TN 9 (06-13)

DI 23022.030 Identifying and Receipting Compassionate Allowances and Quick Disability Determinations Cases

Citations:

20 CFR §§ 404.1619, 416.1019

A. Electronic identification

1. Electronic Disability Collect System (EDCS)

When transferring a case in EDCS, the selection software determines whether the case qualifies for Compassionate Allowances (CAL) fast-track processing; and, the Predictive Model (PM) identifies cases for Quick Disability Determinations (QDD) fast-track processing. When the field office (FO) selects a case, an onscreen message prompts them to complete full non-medical development. The FO must select OK to close the message box to proceed with the transfer.

NOTE: The selection software for CAL and the PM for QDD does not consider cases that are fully paper (all claims in the case are EDCS exclusions). You must establish at least one of the claims in EDCS for the selection software to consider the case for CAL, or for the PM to consider the case for QDD. The official folder may be a Certified Electronic Folder (CEF) or a paper Modular Disability Folder (MDF).

If the disability determination services (DDS) identifies CAL criteria for a fully paper claim, the DDS and FO follow normal expedited claim procedures, such as those used for terminal illness (TERI) cases.

2. DDS case processing systems

All CAL and QDD cases have an associated Electronic Folder Interface (EFI) download. The EFI download contains a data element that identifies the case as CAL, QDD, or both. The DDS case processing system recognizes the CAL and QDD indicators on the EFI, propagates it to the DDS case processing system screens, and uses it for special processing logic.

B. Visual identification of CAL or QDD indicators

The EDCS Routing Form displays “QUICK DISABILITY DETERMINATIONS: YES” or

“COMPASSIONATE ALLOWANCES: YES”, or both in large letters at the top of the page.

The CAL or QDD indicators will display as follows:

  1. The CAL and QDD indicators display as separate header(s) on all eView screens, regardless of whether the selection software or PM screened the case or a user manually added it. The CAL indicator allows the user to access the CAL page in order to view or manually add, remove, or reinstate a CAL action. If the screen shows “QDD: Y” and “CAL: Y”, the case is currently a QDD and CAL case. If the screen shows “QDD: N” and “CAL: N”, the case is not currently a QDD or CAL case. In some instances, the “QDD: N” and “CAL: Y” will appear which means it is designated as a CAL only case and vice versa.

  2. The DDS case processing system displays a CAL or QDD indicator.

C. DDS identifies CAL after receipt of claim

The DDS, Office of Quality Performance (OQP), and Office of Disability Adjudication and Review (ODAR) can manually add cases to CAL processing. If you identify an alleged or existing condition or illness that would allow CAL processing, refer to the processing instructions in DI 23022.055.

D. Automatic EFI “Accept Jurisdiction” of CAL and QDD cases: receipt date

To ensure quick processing of CAL and QDD cases, the DDS case processing systems automate the “Accept Jurisdiction” EFI transaction (0123).

The DDS case processing system Download and Receipt queue indicates whether a claim has been marked for fast-track processing.

The system also indicates whether the Document Management Architecture (DMA) stored an image of the signed SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)). The DDS should monitor the Download/Receipt queue to expeditiously receipt and assign any newly transferred CAL or QDD fast-track claims.

  • The DDS accepts jurisdiction, receipts, and assigns the claim to a QDD and CAL adjudicator the same day that it posts to the Download/Receipt queue, if possible.

  • The DDS must resolve by close of business (COB) any conditions that would cause them not to receipt the claim. For example, if the FO transfers the claim to the wrong DDS, The DDS rejects the claim and sends it back to the FO.

    NOTE: Do not automatically reject jurisdiction of cases that do not have an SSA-827 in DMA. The FO mails the orig