been.

Veterans
Social Security can expedite SSDI and SSI claims for veterans who became disabled while on active duty. The disability need not have occurred in the course of military action — for example, it could be the result of an injury while on leave — but it must have occurred since Oct. 1, 2001. Be sure to notify Social Security at the start of the application process that the condition stems from your period of service.


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