Expedited Claims

Some illnesses and injuries are so serious and so crippling that they obviously meet the disability standards set forth by the Social Security Administration for benefits. Expediting these cases is a priority for the agency, and it does so in three ways:

• Quick Disability Determination (QDD)
• Compassionate Allowances (CAL)
• Terminal Illness Cases (TERI)

At Jeffrey Glassman Injury Lawyers, our Boston disability attorneys know the process is intended to be streamlined for those who qualify. However, there are still some circumstances under which cases could be delayed or even dismissed, so it’s usually still beneficial to have a lawyer handle the claim.

People who qualify for QDD, CAL or TERI are often so sick or their injuries so extreme that it makes sense to allow someone with experience to ensure all proper benefits are secured as quickly as possible.

Normally, SSDI and SSI claims take three to six months to secure. That’s assuming a favorable decision is granted in the initial determination process. In cases that require reconsideration and appeal, it could take longer. That’s why these expedited processes exist.

These are separate processes, but in some cases, applications can overlap as the case is being decided. Figuring out how a person should file to expedite the process is a determination your lawyer can help you make.

Unlike the other two programs, the QDD is not limited to any particular type of illness or impairment. How it works is:

The Social Security Administration runs a software program that flags disability applicants for mental or physical impairments that may qualify for disability benefits. Those who have been flagged have their claims moved to the QDD.

Individuals cannot refer their own claims to the QDD. Rather, the Disability Determination Services will make this call internally. Once a claim is referred to the QDD unit, a disability claims examiner will review it and determine, based on the information contained in the medical record and application, whether the claimant qualifies. In some cases, the examiner may call for a medical consultant to examine the record for further consideration.

If a person’s medical records are complete and the onset date is fairly clear, benefits could be awarded within 20 days. In some cases where the disability onset date was several months prior to the application, the claim could be denied by QDD and referred back to the normal determination process, which could take several months.

The Compassionate Allowances program was started by the Social Security Administration in 2008 as a way to quickly provide benefits to applicants whose medical conditions are so serious, they obviously meet the disability criteria.

The program involves fast-tracking people with specific conditions and illnesses that are already pre-determined. The idea is to allow the agency to target individuals who are the most obviously disabled, on the basis of objective medical information that can be quickly obtained.

These pre-determined conditions are selected after consideration of:

• Public outreach hearings
• Comments from personnel within the SSA and Disability Determination Services
• Medical experts
• Scientific experts
• Research with the National Institutes of Health
• Comparative analysis with the SSA’s current definition of disability

As of 2015, the SSA had held seven Compassionate Allowances public outreach hearings, mostly centered on ailments such as traumatic brain injury, rare diseases, cancers, early-onset Alzheimer’s disease (and other dementias), multiple organ transplants, autoimmune disorders, strokes, heart disease and other serious conditions.

An alphabetized version of the 200 current CAL conditions can be found here. Approved conditions range from acute leukemia to Zellweger Syndrome. Although the list does include some more commonly-diagnosed diseases, they often must be in the later or more serious stages to apply. For example, in order to meet the CAL requirement for prostate cancer, there must be a recurrence despite hormonal intervention, or else the cancer has spread to the bone or visceral organs.

There is no special process to apply for acceptance in the CAL initiative. Rather, your Massachusetts disability attorney will make sure all relevant medical records are present in the application, and that the agency has everything it needs to ensure a decision can be made timely.

The quickness of claim approval can depend on a host of factors, but usually it comes down to:

• How fast the agency obtains medical evidence from a doctor or other health care provider;
• Whether a medical exam is needed to prove the claim;
• Whether the claim is selected randomly for a quality assurance review of the decision.

One of the benefits for those whose cases qualify under CAL is that the paperwork burden is significantly reduced. One doesn’t need to answer certain education and work history questions that might be required of other claimants.

The Social Security Administration describes a terminal illness as a medical condition that is both:

• Untreatable
• Expected to result in death

The agency has committed to identifying these cases – referred to internally as TERI – as early as possible. They do this in one of two ways:

• Directly through claimant’s assertion.
• Indirectly through TERI case descriptions.

There are a few other situations in which benefit awards might be expedited.

The first is Presumptive Disability. This is when a person has one a set number of recognized conditions for which disability is presumptive. These include:

• ALS
• Spinal cord injury resulting in inability to walk
• End stage renal disease
• Down Syndrome
• Low birth weight

In these cases, applicants are entitled to receive SSI payments for up to six months while a claim is pending. If the SSA ultimately denies the claim, that money won’t need to be repaid.

There are also cases of Dire Need. This is where a person has an immediate threat to safety or health, such as not having enough shelter, food or medical care. In these cases, an expedited hearing can be requested.

Finally, persons who became disabled while in active Military Service can seek an expedited claim as well.

Our lawyers work to help claimants and their families expedite these claims as quickly as possible.