SOCIAL SECURITY

News Release

Commissioner Barnhart Presents Her Approach to Improving the Disability Determination Process

Jo Anne Barnhart, Commissioner of Social Security, today presented an approach to improving the disability determination process that would shorten decision times, pay benefits to people who are obviously disabled much earlier in the process and test new incentives for those with disabilities who wish to remain in, or return to, the workforce. 

“Clearly, the current process for determining eligibility must change.  People are waiting too long to get benefits,” Commissioner Barnhart said.  “Today I present an approach that uses 21^st century technology to speed up processing times and to create accountability at every step in the disability process.”

Commissioner Barnhart’s approach is the result of more than a year and a half of study and discussions with groups involved in the disability process – including Social Security employees from across the country, state Disability Determination Services (DDS), Administrative Law Judges (ALJs), health care providers, the federal courts, claimant attorneys and representatives, claimant advocacy groups, Members of Congress and concerned members of the public. 

Under the current process, it takes an average of 628 days for a Social Security disability application that is denied and appealed at each step to reach final agency action.  (To read more about the current disability process and associated delays, visit www.socialsecurity.gov/disability/disability_process_welcome.htm).

“My goals for improving the disability program are to make the correct decision as early in the process as possible and to expand employment opportunities for people with disabilities,” Commissioner Barnhart said.  “My approach would enable us to do that.”

“Designing my approach for improving the process is the first step of what I believe must be – and will continue to make – a collaborative process,” said Commissioner Barnhart.  “I will work within the Administration, with Congress, the state Disability Determination Services and interested organizations and advocacy groups before putting pen to paper to write proposed regulations.  To be successful, perspectives from all parts of the system must be considered.”

None of the suggested changes would require legislative action; none would adversely affect the employment status of current Social Security or DDS employees. 

Commissioner Barnhart’s approach is predicated on successful rollout of the Accelerated electronic Disability process (AeDib).  AeDib creates an electronic folder for the claimant’s application, medical information and other data.  AeDib will eliminate numerous time delays and financial costs related to locating the paper file, maintaining its contents and mailing them from office to office.  The Social Security Administration is currently piloting AeDib in three states, and will phase in its use nationwide during an 18-month roll-out. 

At a hearing before the House Ways and Means Subcommittee on Social Security, Commissioner Barnhart described highlights of her approach.  They include:

• The establishment of expert units and screening for “quick decision.”  New medical expert units would be organized by areas of clinical specialty (e.g., orthopedic, pediatric, psychiatric) and located in Social Security Regional offices.  These units would provide assistance for disability decision makers at all levels of the determination process (DDS examiners, ALJs, etc).  Through a “quick decision” process, these units would screen claims for applicants who are obviously significantly disabled (e.g., ALS, end-stage renal disease, aggressive cancers) and approve them before they are sent to a state DDS. 

• DDS examiners would be required to more fully document and explain the basis for a decision to deny a disability claim.  The DDS reconsideration stage of the current appeal process would be eliminated.  Federal Disability Quality Branches, which presently review DDS decisions, will be replaced by an in-line quality review and a centralized quality control.  As a result of “quick decision” and elimination of reconsideration, the DDS would be able to devote freed-up resources to better documentation of decisions. 

• The creation of the Federal Reviewing Official position.  If a claim is denied by the DDS, the claimant would be able to ask for an independent review by a Federal Reviewing Official.  The Reviewing Official, an attorney, after a thorough examination of the record, would either approve or deny the claim.  If the claim is not allowed, the Reviewing Official would prepare a written report outlining the reasons the claim should be denied or outlining the evidence needed to successfully support the claim.  This report would be provided to the claimant.  If the Reviewing Official’s decision is appealed, a de novo hearing would be scheduled before an ALJ, who would also receive a copy of the report.

• Closing the record following the ALJ hearing.  Following a hearing, the ALJ will issue a written opinion explaining the basis for the decision, and the record will be closed.  The Appeals Council stage of the current process is eliminated. 

• Quality control for disability claims will be centralized, with end-of-the-line reviews and an Oversight Panel.  An Oversight Panel, consisting of two ALJs and one Administrative Appeals Judge, would examine the case after quality review.  If the Oversight Panel affirms the ALJ decision, that decision would become a final agency action.  If the Oversight Panel reverses the ALJ decision, that decision would become a final agency action.  Claimants would continue to be able to appeal any final agency action to Federal district court.

Social Security has developed a Service Delivery Plan to eliminate backlogs within a 5-year period.  The President’s FY 2004 Budget Request provides significant additional funding to begin to eliminate these backlogs.  Backlogs at the DDS have already been reduced.  Progress is being made at hearing and Appeals Council levels.

Social Security plans to conduct several demonstration projects aimed at helping people with disabilities return to work.  These projects would support the President’s New Freedom Initiative and provide work incentives and opportunities earlier in the process.  They would include: early intervention demonstration projects that provide medical and cash benefits and employment supports to applicants who elect to pursue work rather than disability benefits; temporary allowance demonstration projects that provide immediate cash and medical benefits for a specified period to applicants who are highly likely to benefit from aggressive medical care; interim medical benefits demonstration projects that provide health insurance coverage to certain uninsured applicants whose medical condition is likely to improve with medical treatment; and ongoing employment supports to assist beneficiaries who wish to obtain and sustain work will also be tested.

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