Expedited & Critical Cases – Faster Social Security Decisions

Overview – Getting A Faster Social Security Decision

Social Security will fast-track two types of disability cases to make a quicker decision: an 1) expedited case, or a 2) critical case.

At the initial and reconsideration levels, Social Security refers to fast-tracked cases as expedited cases, and there are five types:

1. Compassionate allowance (CAL),
2. TERI – terminal illness,
3. Military casualty/wounded warrior (MC/WW),
4. Quick disability determination (QDD), and
5. Presumptive disability/presumptive blindness.

At the hearing level, Social Security refers to fast-tracked cases as critical cases, and there are six types (the first three overlap with expedited cases):

1. Compassionate Allowance (CAL);
2. TERI – Terminal Illness;
3. Military Casualty/Wounded Warrior (MC/WW);
4. Veteran a with 100% permanent and total disability rating;
5. Dire need case; and
6. Claimant who is suicidal, homicidal, or violent.

Social Security will determine whether your case satisfies the criteria of either. However, Social Security will not send you an official decision on this issue. You will generally only know whether Social Security classified your case as an expedited or critical case if your case is decided quickly or if it is decided after a normal wait-time. In some cases, you may never know if Social Security classified your case as an expedited or critical case. You can request Social Security determine your case satisfies the criteria of either case type in three ways:

1. Dire need request,
2. On-the-record request, and
3. Congressional inquiry.

Types Of Expedited & Critical Cases

Compassionate Allowances (CAL)

A CAL case is a Social Security disability case where a Social Security adjudicator or Social Security’s software identifies a medical condition that clearly and easily satisfies a listing – a very severe impairment. CAL cases primarily include cancers, adult brain disorders, and rare childhood disorders that can be found Here – Social Security List of Compassionate Allowance Conditions.

TERI: Terminal Illness

A TERI case is a Social Security disability case involving a terminal medical condition that is untreatable and expected to cause death – Social Security List of TERI Cases. Social Security identifies TERI cases to include but not be limited to the following:

1. Cancer of the esophagus;
2. Cancer of the liver;
3. Cancer of the pancreas;
4. Cancer of the gallbladder;
5. Small Cell or Oat Cell lung cancer;
6. Cancer of the brain;
7. Mesothelioma;
8. Acute myelogenous leukemia (AML) or acute lymphocytic leukemia (ALL);
9. Any malignant neoplasm (cancer) which is,
   • Metastatic (has spread),
   • Defined as Stage IV,
   • Persistent or recurrent following initial therapy, and is
   • Inoperable or unresectable;
10. Acquired immune deficiency syndrome (AIDS);
11. Amyotrophic lateral sclerosis (ALS), known as Lou Gehrig’s Disease;
12. Any case where a claimant is awaiting a heart, lung, liver, or bone marrow transplant (excludes kidney and corneal transplants);
13. Any case where a claimant has chronic pulmonary or heart failure requiring continuous home oxygen and an inability to care for personal needs;
14. Any case where a claimant is comatose for 30 days or more;
15. Any case where a newborn has a lethal genetic or congenital defect;
16. Any case where a claimant is receiving inpatient, home hospice, or palliative nursing care; and
17. Any case where a claimant has chronic dependence on a cardiopulmonary life-sustaining device

Military Casualty/Wounded Warrior (MC/WW)

A Military Casualty/Wounded Warrior case is a Social Security disability case involving a current or former military member who sustained an illness, injury, or wound while on active duty on or after October 1, 2001, and alleges a physical or mental impairment, regardless of how or where the impairment occurred.

Quick Disability Determination (QDD)

A QDD case is a Social Security disability case where Social Security’s software identifies certain words (medical conditions, medical findings/tests, your age, etc.) in your electronic case file that represents a high degree of probability you are disabled. Social Security has not revealed exactly what words the software identifies. However, it is presumed that a QDD case will usually be a CAL or TERI case.

Presumptive Disability/Presumptive Blindness (PD/PB)

This type of classification applies to SSI (Title 16) cases only. This classification is made when there is a “high probability that you are disabled or blind.” Social Security may make payments to you up to six months before a formal disability decision, and if you are later found not disabled, you will not have to pay these benefits back. PD/PB cases include:

1. Amputation of a leg at the hip,
2. Total deafness,
3. Total blindness,
4. Bed confinement or immobility,
5. Stroke,
6. Cerebral palsy,
7. Down syndrome,
8. Intellectual disability or neurodevelopment impairment with a complete inability to care for oneself,
9. Amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease), and
10. Low infant birth weight.

Veteran – 100% Disability Rating

Veterans should notify Social Security of a 100% disability rating letter. The Veteran should also submit compensation and pension (C&P) exams if available.

Dire Need Case

Social Security defines a dire need case as one when you have no food, no medical care, or no shelter.

Claimant – Suicidal, Homicidal, Or Violent

Social Security defines this type of case if there is an indication of suicidal, homicidal, or violent tendencies by a Social Security employee or your doctor.

How To Request A Faster Social Security Disability Decision

Dire Need Request

A dire need request is a letter to Social Security asking that your case be scheduled quickly because you have no food, no medical care, or no shelter

On-The-Record Request (OTR)

An on-the-record request is a letter submitted at the hearing level to a Social Security administrative law judge (ALJ) at a Social Security Office of Hearings Operations (OHO, where hearings are held) requesting that your case be allowed based on your paper/electronic record without waiting for a hearing wherein you will meet and speak with an ALJ.

OTRs are uncommon for five main reasons. First, ALJs are very busy. They are generally evaluating cases that are ready for hearing now. They rarely have the time to set aside a current case to review another case that is due for hearing in a year. Second, your medical records are usually not updated at the time an OTR is made, and an ALJ is therefore unable to assess your recent medical condition and disability. Third, your hearing file (mainly your updated medical records) is not prepared by OHO until just before your hearing. Therefore, it is more difficult for an ALJ to review your record early. Fourth, most ALJs want to speak with you and combine your presentation with your Social Security record and medical evidence before they make a decision in your case. Fifth, a vocational expert will appear at your hearing to testify about your past work and whether work can be performed considering your medical condition. If an ALJ is to grant an OTR without a hearing, necessary vocational information is not available.

A successful OTR requires four things. First, your medical records must be updated at the time of the OTR. Second, you must have a very, very strong case that you are disabled. Third, you must not have vocational (work) issues that need to be resolved in your case. This relates to point two. You will generally need a disability severe enough that no work can be performed such that vocational issues are not relevant. Fourth, you need a liberal ALJ (someone who generally rules in favor of claimants).

Congressional Inquiry

A congressional inquiry is a letter to your congressperson about either 1) the delay in your case and a request that your case be decided sooner, or 2) that you have been denied when you believe you are disabled. These requests usually have no impact in speeding up your Social Security disability case or causing Social Security to reverse any denial on appeal.

Why Didn’t Social Security Grant My Request For A Faster Social Security Disability Decision

There are a few reasons Social Security does not grant your dire need request or OTR. First, Social Security read your request, review your case for an early decision, determined that you are not disabled, and therefore did not respond to your request. Second, Social Security does not believe you meet the qualifications of a CAL, TERI, PD/PB, QDD, or dire need case; or that you are suicidal, homicidal, or violent. Third, as to OTRs specifically, I gave five reasons above why ALJs very rarely allow OTRs. Fourth, as to dire need request specifically, Social Security commonly denies these requests because most claimants have dire circumstances as they are not working and not making any money to provide for the necessities of life.