From SSA Expedited Most Critical Cases at Hearings Level but Lacks Consistent Policy Implementation, a report by the Government Accountability Office (GAO):
The Social Security Administration (SSA) flags a disability appeals case as critical after determining that the claimant’s health or financial condition, such as having a terminal illness or dire financial need, meets criteria in SSA’s policy manual. Cases can be flagged as critical before reaching a hearing office or during nearly any stage of the hearing process. SSA policy directs staff to expedite the case once it is flagged as critical. However, staff GAO interviewed from three of the five selected offices said that claimants must provide documentation of their dire financial need, even though SSA policy does not require it.
Hearing offices consistently processed critical cases faster than non-critical cases between fiscal years 2010 and 2020, but wait times varied depending on when the case was first flagged. Cases that arrived at a hearing office with a flag took a median 201 days to reach a hearing decision; those first flagged while they were at a hearing office took a median 351 days. This difference exists because hearing offices quickly begin work on flagged cases. In contrast, non-critical cases took a median 469 days (see figure). GAO found that, across the stages of the hearings process, critical cases flagged after reaching a hearing office spent the largest portion of the wait time in the stage before being assigned to a case worker. Once flagged during this waiting period, hearing office staff assigned most cases to a case worker within a week. ...
I wish they'd also look at expediting below the request for hearing level. Where appropriate, I help clients file critical case requests regardless of level. There's supposed to be expediting at the initial and reconsideration levels but I see little sign that it's happening. Backlogs at the initial and reconsideration levels are far worse than at the hearing level at least where I'm practicing.
Also, it would help if the agency came up with its own form for requesting critical case status. My impression is that Social Security employees are often unsure of what to do with a request that doesn't arrive on an official Social Security form.
6 comments:
There are already procedures for expediting terminal illness cases and compassionate allowances. Homeless cases are expedited as well. Most disabled people that have been out of work for a few months are getting financially desperate. Expediting the majority of claims will not help anyone as there isn't the staff available to do it.
Exactly right. Almost everyone who files is financially desperate. If you make every car a priority, then by default none are a priority.
Our local OHO requires a very detailed level of documentation for a dire need designation despite SSA policy not requiring it. Claimants are forced to lose their homes in foreclosure actions before meeting the critical case criteria for this OHO. The claimant must not only prove they are then homeless, but that they are also unable to rectify the situation. "Couch surfing" is not considered homelessness.
In the eyes of the agency they are just file, just widgets, just a thing to do and move along from your list to some other list for some other person to move along of the list and so on. They arent people. Just keep your list close to up to date and cash your check.
It’s a multi-layer issue.
Office I was at for a time, a number of representatives requested critical case status as a matter of routine and as a result getting bumped up the line became more rare than it should have.
The agency is deeply invested in metrics and pulling cases toward the front of the line doesn’t help the metrics. Makes it likely a case drifts into “aged” status.
It’s easy to sort out TERI, 100% VA P&T, Military casualty / wounded warrior, in theory compassionate allowance as long as you have the people to sort through and get them into the scheduling hopper early.
Dire Need is just a mess. It requires without food and unable to obtain it. Well that brings up questions of why aren’t you on SNAP or using food banks, lack of medical care and unable to obtain it, Medicaid expansion has gobbled up much of that path. Without shelter and no way to obtain it, lack of utilities qualifies but the unable to get can be messy, being in a shelter doesn’t qualify unless timing out.
The evidence required makes dire need a complete pain, it’s basically another adjudication that requires resources that are in short supply.
As the regulation is written dire need is supposed to operate on a presumption that the request is proper absent other evidence and since the resources to investigate do not exist as a general rule, all dire need requests should be granted which leads to the situation I first encountered of it becoming a routine ask so it has no real impact.
The real problem is, for the vast number of applicants, the reason they are applying is out of "dire need." Particularly, single and divorced people with no children. Especially, if you live with a relative. Most state aid is barred from you, including SNAP! It is based upon "household" income, not an individual's. You can't get rent subsidies. SSA doesn't consider your case to be "dire." Meanwhile, others get moved up (military, etc.), whether their cases are truly dire or not. So, you wait 1, 1 and a half, 2 years...maybe more...Then you're at the mercy of one ALJ. If things were dire before seeing an ALJ, how dire do you think they will be if they are then denied?
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