Effective Dates: 05/31/2023 - Present Previous | Next

TN 56 (05-23)

DI 23022.040 Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) Fast-Track Case Development

CITATIONS:

20 CFR §§ 404.1619, 416.1019

A. Initial development

The Disability Determination Services (DDS) should initiate development within one working day of case receipt for CAL and QDD fast-track cases. The field office (FO) provides an electronically signed SSA-827 Authorization to Disclose Information to the Social Security Administration (SSA) into the Electronic Disability Collect System (EDCS) before sending the case for processing. If the case includes a title XVI claim, the DDS also needs to consider whether presumptive disability (PD) or presumptive blindness (PB) applies. For DDS responsibilities in PD or PB claims, see DI 23535.010.

The FO will fax up to 15 pages of medical evidence of record (MER) into the electronic folder prior to the electronic transfer of a case . For cases with more than 15 pages of MER, the FO mails evidence to the DDS via REGULAR mail. Because these cases are time critical, The DDS scans the mail in MER upon receipt and does not send to a national scanning contractor.

The impairment summaries for listed CAL conditions provides guidance to help develop useful evidence. The CAL website provides more information on CAL and houses the impairment summaries. An alphabetical list of CAL impairment summaries are located in DI 23022.080.

B. Obtaining additional information from the claimant

Do not tell the claimant that we selected their case for CAL or QDD unless they specifically ask the question.

If necessary, contact the claimant or third party upon receipt of the case to:

  1. 1. 

    verify allegations and claimant or third party contact information;

  2. 2. 

    identify current medical source(s), obtain medical source contact information, and obtain dates of any pending medical appointments;

  3. 3. 

    request assistance in obtaining medical evidence from medical sources, including a request for fax contact information; and

  4. 4. 

    obtain information about Activities of Daily Living (ADLs).

C. Obtaining evidence from the medical source

Follow these steps to obtain evidence from the medical source(s):

  1. 1. 

    Review the disability claim to identify the primary medical provider or specialist(s) who can provide the evidence necessary to fast-track the determination.

  2. 2. 

    Fax, telephone, or express mail requests for medical evidence, whenever possible, to immediately obtain the evidence. Request medical evidence by mail only if no other means of obtaining it are available. If you mail the request, ensure the DDS address is the return address (i.e. not the scanning contractor address).

  3. 3. 

    The disability examiner may also request medical evidence via the Electronic Records Express (ERE) website, if the medical source is a registered user.

NOTE: 

If the disability examiner is unable to obtain the necessary medical evidence via fax, telephone, mail, or ERE, follow the procedures in DI 22501.001 Disability Case Development for Medical and Other Evidence procedures and DI 22505.006 Requesting Evidence – General.

D. Follow-up for medical evidence

To obtain necessary medical evidence, expedite follow-up procedures with the medical source and claimant.

1. Medical source

Take the following actions to follow-up on requests for evidence from the medical source:

  1. a. 

    Follow-up no later than 7 calendar days from the date of the request;

  2. b. 

    Fax or telephone all subsequent requests for evidence, if possible;

  3. c. 

    Consider contacting the claimant for assistance in obtaining required evidence, as per DI 23022.040D.2., in this section.

  4. d. 

    Initiate a second follow-up after an additional 7 days, if you do not receive the evidence after the initial follow-up;

2. Claimant

When following up on requests for evidence from a medical source, consider contacting the claimant or representative to request assistance. When appropriate, mail or fax medical forms or ERE bar codes to the claimant to take to their medical source for completion.

Take the following actions to follow-up requests for evidence from the claimant or representative:

  1. a. 

    After the DDS makes all attempts to obtain the medical evidence needed to make the determination, make an attempt to contact the claimant or representative to request assistance.

  2. b. 

    When appropriate, mail or fax forms to the claimant or representative to take to their medical source for completion.

  3. c. 

    Include a return envelope with the DDS address; do not include a return envelope with the national scanning contractor address. If the medical source is a registered user, you may also request medical evidence via the ERE Website.

  4. d. 

    After subsequent request(s) for evidence, provide the claimant with an opportunity to fax or mail any necessary evidence.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022040
DI 23022.040 - Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) Fast-Track Case Development - 05/31/2023
Batch run: 05/31/2023
Rev:05/31/2023