Feds Struggle To Fix Disability Determination Process

The Social Security Administration is suspending much of a disability claim reform effort it has been testing in Boston.

The Boston pilot program, launched in 2006, has cost $24 million more than expected, and the SSA has decided to cancel some components, even in Boston, and to postpone moves to introduce other components nationwide, U.S. Government Accountability Office analysts write in a review of the SSA's Disability Services Improvement initiative.

The SSA instead will focus on implementing an electronic case processing system and on coping with a mounting backlog of pending hearing requests, the analysts write.

The aging of the population, the complexity of claim determinations and the difficulty of keeping Social Security Disability Insurance claims personnel have contributed to the backlog, David Bertoni, a GAO director, writes in a letter summarizing the GAO's findings.

"Unfortunately, [the] SSA also has a history of implementing initiatives to improve claims processing that have been poorly executed and therefore compounded its problems."

The GAO analysts prepared the review at the request of the leaders of the House Ways and Means Committee.

SSDI is the only disability insurance many U.S. residents have, and, in most cases, U.S. residents with disabilities must collect SSDI benefits for 2 years before they can qualify for Medicare health insurance benefits aimed at people with disabilities.

Private disability insurers are pushing for improvements in the SSDI claims process because many have policies that permit them to subtract SSDI benefits payments from the amounts they pay to claimants.

Although the SSA has been talking about reducing the backlog for years, the total number of backlogged SSDI claims increased to about 576,000 at the end of federal fiscal year 2006, up from fewer than 200,000 in 1999, the researchers write.

In fiscal year 2006, 30% of claims that went through determination hearings took 600 days or more

In Boston, the SSA tried a variety of reforms, such as creating a "quick disability determination process" for individuals with clear-cut cases of disability.

The process "has been successful in fully adjudicating 79% of targeted claims within 20 days or fewer, with an average decision time of 10 days," Bertoni writes.

But, even in that program, there have been problems, Bertoni notes.

"An SSA official in one state noted a case in which applications for disability benefits were submitted for two low-birthweight twins, only one of whom was identified as eligible under the QDD screening process," Bertoni writes. "According to [the] SSA, this happened because the application for the twin that was not selected for QDD did not have a weight listed."

The QDD process also is highly dependent on hospitals getting patient records to the SSA quickly, Bertoni writes.

Another effort, to create new templates for documenting decisions, was rushed into service without being fully developed or tested, Bertoni writes.

The template "caused considerable delays in processing caseloads," Bertoni writes.

System problems often caused the word processing program used to fill out the forms to crash and lose all data entered.

Because the "template was designed to address every possibility disability claim, it required examiners to sort through an unrealistically long list of choices to document each element of every claim," Bertoni writes.

The SSA has expressed disappointment in the results of a new Office of the Federal Reviewing Official, which is supposed to provide more extensive documentation of claim decisions.

The Boston FedRO system seems to have improved case documentation and accuracy, but it also has increased the average time to adjudicate a claim to more than 80 days, from 41 days, Bertoni writes.

Meanwhile, simply adding and keeping enough staff people to implement the reforms has proven to be more difficult and costly than expected, and fully staffing the Boston region, which is relatively small, would take $46 million, SSA officials estimate.

The SSA has not yet conducted a thorough analysis of the components of the Disability Services Improvement initiative, Bertoni writes.

SSA officials wrote back to argue that the GAO analysts should give more attention to SSA funding levels.

Since 2001, Congress has appropriated $150 million less each year for the SSA than the SSA has requested, according to the SSA.

A copy of the report is available