Initiatives to expedite Social Security Disability Insurance benefits to thousands of individuals.
Combating the backlog of nearly 700,000 claims now waiting for a hearing before the Social Security Administration (SSA), the federal agency has launched a number of initiatives to expedite Social Security Disability Insurance benefits to thousands of individuals, according to Allsup, a nationwide provider of Social Security disability representation and Medicare plan selection services.
"Several initiatives are designed to help those people whose medical conditions clearly meet Social Security's standards to receive their SSDI benefits more quickly," said Mike Stein, assistant vice president of claims. "When combined with expert SSDI representation such as Allsup, applicants deemed eligible can find their claims accelerated through the process to receive much-needed financial assistance more quickly."
Several initiatives can be traced back to 2007, when SSA Commissioner Michael J. Astrue introduced the SSA's plan to eliminate the backlog of hearing requests by 2013 and prevent its recurrence. Fast-track programs include Quick Disability Determination (QDD), Compassionate Allowances and terminal illness (TERI) cases.
"Allsup professionals work hard to identify and fast-track the most vulnerable claimants, helping them to benefit from these SSA initiatives," Mr. Stein said. "While a narrow segment of SSDI applicants qualify, the impact for individuals and their families cannot be understated."
Below Allsup outlines several SSA fast-track initiatives that streamline review of SSDI applications.
Quick Disability Determinations
The Quick Disability Determination (QDD) process is designed to analyze data in an SSDI claimant's file in order to identify those cases that can be fast-tracked for approval of benefits. The SSA announced plans to extend the Quick Disability Determination (QDD) process to all state Disability Determination Services (DDS) nationwide in 2007.
In QDD cases, the SSA relies on a predictive model to electronically determine claims where there is a "high potential that the claimant is disabled and where evidence of the person's allegations can be quickly and easily obtained."1 This model relies on scoring criteria to identify cases that qualify for consideration.
"The SSA's goal with QDD is to find those cases that clearly qualify for benefits and process them through to a favorable decision within 20 days of receipt at the state DDS office," Mr. Stein said. The SSA has reported that about 3 percent of all applications waiting for an initial decision are targeted for QDD processing.2 Typical cases flagged for QDD processing include those involving end-stage renal disease and some forms of cancer.
Successful processing under this model can occur only if a designated QDD examiner can confirm that available medical evidence in the claimant's case file is sufficient to determine chronic physical or mental disability as of the alleged onset date. In addition, QDD decisions are based exclusively on available medical and non-medical evidence in the case file.
The Compassionate Allowances initiative speeds SSDI applications for individuals whose disabilities are so severe that they clearly meet established medical criteria. The original initiative was introduced in October 2008 and targeted 25 rare diseases and 25 cancers. The list recently was expanded to include 38 more conditions. These conditions range from adult brain disorders to rare diseases that predominantly affect children.
Unlike QDD, which employs scoring criteria to rank the severity of the disability, Compassionate Allowances affords qualifying claimants expedited review of disability applications based on confirmation of a qualifying diagnosis. Once the diagnosis is confirmed based on minimal objective medical information, the claim is approved in a matter of days"instead of months or even years.3
Terminal Illness (TERI) Cases
The requirements for disability benefits for a person with a terminal illness are the same as the requirements for a person with a non-terminal illness but the processing time is faster. Cases deemed "TERI" merit special handling, with carefully prescribed protocols for appointment setting, labeling and flagging of TERI cases, tracking and continuous monitoring of timing to ensure processing without delay.
Applicants with an un-treatable impairment must present a credible claim (from the individual, friend, family member, doctor or other medical source). Qualifying claims may include diagnosis, such as ALS (Lou Gehrig's disease) or AIDS, or a statement that the claimant is receiving in-patient hospice care. Additional qualifying conditions include a bone marrow transplant, any malignant cancer that is metastatic (stage IV), and small cell or oat cell lung cancer, among others.4
Military Service Casualty Cases: Wounded Warriors Program
If a military service member is seriously injured or disabled while on active duty on or after Oct. 1, 2001, the SSA expedites the processing of disability claims regardless of where their disability occurred. To qualify for disability benefits, service members must be unable to do substantial work because of their medical condition, and the medical condition(s) must have lasted or is anticipated to last at least one year, or expected to result in death. To assist in case evaluation, service members frequently undergo a qualifying medical exam or medical test.
SSA and DDS staffs are instructed to process these claims as TERI cases. As with terminal illness cases, special protocols apply; cases are flagged for special processing, and rigorous mailing protocols followed to ensure expeditious review. In addition, field office staff pays careful attention to identifying the permanent address of the claimant, since military service members may be in transit and addresses may not match the address specified on the initial application.5
Presumptive Disability and Blindness Cases
Presumptive disability is granted when a claimant is applying for the first time based on disability or blindness. Presumptive disability cases must meet all non-medical factors of eligibility, and the severity of the condition must be sufficiently acute to merit a high likelihood of determination of disability. This program permits qualifying claimants to begin receiving payments before a final decision is made on their application.6 This program dates back to the 1970s.
Qualifying presumptive disability impairments include amputation of two limbs; amputation of a leg at the hip; allegations of total blindness; allegation of total deafness; allegation of a cerebral vascular accident (stroke) more than three months in the past and continued difficulty using hands, arms or walking. Additional qualifying impairments range from allegation of muscular dystrophy, muscular atrophy, and cerebral palsy, among others. Presumptive disability payments begin during the month the claimant becomes disabled or blind, and continue for up to six months while the claim is awaiting a final decision (assuming the claimant is found to be disabled and meets all other eligibility criteria).
According to the SSA, more than 3.3 million applications are anticipated in FY 2010, which is about 700,000 more than in FY 2008, adding to the workload for disability examiners nationwide.
This surge of disability claims highlights the importance of expert SSDI representation, especially for those individuals whose disabilities clearly qualify them for one of these fast-track programs, according to Mr. Stein.
"Allsup experts carefully monitor these programs and quickly identify those individuals who are likely to qualify through a fast-track initiative," Mr. Stein said. "The benefits are significant for those who qualify, so it's important to ensure you have someone on your side providing you with guidance should your claim fall under one of these programs."
For more information, contact the Disability Evaluation Center at (800) 279-4357 or visit www.Allsup.com
ABOUT ALLSUP - Allsup is a nationwide provider of Social Security disability, Medicare and workers' compensation services for individuals, employers and insurance carriers. Founded in 1984, Allsup employs more than 600 professionals who deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. The company is based in Belleville, Ill., near St. Louis.
1 - "Commissioner Astrue Extends Social Security's Quick Disability Determination Nationwide," Sept. 5, 2007.
2 - Program Operations Manual Systems (POMS), Quick Disability Determination (QDD)
3 - "Social Security Adds 38 New Compassionate Allowance Conditions," Feb. 11, 2010
4 - POMS, Identifying Terminal Illness (TERI) Cases
5 - POMS, Emergency and Expedited Procedures Related to Military Service Casualty Cases
6 - Social Security Handbook, Presumptive Blindness or Presumptive Disability Payments