April 24, 2014

More on Compassionate Allowances and Quick Determinations

Compassionate allowances and quick disability determinationsOn October 13, 2010, SSA announced new rules effective on November 12, 2010 that will allow SSA personnel to fast track disability claims.   Now there are two programs that will allow SSA personnel to quickly approve cases there the medical evidence for disability is overwhelming.

The first program is called the “compassionate allowance” program, and it identifies specific diseases that produce work activity limitations that meet SSA’s definition of disability – in other words, if someone has one of these medical conditions, they would not be able to engage in substantial gainful activity and the symptoms will last 12 consecutive months or result in death.  I discussed the compassionate allowance program in a previous blog post, and you can review the diagnoses on the list by clicking on the link.

The second and newer program is called the Quick Disability Determination (QDD) program.   This program uses a computer program to analyze the electronic claim files to identify “cases where there is a high likelihood that the claimant is disabled” so that a claims representative within Social Security can approve a case without the need to review the claim with a medical or psychological consultant.  In a regular claim adjudication the claims rep, or “Adjudicator” must get a medical or psychological consultant to sign off on an approval, a process that takes time and can yield inconsistent results.

The QDD program only applies to adult claims at this point – not child SSI cases.

At this point SSA has not released any information about the computer program it uses to evaluate electronic claims or what information therein will trigger a QDD.   However, the presence of this program would suggest to me that a claimant with a significant medical problem would benefit from taking actions to insure that his medical file is as complete as possible as early as possible.   Specifically I would:

  • make sure that the names, addresses and phone numbers of treating physicians and hospitals is accurate and readable on the application forms
  • alert treating physicians that SSA will be contacting them for medical records
  • provide treating doctors with a copy of SSA’s “blue book” of disabling medical conditions so that your records will contain wording that tracks SSA’s requirements
  • providing the Adjudicator with accurate and up to date medication lists
  • clearly identify on SSA’s disability reports the specific symptoms that prevent you from engaging in competitive work
The following two tabs change content below.

Jonathan Ginsberg represents Social Security disability claimants in Georgia. In practice for over 23 years, Jonathan publishes a widely known disability blog, a podcast and several disability web sites. In 2004, Jonathan published a "how to" book about Social Security disability called the Disability Answer Guide. Jonathan lives with his wife and 2 children in Atlanta.

Comments

  1. Its good to read a report about the SSA getting more efficient as disability insurance beneficiary numbers are rising.

  2. Thomas Paulos says:

    I have cancer and no income. Can you help expedite my claim?

  3. Thomas, if you are able to do so, you should look to see if your cancer is on the list of compassionate allowance conditions. If not, you or your representative can write a “dire need” letter to SSA asking for an expedited determination. You may also want to contact your federal elected representatives for help. In some cases the “squeaky wheel” gets the grease – but so many people are experiencing hardship because of the delays even a serious medical condition like cancer may not move the meter. Best of luck to you.

  4. John Hartsoe says:

    I have had 3 heart attacks, seven stents, lost my bladder and prostate to cancer, and have a fibulater. I did get my S S D right away with out a lawyer, but the 5 month waiting period is hurting me bad, plus I don’t get medicare for 2 yrs. I can see where that rule would work for some, but come on we all know I will never work again. If they are lucky maybe I will die before they have to pay me anything. I am waiting 5 months to do what die. They want to save money, my money. I’s just a shame, throwing you away like a used garment. Could vent forever!!!!!!!57 yr old male!!!!!

Speak Your Mind

*