Last Update: 9/13/05 (Transmittal I-4-15)
OHA's Division of Congressional and Public Inquiries (DCPI) (see also I-3-1-51) designates a case requiring special processing for one of the reasons listed in subsection B., below, as a “critical case” to ensure that the appropriate component(s) takes prompt action on the case.
Four situations warrant instituting critical case processing procedures:
The claimant's illness is terminal (see subsection C., below).
The claimant is without, and is unable to obtain food, medicine or shelter.
There is an indication that the claimant is suicidal or homicidal (see I-2-1-37).
The case has been delayed an inordinate amount of time, e.g.,, it has been pending more than 60 days longer than the average processing time for the office in question, and there is a public, congressional or other high priority inquiry on the case.
A critical case involving terminal illness (a “TERI” case) requires additional special handling. OHA tracks a TERI case while it is within OHA, and SSA's ROs also monitor the case to ensure that it is expedited. TERI cases include any case already identified as a TERI case (by the special flag, Form SSA-2200 at I-3-0-92) when received, and any case involving:
An allegation (e.g., from the claimant or a friend, family member, doctor or other medical source) that the claimant's illness is terminal.
An allegation or diagnosis of AIDS.
A claimant registered in a hospice or receiving hospice care at home (e.g., counseling or nursing care).
A claimant with a condition which medical records indicate cannot be reversed and is expected to end in death. Such cases include (but are not limited to) those involving a claimant:
with a chronic dependence on a cardiopulmonary life-sustaining device
awaiting a heart, heart/lung, liver or bone marrow transplant (excluding kidney and corneal transplants)
with chronic pulmonary or heart failure requiring continuous home oxygen and who is unable to care for personal needs
with a malignant disease (e.g., cancer) who is home confined or institutionalized, unable to care for personal needs or unresponsive to therapy
with diabetes and one or more of the following: multiple amputations due to diabetic gangrene; recurrent cardiovascular events (e.g., myocardial infarction or congestive heart failure); or recurrent cerebrovascular events with neurological deficit
with chronic liver disease (e.g., cirrhosis or hepatitis) and a recent history of massive gastrointestinal hemorrhage
who is comatose for 30 days or more
who is a newborn with a lethal genetic or congenital defect
The presence of one of the above criteria does not mandate a finding of disability. The claimant's impairment must be evaluated under the sequential evaluation process.
Within OHA central office, DCPI is responsible for designating a case as critical, initiating critical case procedures, and requesting expedited payment from the SSA effectuating component, if necessary.
All central office components are responsible for alerting DCPI of any case not previously identified which appears to meet the critical case criteria, expediting and hand-carrying all cases designated as critical, and advising DCPI of completed processing actions or delays in processing.
Within the CCPRBs, each Branch Chief is responsible for ensuring that the critical case procedures are followed. All CCPRB employees are responsible for bringing any case, which may meet the criteria in subsection B. or C., above, to the attention of the Branch Chief.
Critical cases (other than TERI) are identified by a Critical Case/Dire Need flag. TERI cases are identified by a special TERI flag (Form SSA- 2200).
NOTE:
See I-3-0-92 for the Critical Case/Dire Need flag and TERI flag, respectively. The former may be reproduced locally. The TERI flag may be ordered through the usual channels.
Upon receipt of a case flagged as critical or TERI, the CCPRB Branch Chief will immediately:
Ensure that DCPI is aware of the case.
Commence expedited processing, as described below.
Upon receipt of critical case information newly raised during the time that a case is pending in the CCPRB, the Branch Chief will ensure that such information is hand-carried to DCPI. In the case of a telephone report of a potential critical situation, a report of contact describing the telephone conversation will be provided to DCPI.
Following designation of a critical case (including TERI) by DCPI, the Branch Chief will immediately assign the case and ensure that CCPRB staff:
Attach to the front of the claims file (to each claims file in a concurrent case) a Critical Case or TERI flag (Form SSA-2200), as appropriate (see examples at See I-3-0-92 for the Critical Case/Dire Need flag and TERI flag).
Expedite processing by immediately working the case and hand-carrying it between processing stages.
Advise DCPI of any delays in processing.
For TERI cases, the CCPRB staff will also:
Ensure that the TERI flag (Form SSA-2200) is completed and correct, including attorney fee waiver information, if available.
Send a photocopy of the TERI flag to DCPI.
Enter “TERI Case” into the LOTS and ACAPS.
NOTE:
When routing TERI cases to another component or office, clearly annotate transmittal slips/envelopes “TERI Case” and send the case via the most expeditious means practical (e.g., hand-carrying, express mail, SSA Central Office shuttle).
If the AC issues a fully or partially favorable decision, the Branch Chief will advise DCPI of the action and follow DCPI's instructions on routing. DCPI will ask that the CCPRB either forward the case to the effectuating component, or hand-carry it to DCPI so that DCPI can arrange immediate payment. If the case is sent to the effectuating component, the Branch Chief will ensure that the CCPRB staff:
Hand-carry the case to the mailroom to be sent to the effectuating component, using the address supplied by DCPI, by the most expeditious means practical (e.g., express mail, the SSA Central Office shuttle).
For TERI cases, clearly annotate transmittals and envelopes “TERI Case.”
NOTE:
The TERI case flag may not be removed. DCPI will continue to monitor processing until all retroactive benefits, if any, have been paid.
If a Certified Administrative Record (CAR) is needed because the AC is issuing a partially favorable decision, the Branch Chief will hand-carry the case to an Operations Supervisor to have the CAR prepared. If the CCPRB is mailing the case for effectuation, the CAR will be prepared before mailing. If DCPI is arranging immediate payment, the CAR will be prepared after DCPI makes these arrangements, but before DCPI forwards the file to the effectuating component. All these actions will be taken within 24 hours of issuance of the decision.
If the AC's decision is unfavorable, the Branch Chief will notify DCPI and ensure that staff release the decision promptly and follow normal procedures for distributing copies of the decision, preparing the CAR if necessary, and forwarding files for storage.
If the AC issues a remand to an ALJ, the Branch Chief will notify DCPI, expedite standard procedures for releasing the remand order, and forward the file(s) to the HO by the most expeditious means practical (e.g., express mail). For TERI cases, clearly annotate all transmittals and envelopes “TERI Case.”
DCPI may remove the critical designation and discontinue tracking a critical case other than a TERI case when the condition(s) which formed the basis for the critical designation no longer applies. Neither DCPI nor the CCPRB may remove TERI case flags or cancel TERI designations.