Last Update: 12/16/08 (Transmittal I-4-19)
ODAR's Congressional and Public Affairs Branch (CPAB) designates a case requiring special processing for one of the reasons listed in subsection B., below, as a “critical case” to ensure that the appropriate component(s) takes prompt action on the case (see also I-3-1-51).
Six situations warrant instituting critical case processing procedures:
The claimant's illness is terminal (see subsection C., below);
A disability claim for any military service personnel injured October 1, 2001 or later, regardless of how or where the disability occurred, whether in the United States or on foreign soil, provided that the individual was on active duty when the injury occurred (see subsection D., below and POMS DI 11005.003);
A claim which has been identified as a Compassionate Allowance (CAL) case (see subsection E., below);
The claimant is without, and is unable to obtain, food, medicine or shelter;
There is an indication that the claimant is suicidal or homicidal/potentially violent (see I-2-1-37);
The case has been delayed an inordinate amount of time, e.g., it has been pending more than 60 days longer than the average processing time for the office in question, and there is a public, congressional or other high priority inquiry on the case.
A critical case involving terminal illness (a “TERI” case) requires additional special handling. ODAR tracks a TERI case while it is within ODAR, and the SSA Regional Office also monitors the case to ensure that it is expedited. TERI cases include any case already identified as a TERI case by the TERI Flag (form SSA-2200) or electronically through the Electronic Folder Flag and/or ARPS Case Characteristic [Terminal Illness], when received, and any case involving the situations and conditions described in POMS DI 11005.601C.
The presence of one of the criteria listed in DI 11005.601C. does not mandate a finding of disability. The claimant's impairment must be evaluated under the sequential evaluation process.
A critical case involving a Military Service Casualty Case also requires additional special handling. To provide this assistance, Court Case Preparation and Review Branch (CCPRB) staff will follow the TERI procedures to expedite these cases through all stages of case development and adjudication. A special Military Service Casualty Case [MSCC] flag, for use in Paper cases, can be found at POMS DI 11005.003H. MSCC cases include any case already identified as a MSCC case, when received, and any case subsequently identified as a case involving a disability claim for any military service personnel injured October 1, 2001 or later, regardless of how or where the disability occurred, whether in the United States or on foreign soil, provided that the individual was on active duty when the injury occurred. See POMS DI 11005.003.
A critical case involving a Compassionate Allowance (CAL) claim also requires additional special handling. To provide this assistance, CCPRB staff will follow the TERI procedures to expedite these cases through all stages of case development and adjudication.
The CAL process is a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. CAL will allow the Social Security Administration to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly. Many of these claims can be allowed based on confirmation of the diagnosis alone; for example, acute leukemia, amyotrophic lateral sclerosis (ALS) and pancreatic cancer. In these cases, allowances can be made as soon as the diagnosis is confirmed or the other necessary objective medical evidence is obtained. CAL cases are identified at the initial level through an automated process (e.g., predictive modeling). Subsequent identification, including at the Court level, is based on claimant allegations of a condition listed on the CAL list of impairments (see POMS DI 11005.604G.).
CAL cases include any case already identified as a CAL case (e.g., Electronic Folder Indicator (CAL = Y)) and/or the ARPS Case Characteristic (e.g., [Compassionate Allowance Case]), when received, and any case identified by CCPRB staff in which the claimant alleges an impairment that appears on the list in DI 11005.604G.
NOTE:
Cases that are fully-paper (all claims in the case are EDCS exclusions) are not initially considered for CAL because CAL cases are automatically identified by the system through the predictive model upon EDCS transfer from the Field Office (FO) to the Disability Determination Service (DDS). However, if CAL is discovered on review of a claim (either fully paper or electronic), or upon the receipt of additional evidence, use the normal expedited procedures for a TERI case, using the Critical Case/Dire Need Flag rather than the Form SSA-2200. Clearly indicate on the flag that the case involves CAL.
Within ODAR Headquarters, the Congressional and Public Affairs Branch (CPAB) is responsible for designating a case as critical, initiating critical case procedures, and requesting expedited payment from the SSA effectuating component, if necessary.
All ODAR Headquarters components are responsible for alerting CPAB of any case, not previously identified, which appears to meet the critical case criteria; expediting and hand-carrying all cases designated as critical; and advising CPAB of completed processing actions or delays in processing.
Critical cases (other than TERI and MSCC cases) are identified by a Critical Case/Dire Need flag (I-3-0-93 Exhibit). Also, in CAL cases, OAO staff will annotate the Critical Case/Dire Need flag with the term “CAL Case.” TERI cases are identified by use of the TERI flag (See form SSA-2200 in POMS OS 15020.301). MSCC cases are identified by a MSCC Flag (POMS DI 11005.003H.).
Flags will be attached to claim files in paper claims and to the Appeals File in fully electronic cases.
Within CCPRB, the Branch Chief (or his/her designee) is responsible for ensuring that the critical case procedures are followed. All CCPRB staff are responsible for bringing any case which may meet the criteria in subsection B., above, to the attention of the Branch Chief.
Upon receipt of a flagged critical (including TERI, MSCC, or CAL) case, the CCPRB Branch Chief will immediately:
Ensure that CPAB is aware of the case; and
Commence expedited processing, as described below.
