With the backlog of Social Security Disability Insurance claims reaching a wait time averaging two years and effecting 1 million Americans, the Social Security Administration has special programs to allow the most critical of cases to receive quicker decisions. These programs are targeted to the claimants in the direst need who are at risk for homelessness, lack of income and other serious situations.
COMPASSIONATE ALLOWANCES (CAL)
The Social Security Administration maintains a list of more than 200 diseases and other medical conditions that qualify for quicker processing time for SSDI benefits. This initiative is called the Compassionate Allowances (CAL) program. The current list of CAL conditions can be found on SSA’s website: http://www.ssa.gov/compassionateallowances/conditions.htm. The SSA has developed this list using information from advocacy groups, the public, medical and scientific professionals, research from the National Institutes of Health (NIH), and information gathered at past public outreach hearings.
Individuals with a CAL condition apply for benefits using the standard SSA process for filing claims for disability benefits. The conditions qualified for Compassionate Allowance will be red flagged and then expedited by SSA staff. For these conditions, the SSA requires less medical evidence, and at times, staff will grant approval based solely on a diagnosis. Some of the qualifying conditions are ALS, pancreatic cancer, small cell lung cancer, and trisonomy 18.
TERMINAL ILLNESS (TERI)
SSDI benefits may also be expedited if the applicant is facing an imminent death. An applicant with a terminal illness (TERI) claim doesn’t need to state the terminal diagnosis at time of application. In fact, the examiner rarely notes “terminal” in the file. An SSA staff representative or claims examiner can send this claim to the Terminal Illness (TERI) program when a medical professional states the illness is expected to end in death. Claims are also expedited when an applicant is receiving hospice care. Also, if the applicant has applied for disability on account of ALS, or AIDS, the case is brought into the TERI system. Some other illnesses that can qualify are metastatic or Stage IV cancer, a fatal genetic defect in a newborn, current listing on major organ transplant list, or chronic heart or pulmonary failure.
PRESUMPTIVE DISABILITY (PD)
In certain situations, an applicant can receive payments for up to six months when the disability is “presumed” to qualify. SSA’s decision to grant Presumptive Disability (PD) payments is based on the severity of the applicant’s condition and the likelihood that the applicant will be approved. Financial need is not considered in presumptive decisions. Some of these conditions include terminal illness, total blindness, end stage renal disease, and Down Syndrome. If for some reason the application is not approved, the SSA does not require repayment of the benefits.
Another example of a critical case that requires expedition is if an applicant is considered in “dire need.” These claimants are waiting for a hearing to be scheduled with an Administrative Law Judge but do not have the necessary income to get basic necessities like food, medicine or shelter. In this situation, a dire need letter advises SSA why waiting the normal amount of time for a hearing might have severe consequences for the claimant. If the SSA contradicts the claim, proof may be required. Such proof can be notification of eviction from landlord, notification of imminent foreclosure, letter from homeless shelter, copies of medical bills, or a letter from a utility company that states water, electric, or gas services have been discontinued because of overdue bills.
MILITARY SERVICE PERSONNEL
Veterans can qualify for special expedited programs such as the “100% Permanent and Total Veterans Initiative.” Beginning in 2014, the SSA can expedite the claim if the applicant has a 100% Permanent and Total (P&T) disability rating from the Veterans Administration (VA). Veterans should identify themselves as a “Veteran rated 100% P&T” when initiating the SSI/SSDI application and should provide the VA rating notification letter to SSA. Veterans who received their injuries while on active duty after October 1, 2001 are eligible for the Wounded Warriors initiative. These applicants should inform SSA that their injury occurred while on active duty.
OTHER CASES FOR EXPEDITED CLAIMS
If there is evidence that a person applying for SSDI is suicidal or homicidal, the SSA will expedite the claim. In these cases, the SSA will contact the appropriate authorities and provide referral resources so the applicant can receive needed care. SSA may be able to make an emergency payment to applicants who face a financial emergency. However, SSA can only make one advance payment. These recipients are 1) initially applying for SSI benefits, 2) already receiving benefits, or 3) due SSI benefits that are delayed by processing errors or mail delays. There are no formal appeals for claimants who are denied an emergency payment.
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“Social Security Administration Programs for Expediting Disability Claims” SoarWorks
“When Social Security Will Expedite a Disability Application as a Critical Case?” Disability Secrets
“Social Security disability backlog tops 1 million; thousands die on waitlist” Denver Post