Compassionate Allowances(part 3)

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DI 23022.015 Compassionate Allowance (CAL)–DDS Instructions

The CAL initiative is designed to quickly identify diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal, but sufficient, objective medical information. If the condition does not meet these strict criteria, it will not be designated as a CAL case.

All CAL-identified conditions are entered into the Predictive Model (PM) and are selected for CAL processing based solely on the claimant’s allegations listed on the SSA-3368 (Disability Report—Adult) or SSA-3820—(Disability Report—Child).

Like Quick Disability Determinations (QDD), CAL cases will receive expedited processing within the context of the existing disability determination process.

CAL cases are similar to Terminal Illness (TERI) claims, although not all CAL cases involve terminal illness. For example, a person with a spinal cord injury could qualify as a compassionate allowance – even if he or she is expected to live for many years.

DI 23022.017 Compassionate Allowance (CAL) and Quick Disability Determination (QDD): Similarities and Differences
Process CAL cases in the same manner as QDD cases. Review QDD procedures in this subchapter before processing a CAL case.

Similarities include:

Most CAL cases are identified by the Predictive Model (PM) upon Electronic Disability Collect System (EDCS) transfer to the disability determination services (DDS) at the initial classification, initial adjudicative level. CAL and QDD do not apply to Continuing Disability Review (CDR) classification cases.

CAL cases are processed in the DDS by adjudicators who meet the qualifications set forth in DI 23022.020.

Expedited processing applies to all CAL-identified cases.

CAL cases can be removed from the CAL process; however, the reasons for taking such action on a CAL case are very limited, as described in DI 23022.055B.

In certain circumstances, cases removed from the CAL process can be reinstated, as described in DI 23022.055C. This link (http://ssahost.ba.ssa.gov/ecal/Index.aspx ) will take you to the Office of Disability Programs (ODP) Compassionate Allowance website that provides more information on CAL and houses the Impairment Summaries.

Cases determined to be CAL could also meet the criteria for QDD and would be designated both QDD and CAL. For example, the case could meet the scoring criteria for QDD and also have an allegation of a CAL condition.

If the PM identifies a case as both QDD and CAL, the case can be removed from QDD yet maintain its CAL status, and vice versa.

Differences include:

The PM criteria for CAL are simpler than the criteria for QDD. A CAL case is identified solely when a claimant alleges having a disease or other medical condition that matches a disease or condition loaded in the PM (by name, synonym and abbreviation). No scoring or threshold criteria are necessary for CAL selection. For example, a case must have a high enough score from the PM to be considered a QDD. For CAL, all the PM needs to see is the allegation of a condition on the CAL list.

Designated employees in the DDS, the Office of Quality Performance (OQP), and the Office of Disability Adjudication and Review (ODAR) can manually add a CAL indicator to a case, which is not an available function in QDD process. Similar to QDD, designated employees can remove and reinstate a case from the CAL process. (See DI 23022.055). FO employees cannot add, reinstate or remove CAL cases.

NOTE: The field office (FO) workload management information (WMI) listings do not capture these manual additions, reinstatements or removals. For CAL cases that are not already identified as QDD, the FO is automatically notified when a case has been added, removed or reinstated from the CAL process, via the EDCS action items on electronic claims. FOs regularly monitor EDCS action lists to identify any case where a CAL indicator has been set after transfer so that full non-medical development of the case can be initiated.

Unlike QDD, there are very few reasons for removing a case from CAL processing (DI 23022.055). Most significant is that, unlike QDD, a CAL case can be processed to a denial determination.

If a case is identified as CAL, continue to follow expedited QDD processing guidelines even if the DDS removes the case from QDD processing (e.g., if a case cannot be completed in the QDD timeframes or if the claimant moves, these are not reasons to remove a case from the CAL process).

There is a Compassionate Allowance page which can be accessed by selecting a hypertext link labeled [CAL] in the top right hand frame of the Electronic Folder (EF) in eView. The CAL link will display [CAL: Y] or [CAL: N.]

CAL cases can be identified at Initial, Reconsideration, Hearing and Appeals Council adjudicative levels.