SSA Faces Difficulties Managing Disability Claims Processing

SSA has experienced difficulty managing its complex disability  determination process, and consequently faces problems in ensuring the  timeliness, accuracy, and consistency of its disability decisions. Although  SSA has made some gains in the short term in improving the timeliness of  its decisions, the Commissioner has noted that it still has “a long way to  go.” Over the past 5 years, SSA has slightly reduced the average time it  takes to obtain a decision on an initial claim from 105 days in fiscal year  1999 to 97 days in fiscal year 2003, and significantly reduced the average  time it takes the Appeals Council to consider an appeal of a hearing  decision from 458 to 294 days over the same period. We are currently reviewing SSA’s efforts to  assess consistency of decision-making between the initial and the hearings  levels. SSA’s  disability programs remain grounded in an approach that equates  impairment with an inability to work despite medical advances and  economic and social changes that have redefined the relationship between  impairment and the ability to work. In  addition, employment assistance that could allow claimants to stay in the  workforce or return to work—and thus potentially to remain off the  disability rolls—is not offered through DI or SSI until after a claimant has  gone through a lengthy determination process and has proven his or her  inability to work. Commissioner’s New Strategy for Improving the Disability Determination Process Appears Promising, but Faces Several Challenges

In SSA’s most recent attempt to improve its determination process, the  Commissioner, in September 2003, set forth a strategy to improve the  timeliness and accuracy of disability decisions and foster return to work at  all stages of the decision-making process. In 2000, SSA issued a plan  to develop an electronic disability folder and automated case processing  systems. While the Commissioner’s proposed approaches for improving the  disability determination process appear promising, challenges, including  automation, human capital, and workload growth, have the potential to  hinder its success. High examiner turnover. Gaps in key knowledge and skill areas. In closing, as stated earlier, SSA is at a crossroads and faces a number of  challenges in its efforts to improve and reorient its disability determination  process.
Why GAO Did This Study

Delivering high-quality service to the public in the form of fair, timely, and consistent eligibility decisions for disability benefits is one of SSA's most pressing challenges. This testimony discusses (1) the difficulties SSA faces managing disability claims processing; (2) the outmoded concepts of SSA's disability program; and (3) the Commissioner's strategy for improving the disability process and the challenges it faces.

What GAO Found

SSA is at a crossroads in its efforts to improve and reorient its disability determination process. Although SSA has made some gains in the short term in improving the timeliness of its decisions, we found that SSA's disability decisions continue to take a long time to process. Despite some recent progress in improving the timeliness of disability decision-making, individuals who initially are denied disability benefits and who appeal still have to wait almost an additional year before a final hearing decision is made. In addition, evidence suggests that inconsistencies continue to exist between decisions made at the initial level and those made at the hearings level. Also, SSA's disability programs are grounded in an outdated concept of disability that has not kept up with medical advances and economic and social changes that have redefined the relationship between impairment and the ability to work. Furthermore, employment assistance that could allow claimants to stay in the workforce or return to work--and thus to potentially remain off the disability rolls--is not offered through DI or SSI until after a claimant has gone through a lengthy determination process and has proven his or her inability to work. Further, the Commissioner has developed a strategy to improve the disability determination process, including the timeliness and consistency of decisions. While this strategy appears promising, we believe that several key challenges have the potential to hinder its progress, including risks to successfully implementing a new electronic disability folder and automated case processing systems; human capital problems, such as high turnover, recruiting difficulties, and gaps in key knowledge and skills among disability examiners; and an expected dramatic growth in workload.