GAO Finds SSA’s Treatment of Critical Cases Inconsistent

Empire Justice Center July 31, 2022

The Government Accountability Office (GAO) has issued a report finding fault with the Social Security Administration’s (SSA’s) implementation of its policies for the expediting critical cases at the hearing level. See GAO-22-104191. The GAO found that SSA flags appeals as critical after determining the claimant’s health or financial circumstances, such as terminal illness or dire financial need, meet SSA’s criteria as set forth in HALLEX I-2-1-40. But the cases are not always identified or expedited.


“Critical” cases include “TERI” cases, or those where a claimant’s illness is identified as terminal; VAPT, or Veteran 100 Percent Permanent and Total; MC/WW, or Military Casualty/ Wounded Warrior Case; CAL, or those cases identified as Compassionate Allowances per POMS DI 11005.604; DRND, or Dire Need Cases, where a claimant may be without food, education, or shelter; or Potentially Violent, where there is an indication the claimant is suicidal, homicidal, or potentially violent. Hearing offices flag critical cases for expedited processing based on evidence that the above criteria are met. Receiving a flag does not ensure that the claim will be approved, only that it should receive expedited processing.


The GAO found that while hearing offices consistently processed critical cases faster than non-critical cases between 2010 and 2020, the wait times varied depending on when the case was first flagged. Cases that arrived at hearing offices already flagged were processed more quickly than those first flagged at the hearing office – a median of 201 days versus 351. The GAO also found that although SSA may have initially identified a case as dire, such designations do not always trigger expedited processing unless and until it is also “flagged” by the hearing office as fitting into one of the HALLEX categories. For example, only 28.5 percent of cases with a homelessness designation also had a critical case flag and selected for expedited processing. Finally, the GAO found that even though SSA policy does not require claimants to provide documentation of dire financial need, some hearing offices required documentation before expediting claims.


The GAO recommended that SSA review the requirements for documentation of dire need for consistency and examine its handling of cases indicating critical need to ensure they are expedited in accordance with policy. SSA agreed with these recommendations.