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SSA Disability Determination - New Approach

On March 27, 2006 the Social Security Administration (SSA) announced their final rules for what has been called a "New Approach" to disability determination. This announcement marks the culmination of efforts to revise the existing process that have been taking place for the past several years. The new procedures, built upon Social Security's electronic disability claims process, will shorten decision times and pay benefits to people who are obviously disabled much earlier in the process. Social Security plans to phase in the new process on a region-by-region basis beginning with the Boston Region in August 2006. The Boston Region is comprised of the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont.

Highlights of the New Approach

All of the changes were made using administrative rather than legislative actions. Features of the new approach include the following:

·           A quick disability determination process for those who are obviously disabled. Favorable decisions would be made in such cases within 20 days after the claim is received by the state disability determination agency.

·           A new Medical-Vocational Expert System (MVES) to enhance the expertise needed to make accurate and timely decisions. The MVES will be composed of a Medical-Vocational Expert Unit and a national network of medical, psychological and vocational experts who meet qualification standards established by the SSA Commissioner.

·           A new position -- the Federal Reviewing Official -- that will review state agency determinations upon the request of the claimant. This will eliminate the reconsideration step of the current appeals process.

·           Retention of the right to request a de novo hearing and decision from an Administrative Law Judge if the claimant disagrees with the decision of the Federal Reviewing Official. (Note: A "de novo" review means a completely new and independent review that is not bound by other adjudications.)

·           Closing the record after the Administrative Law Judge issues a decision, with provision for certain good cause exceptions to this rule.

·           A new body -- the Decision Review Board -- to review and correct decisional errors and ensure consistent adjudication at all levels of the disability determination process. The current Appeals Council will be phased out gradually.

New Approach Flowchart

This version of WorkWORLD contains a flowchart that summarizes the Final Rule for the New Approach. It is available in PDF format (requires Adobe Acrobat Reader).

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Background

For years, disability applicants, their families, advocates, and state and federal employees have been forced to deal with an outdated disability system with ever-growing backlogs, processing problems and lengthy time delays in decisions. In 2003, the SSA Commissioner presented Congress with a conceptual version of a new approach for improving the disability process.

The Commissioner noted that at one time (FY2001), the length of time required to move through the entire appeals process was 1153 days -- 525 days due to backlogged cases and 628 days to move through the process. (See the Flow Of Cases Through The SSA Disability Process topic for comprehensive information.)

By 2003, SSA had implemented strategies to help eliminate backups, and provide more timely and accurate service. The short-term initiatives included:

·           including Administrative Law Judges (ALJs) in early screening for on-the-record decisions;

·           developing a short form for fully favorable decisions;

·           creating a law clerk (attorney intern) position;

·           deploying speech recognition technology to hearing offices;

·           ending the practice of rotating hearing office technicians among different positions;

·           using scanning technology to track and retrieve folders;

·           eliminating the tape transcription backlog; and

·           eliminating delays in presenting cases to the U.S. District Courts.

At the same time, SSA began to plan for an electronic disability folder, to replace the paper folders in use at the time. This was intended to avoid the necessity of tracking, maintaining, and moving the many documents involved in disability decisions. It also allowed for many people to simultaneously access these records. Additionally, it permitted initial disability applications to be completed, submitted, and processed electronically, rather than through paper documents.

In 2004, the Commissioner noted that SSA was implementing the electronic disability process, which would provide the infrastructure needed to support the new approach. The new approach would be workable only when SSA's electronic disability system -- called "e-Dib" -- was fully functional so that a claimant's file was accessible to those working on the case anywhere in the nation. Work continued on studying problems in the current system and devising the details of the new approach, with an eye towards accountability and feedback at each level of the process, and better documentation.

By mid-2005, virtually all of the Disability Determination Services had rolled out the electronic disability folder, which meant that some or all of the decision makers in these DDSs were adjudicating cases in an electronic environment. In July 2005, SSA published a Notice of Proposed Rulemaking (NPRM) that set out the completed plan to improve the disability determination process (the "New Approach"). Its intent was to make the right decision as early in the process as possible; and to foster return to work at all stages of the process.

In response to public comment about the NPRM, SSA revised the proposed regulations and issued the Final Rule on March 27, 2006.

Additional Information

The full text of the Final Rule (191 pages) is available in PDF format (requires Adobe Acrobat Reader) from the SSA website at:
http://www.socialsecurity.gov/disability-new-approach/finalrule.pdf

Congressional testimony by the Commissioner of Social Security reveals much of the background planning and implementation of the new approach. Links to transcripts of this testimony, in reverse chronological order, are provided below:

·           View the March 14, 2006, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the Senate Finance Committee regarding Administrative Challenges Facing SSA, available online at:
http://www.socialsecurity.gov/legislation/testimony_031406.html

·           View the September 27, 2005, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the U.S. House of Representatives Committee on Ways and Means Subcommittee on Social Security and Subcommittee on Human Resources regarding her Proposed Improvements to the Disability Determination Process, available online at:
http://www.socialsecurity.gov/legislation/testimony_092705.html

·           View the September 30, 2004, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the U.S. House of Representatives Committee on Ways and Means Subcommittee on Social Security and Subcommittee on Human Resources regarding her Proposal to Improve the Disability Determination Process, available online at:
http://www.socialsecurity.gov/legislation/testimony_093004.html

·           View the September 25, 2003, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the U.S. House of Representatives Committee on Ways and Means Subcommittee on Social Security regarding An Approach to Improving the Disability Determination Process, available online at:
http://www.socialsecurity.gov/legislation/testimony_092503.html

·           View the July 24, 2003, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the U.S. House of Representatives Committee on Ways and Means Subcommittee on Social Security regarding the Social Security Administration's Service Delivery Budget Plan, available online at:
http://www.socialsecurity.gov/legislation/testimony_072403.html

·           View the May 2, 2002, statement of Jo Anne B. Barnhart, Commissioner of Social Security, before the U.S. House of Representatives Committee on Ways and Means Subcommittee on Social Security regarding Challenges Facing the New Commissioner of Social Security, available online at:
http://www.socialsecurity.gov/legislation/testimony_050202.html

Also See:

Other topics in WorkWORLD that discuss disability determination and review include the following:

SSI/DI Application Information

SSA Disability Determination Process

Flow Of Cases Through The SSA Disability Process

SSA Appeals Process

Source

http://www.socialsecurity.gov/disability-new-approach/

http://www.ssa.gov/pressoffice/pr/DSI-pr.htm

http://www.socialsecurity.gov/disability-new-approach/message1.htm

http://www.socialsecurity.gov/disability-new-approach/finalrule.pdf

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