GAO: Rising claims, fewer employees feed SSA disability backlog

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GAO: Rising claims, fewer employees feed SSA disability backlog

By Mosquera

http://www.fcw.com/online/news/151278-1.html

With more people applying for Social Security disability claims, the

process slows to a crawl when applicants seek a hearing to consider

their case more closely. The Government Accountability Office

evaluated the claims process as of the end of fiscal 2006 to

determine where the Social Security Administration should focus its

activities.

Claims for Social Security disability benefits continue to backlog

in various stages of the process, reaching 576,000 at the end of

fiscal 2006. Most of the backlog — or 72 percent — occurs at the

hearing level, GAO said in a report released Jan. 7.

SSA said last month that disability hearing backlogs now stand at

750,000.

Disability benefits provide cash for living expenses when people

with severe physical or mental impairments can no longer work. After

an individual applies for disability benefits, the claim may go

through an initial determination. If the claim is denied, the

claimant can proceed to a different group for reconsideration, and

if dissatisfied with that decision, request a hearing and go from

there to an appeals council.

Rising numbers of disability claims, staff losses and turnovers, and

management weaknesses have contributed to the backlog and claimants'

longer waits for resolution, GAO said. An overall loss of

experienced staff combined with increasing workloads and resource

constraints can reduce the success of any initiative aimed at

reducing backlogs, GAO said.

" Unfortunately, SSA also has a history of implementing initiatives

to improve claims processing that have been poorly executed and

therefore compounded its problems, " said Bertoni, director of

GAO's education, workforce and income security issues.

SSA introduced reforms in 2006 under the Disability Service

Improvement initiative, but suspended the national rollout to

concentrate on reducing the backlog of pending hearing requests and

bringing SSA's electronic case processing system into full

operation, which should smooth the processing of disability claims.

SSA has used an electronic folder system, a component of the

electronic disability process, but did not implement the e-pulling

function at hearing offices. That function automatically eliminates

duplicate documents and organizes the remaining documents.

Although SSA has planned a test to implement e-pulling in April,

technicians must still perform this time-consuming activity

manually. SSA also expects to have the electronic folder system

implemented for the appeals council.

To reduce the number of existing hearings backlog, SSA is updating

its medical eligibility criteria, expediting cases where eligibility

is clear, improving the electronic processing system and focusing on

resolving claims at the hearing level through a number of targeted

actions. Besides automating file assembly at the hearings level, SSA

also will allow electronic signatures on approved cases, provide for

employees' shared access to the folder, and expand Internet support

and functionality for claimants or their representatives.

GAO recommended that SSA better track backlogs in the

reconsideration stage, which may have some bearing on the gridlock

of claims in the hearings stage, and plan, carry out and evaluate

initiatives to reduce them.

SSA said it had already taken steps to improve the likelihood of

success of future initiatives.

SSA launched the National Hearing Center on Dec. 17 with seven

administrative law judges hearing cases via videoconferencing and

using electronic disability folders. The center will initially hear

cases for the Atlanta, Cleveland and Detroit hearing offices, areas

of the country where the wait for a hearing can be two years or

more. More administrative law judges may be added over time so the

center will be able to assist more offices.

Although SSA agreed with GAO's recommendations, the agency believed

GAO did not sufficiently emphasize the need for more funding.

" The lack of resources has played a significant role in the reasons

for the pending workloads, " SSA Commissioner Astrue said in

a response letter.

Since 2001, Congress has reduced SSA's budget while increasing its

workload outside of its core mission, such as activities related to

the Medicare Prescription Drug Program and verification of employee

work eligibility for immigration purposes. In fiscal 2008 spending

just signed into law, the agency received about $150 million more

than last year with plans to hire 150 administrative law judges to

help shrink the case backlog.