The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
The Social Security Administration's Disability Decision Process: A Framework for Research, Second Interim Report
Over the years statutory amendments and judicial construction of eligibility criteria have extended the scope of the program. Many other factors have also contributed to the growth of the programs: incentives to apply for benefits affected by changes in the structure of alternative public and private income support programs for persons with disabilities, economic conditions, structural shifts in the labor market, and changes in the composition and characteristics of working age population (Lahiri, et al., 1995; Hu, et al., 1997). At the same time SSA has faced reductions in its administrative resources. As a result SSA has been faced with large workload increases in the disability programs and consequent backlogs in claims and appeals. These increases, however, have not been matched by increases in personnel. A study conducted by SSA (1993) of the disability claim and appeal processes found that the processing time for a claim from the initial inquiry through receiving an initial claims decision notice can take up to 155 days, and through receipt of hearing decision notice, can take as long as 550 days. However, the actual time during this period that employees devote to working directly on a claim was found to be 13 hours up to the initial decision notice and 32 hours through receipt of hearing decision notice. Delays in the receipt of required medical evidence at each level and consultations, the movement of paper, and the wait at each workstation because of missing information as the case is developed, account for a considerable portion of the claims processing time (SSA, 1994a). Increases in litigation combined with major reductions in staff resources have also contributed to the claims backlog.
Errors in making denial decisions by the state disability determination service (DDS) adjudicators, backlogs in appeals, and inconsistencies in decisions reached by the DDS adjudicators and the administrative law judges (ALJs) are also a matter of concern (DHHS, 1982; GAO, 1995, 1997b). The decision-making standards and procedures used by the ALJs are not always the same as those followed by the DDS adjudicators. The inconsistent decisions result mostly from differences in the assessment of residual functional capacity. The number of decisions being appealed for reconsideration and then approved at the higher level has increased. Over time the process has become lengthy, fragmented, confusing, and burdened by complex policies applied at different adjudicatory levels. It is hardly surprising that many have complained that the Social Security claims process takes too long, is confusing, complicated, and fragmented, resulting in inconsistent decisions often based on subjective criteria (GAO, 1995, 1997a; SSA, 1994a).
In the early 1990s, the National Performance Review identified improvement of the Social Security Administration's (SSA) disability process as one of the key service initiatives for the federal government. SSA realized that significant improvements could not be achieved without fundamentally restructuring the entire claims process. In view of these numerous concerns and the agency's recognition of the need to improve the quality of the service in the disability claims process, SSA decided to develop an ambitious long-term strategy for reengineering “… the disability determination process that would be simpler than the existing one, deliver significantly improved service to the public, remain neutral with respect to program dollar outlays, and will be more efficient to administer” (SSA, 1994a, p. 46).
As outlined by SSA (1994a), the basic goals of the reengineered claims process are that it should be: