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Which Disability Cases Are Considered “Critical”?

April 30, 2021 Disability

Applying for Social Security disability (SSDI) benefits can be a lengthy process. The Social Security Administration (SSA) states that it generally takes about three to five months to get to a decision, but that timeline can be much longer if a claimant’s application is denied (as most are) or if the claimant appeals the denial. However, this presents a problem for claimants who suffer from severe, debilitating conditions and who need assistance right away. For extreme cases, the SSA implements an expedited review process if it considers the claimant’s condition to be “critical.” A Baltimore disability attorney explains what that means below. 

Terminal Illnesses (TERI) 

Terminal illnesses — those that are untreatable, irreversible, and expected to result in death — are critical cases under the SSA’s framework. Illnesses and conditions presumed to fall under the TERI category include: 

  • A diagnosis of Amyotrophic Lateral Sclerosis (ALS) 
  • A diagnosis of Acquired Immune Deficiency Syndrome or Acquired Immunodeficiency Syndrome (AIDS)
  • The claimant is receiving inpatient or home hospice care
  • Chronic dependence on a cardiopulmonary life-sustaining device
  • The patient is awaiting a heart, lung, liver, or bone marrow transplant 
  • Chronic pulmonary heart failure requiring continuous home oxygen and an inability to care for personal needs 
  • Any cancer that is metastatic, defined as Stage IV, persistent or recurrent following initial therapy, or inoperable 
  • A diagnosis of esophageal cancer, liver cancer, pancreatic cancer, gallbladder cancer, mesothelioma, lung cancer, brain cancer, or Acute Myelogenous Leukemia (AML) or Acute Lymphocytic Leukemia (ALL)
  • The claimant is comatose for 30 days or more
  • The claimant is a newborn with a lethal genetic or congenital defect 

Even if a case is not explicitly listed in the SSA’s guidelines, it may still be considered a TERI case so long as the condition is untreatable and expected to end in death. 

Veteran 100% and Total 

A case is critical when the claimant has received a 100% permanent and total disability rating from the Department of Veterans Affairs. 

Military Casualty/Wounded Warrior 

A current or former member of a military service may have his or her disability designated critical when the claimant: 

  • Sustained an illness, injury, or wound, 
  • Alleges a physical or mental impairment, regardless of how the impairment occurred or where it occurred, and. 
  • Sustained the impairment while on active duty status on or after October 1, 2001

Compassionate Allowances 

Any case that qualifies for the SSA’s Compassionate Allowances program also generally will be considered to be critical.  

Dire Need 

Dire need situations exist when the claimant: 

  • Is without food and is unable to obtain it,
  • Lacks medicine or medical care and is unable to obtain it, or
  • Lacks shelter

In cases such as these, the SSA generally accepts a claimant’s allegation that he or she is in dire need, erring on the side of designating the case critical. 

Potentially Violent

Cases may be designated critical if there is an indication that the claimant is suicidal, homicidal, or potentially violent. 

Contact a Baltimore SSD Attorney If You Think Your Case Might Be Critical

If you think your case might qualify for expedited processing as a critical case, you should speak to an attorney who can help you with your application. For more information, please contact Baltimore SSD attorney Emmett B. Irwin by using our online form or calling us at 443-839-0818.