When Social Security Will Expedite a Disability Application as a Critical Case?

Certain situations require Social Security to make fast disability decisions.

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Gavel and Scales

The process of applying for and getting Social Security disability is lengthy, and it can take up to two years to get a final decision. Fortunately, there are six types of claims called “critical cases” that the Social Security Administration (SSA) will process quickly.

Dire Need

If a claimant does not have the resources to get food, medicine, or shelter, the SSA will treat the claim as a critical case.

Types of Dire Need Cases

These types of claims are called “dire need” cases, and you should advise the SSA if you are in need of one of the following.

Food. Tell the SSA immediately if you are without food or cannot afford to get food.

Medical care. Tell the SSA immediately if you do not have access to the medicine or medical care you need. This can be because you don’t have the insurance, money, or other resources to get proper care.

Shelter. Tell the SSA if your home lacks utilities (because of inability to pay the bills), you are homeless, you are facing eviction or foreclosure, or you have reached the limit on how long you can stay in a homeless shelter.

You do not need to provide the SSA with specific evidence that supports your allegation of “dire need.” However, if the SSA discovers evidence that contradicts your claim, it may require that you provide further proof of your situation.

Evidence That Helps Prove a Dire Need Case

The SSA will not immediately label the file of every claimant who alleges financial hardship as a “dire need” case because it would prevent the SSA from being able to help the most serious cases. Therefore, if you request that your claim be treated as a “dire need” case, you should provide the SSA with as much evidence as possible to support your statements. The following are some examples of evidence that may be helpful in a “dire need” case:

  • notification of immediate eviction from your landlord

  • notification from your lender that foreclosure is imminent (not just threatened)
  • a letter from your homeless shelter that states you are no longer eligible for services
  • a letter from your utility company that states water, electric, or gas services have been discontinued because of overdue bills
  • evidence that you have lost insurance coverage
  • pharmacy records that indicate prescription medication costs
  • copies of medical bills, and
  • copies of estimated costs for any medical treatment you need.

Be sure to let the SSA when you apply if you are without any of these basic needs. If your situation worsens after you applied for disability, you can go to your local field office to notify the SSA of your situation. If your circumstances improve, the SSA may remove the “dire need” designation on your disability claim.

For more information, read about dire need letters.

Personal or Public Safety

If there is evidence that a claimant (applicant for disability) is suicidal or homicidal, the SSA will expedite the claim. Evidence of suicidal or homicidal ideations may come from any source, including:

  • the claimant
  • treating physicians
  • family or friends
  • law enforcement officials, or
  • SSA employees.

If it is determined that a claimant is a threat to either him or herself or to others, the SSA will contact the appropriate authorities immediately to ensure everyone’s safety. The SSA will also provide referral services to local physicians, community service centers, suicide prevention programs, or other appropriate medical facilities.

It is important that family members and friends of claimants advise the SSA immediately (along with the appropriate authorities) if the claimant expresses any suicidal or homicidal thoughts.

Terminal Illness

The SSA will expedite claims based on a terminal illness. The SSA calls these claims “TERI” cases. Because of the sensitive nature of TERI cases, the SSA will never mark or note the case as “terminal” in the file. However, a claim will be identified as a TERI case when:

  • the claimant, the claimant’s friends or family, or the claimant’s doctor states that the condition is terminal
  • the claim is based on a diagnosis of Amyotrophic Lateral Sclerosis (ALS), also called Lou Gehrig’s disease
  • the claim is based on Acquired Immune Deficiency Syndrome (AIDS), or
  • the claimant is enrolled in an at-home or in-patient hospice care program.

The case will also be flagged as a TERI case if the claimant:

  • has an ongoing need for life-support (heart and breathing machine)
  • is on a wait-list for a heart, lung, liver, or bone marrow transplant (all transplants except kidney and corneal transplants)
  • has chronic pulmonary or heart failure that needs continuous home oxygen and cannot care for his or her personal needs
  • has cancer that has metastasized, is stage IV, recurs after treatment, or is inoperable or unresectable
  • has been diagnosed with certain cancers such as liver or gallbladder
  • is in a coma that lasts longer than 30 days, or
  • is a newborn who was born with a fatal genetic or congenital defect.

Other terminal conditions may also qualify as a TERI case. For more information on TERI cases, read our full article about getting disability benefits for terminal patients.

Military Service Personnel

The SSA will expedite disability claims filed by military service personnel for injuries or illnesses that developed on or after October 1, 2001. The claimant does not need to be a current service member, but the disability must have begun while the claimant was on active duty.

For more information, see our article on how to expedite disability claims filed by U.S. military service personnel or U.S. military veterans.

Compassionate Allowances

Some medical conditions may qualify for what the SSA calls a “compassionate allowance” (CAL). CAL conditions are so severe that they are almost always immediately approved under the SSA’s Listing of Impairments.

The SSA requires minimal objective medical evidence for some CAL conditions and will sometimes grant approval based on a diagnosis alone. This makes it easier to approve these claims quickly, sometimes in as little as ten days.

There are currently 165 CAL conditions currently recognized by the SSA, including:

  • pancreatic cancer
  • ALS (Lou Gehrig’s)
  • malignant multiple sclerosis
  • pulmonary atresia
  • small cell lung cancer
  • mixed dementias, and
  • trisomy 18.

For more information, see our article on getting approved based on a compassionate allowance. You can review the requirements for each CAL condition on the SSA website.

Contact an Attorney for Help

If you tell the SSA that your claim should be expedited because you are in dire need or qualify under one of the above "critical case" reasons, but the SSA doesn't expedite you case, it may be helpful to contact an experienced disability attorney to discuss whether your claim qualifies as a critical case. To find an attorney in your area, visit our attorney locator page.

 

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