Upon receipt of critical case information newly raised during the time that a case is pending in the CCPRB, the Branch Chief will ensure that such information is hand-carried to CPAB. In the case of a telephone report, a report of contact describing the telephone conversation will be provided to CPAB.
Following designation of a critical case (including TERI, MSCC, or CAL) by CPAB, the Branch Chief will immediately assign the case and ensure that CCPRB branch staff:
Attach to the front of the claims file (to each claims file in a concurrent case) a Critical Case flag, for Critical and CAL cases flag (I-3-0-93 Exhibit); a TERI flag for TERI cases (See form SSA-2200 in POMS OS 15020.301); or an MSCC Flag for MSCC cases (POMS DI 11005.003H.), as appropriate.
For electronic folder cases, activate the appropriate Flag(s) in eView (see DI 81010.080), as well as the CAL indicator in Compassionate Allowance cases. (See also DI 23022.055 for instructions on adding, removing, and reinstating CAL cases).
For both paper and electronic cases, activate the appropriate Case Characteristic(s), if the case is controlled in ARPS. The relevant Case Characteristics in ARPS are:
[AC Level Case – Inordinate Delay]
[Dire Need Case]
[Military Service Casualty Case]
[Potentially Homicidal/Violent]
[Suicidal]
[Terminal Illness]
[Compassionate Allowance]
Expedite processing by immediately working the case and hand-carrying it between processing stages (e.g., the Appeals File in fully electronic cases and both the Appeals File and Claim File in paper cases); and
Advise CPAB of any delays in processing.
For TERI and MSCC cases, CCPRB branch staff will also:
Ensure that the paper TERI or MSCC flag is completed and correct, including attorney fee waiver information, if available;
Send a photocopy of the paper TERI and/or MSCC flag to CPAB;
Enter the TERI Case into the LOTS processing system, if the case is not being controlled through ARPS; and
For TERI and CAL cases first identified in the CCPRB, immediately notify the SSA field office to begin non-medical development.
NOTE:
When routing TERI, MSCC, and CAL cases to another component or office, clearly annotate transmittal slips/envelopes “TERI/MSCC/CAL Case” and send the case via the most expeditious means practical (e.g., hand-carrying, express mail, SSA Central Office shuttle).
If the Appeals Council issues a fully or partially favorable decision, the Branch Chief will advise CPAB of the action and follow CPAB's instructions on routing paper claim files. CPAB will ask that the CCPRB either mail the paper case to the effectuating component, or hand-carry it to CPAB so CPAB can arrange immediate payment. If the paper case is sent to the effectuating component, the Branch Chief will ensure that CCPRB staff:
Hand-carry the paper case to the mailroom to be sent to the effectuating component, using the address supplied by CPAB, by the most expeditious means practical (e.g., express mail service, SSA Central Office shuttle).
For TERI/MSCC/CAL cases, clearly annotate all transmittals and envelopes “TERI/MSCC/CAL Case.”
If a Certified Administrative Record (CAR) is needed because the Appeals Council is issuing a partially favorable decision (i.e., in a sentence 6 case), the Branch Chief will hand-carry the case to the Operations Supervisor to have the CAR prepared. If the CCPRB is mailing the case for effectuation, the CAR will be prepared before mailing. If CPAB is arranging immediate payment, the CAR will be prepared after CPAB makes these arrangements, but before CPAB forwards the file to the effectuating component. All these actions will be taken within 24 hours of issuing the decision.
NOTE:
The TERI/MSCC case flag may not be removed. CPAB will continue to monitor processing until all retroactive benefits, if any, have been paid.
If the AC's action is unfavorable, the Branch Chief will notify CPAB, ensure that CCPRB staff release the decision promptly and follow normal procedures for distributing copies of the Appeals Council decision, preparing the CAR, if necessary, and forwarding files for storage.
If the AC issues a remand to an ALJ, the Branch Chief will notify CPAB, expedite standard procedures for releasing the remand order, and forward the file(s) to the hearing office by the most expeditious means practical (e.g., express mail). For TERI/MSCC/CAL cases, clearly annotate all transmittals and envelopes “TERI/MSCC/CAL Case.”
CPAB may remove the critical designation and discontinue tracking a critical case other than a TERI/MSCC case when the condition(s) which formed the basis for the critical designation no longer applies. Neither CPAB nor the CCPRB may remove TERI/MSCC case flags or cancel TERI/MSCC designations.
For cases that have been designated as CAL cases, there may be appropriate reasons for removing the CAL designation and to discontinue handling such cases expeditiously. These reasons include (but are not limited to):
Medical evidence did not confirm CAL condition.
Removed to revise or correct condition(s) (there is no functionality to modify conditions – CAL indicator must be removed, corrected, and reinstated.)
System mistakenly identified a CAL condition.
Certain cases that have been removed from CAL processing can be reinstated. Reasons for reinstatement include (but are not limited to):
Revised CAL condition (there is no functionality to modify conditions – CAL indicator must be removed, corrected, and reinstated.)
CAL condition was mistakenly removed.
Medical evidence was received after CAL indicator was removed.
Branch Chiefs will remove CAL designations from eView (both Flags and CAL indicator) and close ARPS Case Characteristic for CAL, when appropriate and notify CPAB of the removal. See DI 23022.005 for instructions on adding, removing, and reinstating CAL cases.