Compassionate Allowances(part 5)

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DI 23022.030 Identifying and Receipting Quick Disability Determination (QDD) and Compassionate Allowance (CAL) Cases

20 CFR § 404.1619 Quick Disability Determination process


20 CFR § 416.1019 Quick Disability Determination process


A. Electronic identification
1. Electronic Disability Collect System (EDCS)
When transferring a case in EDCS, the Predictive Model (PM) software determines whether the case qualifies for processing as a QDD and/or CAL case. The field office (FO) receives one of the following on-screen message boxes in EDCS:

“This case has been marked as a Quick Disability Determination case. Full non-medical development required.”, or

“This case has been marked as a Compassionate Allowance case. Full non-medical development required.”, or

“This case has been marked as a Quick Disability Determination and Compassionate Allowance case. Full non-medical development required.”

The FO must select OK to close the message box to proceed with the transfer.

NOTE: Cases that are fully-paper (all claims in the case are EDCS exclusions) are not considered for QDD/CAL. At least one of the claims must be established in EDCS for the PM to consider the case for QDD and/or CAL. 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 will follow normal expedited claim procedures, such as those used for TERI cases.

If a fully electronic CAL case requires conversion to the paper process, the case must be removed from CAL processing (see DI 23022.055) and select the “other” block. Type in “conversion from electronic to paper” as the reason.

2. DDS case processing systems
All QDD and CAL cases have an associated Electronic Folder Interface (EFI) download. The EFI download contains a data element that identifies the case as QDD and/or CAL. (Until each DDS legacy system receives the appropriate upgrades, only the current QDD indicator will be visible in the DDS download.)

The DDS case processing system recognizes the QDD/CAL indicator on EFI, propagates it to the DDS case processing system screens, and uses it for special processing logic.

NOTE: Until each DDS legacy system receives the appropriate upgrades, all CAL cases are identified in the download through the QDD data element. In addition to the data element, a special message is generated in the legacy system to alert the user that CAL is involved. The message notification states: “Case has been identified as a Compassionate Allowance because of the following condition(s): .” The adjudicator will need to check eView to determine if QDD is also applicable.

B. Visual identification
The EDCS Routing Form displays “QUICK DISABILITY DETERMINATION: YES” and/or “COMPASSIONATE ALLOWANCE: YES” in large letters at the top of the page.

The QDD and CAL indicators display as separate header(s) on all eView screens, regardless of whether the case was screened by the PM or manually added. The CAL indicator allows the user to access the Compassionate Allowance page in order to view or manually add, remove, or reinstate a CAL action. If the screen shows “QDD: Y” and/or “CAL: Y”, the case is currently a QDD and/or CAL case. If the screen shows “QDD: N” and/or “CAL: N”, the case is not currently a QDD and/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.

The DDS case processing system displays a QDD or CAL indicator (if the system has the proper systems enhancements).

C. DDS identifies CAL after receipt of claim
While a QDD indicator cannot be manually added to a case, for CAL, the DDS, Office of Quality Performance (OQP), and Office of Disability Adjudication and Review (ODAR) have the capability to manually add cases to CAL processing. If an alleged or existing condition or illness that would allow CAL processing is identified, refer to DI 23022.055 for processing instructions.

D. Automatic EFI “Accept Jurisdiction” of QDD/CAL cases: receipt date
To ensure that QDD/CAL cases are processed expeditiously, the DDS case processing systems automate the “Accept Jurisdiction” EFI transaction (0123) for QDD/CAL cases.

The DDS case processing system Download/Receipt Queue indicates whether a claim has been marked for QDD and/or CAL processing. (If the state legacy system has not received the appropriate upgrades, QDD and CAL are identified ONLY as QDD. A special message notification is sent in the download to identify a case as CAL. The message states: “Case has been identified as a Compassionate Allowance because of the following condition(s): .” The adjudicator will need to check eView to determine if QDD is also applicable.)

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

The recommended 20-day time period for QDD cases starts when the DDS accepts jurisdiction of the case.

The time period for CAL cases is not limited to the 20-day processing time period; however, expedited processing procedures remain in effect for CAL cases. A case is not removed from CAL solely because evidence is not received or a favorable determination is not made within a certain time period.

The DDS accepts jurisdiction, receipts, and assigns the claim to a QDD/CAL adjudicator the same day that it posts to the Download/Receipt queue, if at all 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 claim was transferred to the wrong DDS, it should be rejected back to the FO.

NOTE: Do not automatically reject jurisdiction of cases that do not have an SSA-827 in DMA. The original document is mailed to the DDS (or destroyed, depending on local procedures) by the FO, so the FO no longer has an SSA-827 in the office to fax. Discuss any cases with a missing SSA-827 with FO management, using local procedures, before rejecting jurisdiction.

The DDS case processing system propagates the date that the DDS accepted jurisdiction of the case to the State Receipt Date (SRD) field on the NDDSS DREC mask. The SRD field cannot be modified by the DDS.

If a QDD/CAL claim is still on the Download/Receipt Queue by COB of the day it was posted to the Download/Receipt Queue (or the next business day for cases transferred on non-business days), the DDS case processing system automatically generates the “Accept Jurisdiction” EFI transaction (0123). The DDS must receipt and assign these cases expeditiously because the receipt date is the date of the system generated Accept Jurisdiction transaction.

For additional information about DDS case receipt, see DI 81020.015, Electronic Claim Receipt Process.