The social security disability claims process is a lengthy one. About 40% of those who apply for disability benefits are granted benefits on their initial application. It usually takes 3 to 6 months for the initial decision. For those that are not granted benefits upon their initial application, the delay can be from 12 to 24 months. Given that the claimant is unable to work during those 1-2 years — the delay is most often an extreme hardship. The Social Security Administration (SSA) will expedite some types of claims. Below I describe the five situations in which the SSA will speed up the evaluation process.
1. Terminal Illness
If there are medical records indicating the diagnosis of a terminal illness, the SSA will expedite the evaluation of the claim. Examples of conditions that SSA considers terminal are metatastic cancer, if the claimant is awaiting a heart or liver transplant, or if the claimant has been comatose for more than 30 days. These are just examples only and are not by any means an exhaustive list.
2. Military Service Casualty Case
The evaluation will be expedited if the allegation of disability is as a result of an injury occurring on or after October 1, 2001 during active duty. The active duty requirement is very broad and includes injuries to reserves and does not require the injury to occur on foreign soil. The manner of the injury or disability is also not important so long as it was while the claimant was on “active duty.”
3. Compassionate Allowance
The SSA has identified certain medical conditions which are so serious that they will most likely lead to a determination that the claimant is disabled. If a claimant has one of these conditions, the case will be expedited. The list currently has 100 conditions including Lou Gehrig’s disease (ALS), liver cancer and acute leukemia. For the complete list, see http://www.ssa.gov/compassionateallowances/conditions.htm
4. Dire Need
A claimant is in a “dire need” situation when they have insufficient income or resources to meet an immediate threat to health or safety. Most commonly, the “dire need” is a lack of food, clothing, shelter or medical care. The situation must be immediate and the claimant must not be able to rectify the situation. If the claimant is currently receiving food and/or shelter through a charitable organization – the claimant has rectified the immediate threat and therefore will not be considered for expeditious processing. When attempting to prove “dire need,” the claimant needs to allege the above facts with specificity and, if possible, provide documentary proof (e.g., eviction notice, foreclosure notice).
In any case in which there is an indication that the claimant is suicidal or homicidal, the SSA will expedite the evaluation of the claim.
6. Congressional Inquiry
A common technique for claimants who have been waiting an inordinately long time for a decision is to get their congressional representative to intervene on their behalf. Many congressional offices do this routinely. The SSA rules indicate that a prompt investigation and response is required to any congressional inquiries. However, there is no rule requiring that evaluation of the case be expedited like in the previous five situations. Of course, if the congressional inquiry identifies the case as one of the five types discussed above, that would then put the case onto an expedited track.
Managing Partner – Estates and Social Security Practice
Berman, Sobin, Gross, Feldman & Darby, LLP
481 N Frederick Avenue, Suite 300
Gaithersburg, MD 20877