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The Social Security Administration has not adequately addressed discrepancies in its disability benefits decisions despite a "process unification" initiative it began in 1994, according to a new Government Accountability Office report.

According to GAO, formerly the General Accounting Office, this inconsistency contributed to the watchdog agency's decision to list SSA's disability programs as a high-risk government program.

The report (GAO-04-646) cited a high number of claims denied by state Disability Determination Services, which make initial rulings on all disability claims, but allowed when the cases are appealed to SSA's administrative law judges. If an initial claim is denied by DDS, the claimant may request a review by a different team at the state agency. If denied again, he or she may appeal to an administrative law judge.

In 2003, ALJs approved 61 percent of the claims they reviewed. A high allowance rate at the hearings level may encourage claimants to file appeals, which are far more expensive to process than initial claims, the report said. Though disability benefits account for just 15 percent of SSA's program expenses, they represent 45 percent of administrative costs. In addition, the high number of appeals overburdens the system; it takes about a year to get a disability decision from an ALJ. About 2.5 million people file disability claims with SSA each year.

The agency began investigating the discrepancies between DDS and ALJ rulings in 1980, when Congress requested a study to investigate how well hearings decisions met legal requirements. The study found that ALJs allowed 64 percent of disability cases, while SSA's quality assurance reviewers said only 13 percent should have been allowed.

In 1994, SSA developed its process unification initiative, which included issuing consistent guidelines, providing training, conducting reviews of hearings decisions, and studying factors that contribute to inconsistencies. GAO found that while the agency had made some initial improvements, especially in training and guidance, the agency had largely abandoned its efforts, and after an initial improvement, ALJ allowance rates had climbed since 1999.

In September 2003, SSA Commissioner Jo Anne Barnhart unveiled an overhaul of the disability claims process that includes changes to improve consistency, such as requiring more complete documentation of decisions at the DDS level, and centralizing quality control and medical expertise. Some stakeholders question the availability of resources for these changes, GAO reported.

The new plan will not be put into place until SSA has rolled out its new paperless file system, the accelerated electronic disability system (AeDib), which should also contribute to improved consistency, according to the watchdog agency. GAO warned in an earlier report (GAO-04-466) that inadequate testing of the AeDib system could pose significant risks.

COMMENTS

• Having dealt with this agency and its' capricious crochets, I know all to well that it fails 90% of the time. Most who are denied simply make do. They have children and can recieve assistance or they just become part of the homeless in America or they are forced to move in with family and lose all independence. However, the system under G W Bush has gotten 200 times worse due to his desire to borrow money from the Social Security Trust Fund to pay for his wars. Wayne Dunn Posted January 15, 2008 11:23 PM
• Is there such a decision based on first time application, depending on the disibility such as: Residual anferior communicating artery aneurysrm, ruptured. 48 year old male, worked all his life and was working as a nurse with handicape childeren. He servived the ruptured with a coiling and a second operation with another aneurysrm that was clipped off. All of this took place in Jan of this year and the last surgery in April and he also suffered a stroke that left his left side limp but not paralyzed. He applied for SSD in July afer benefits ran out from job... six months of disibility. He still have not heard from SSD. Is there a posiblity that he is going to be awarded monies with out being denied? Belinda, Posted December 5, 2007 10:32 PM
• I find your article on Social Security disability very interesting. It has been known for years that an individual, in order to obtain a needed disability, had to do four steps. Step 1, apply and be denied, step 2 appeal and be denied, step 3 get a lawyer who specializes in Social Security appeals to file a second appeal, and Step four be approved, usually with back pay. The first application is automatically denied because there are not any medical people, the second on is because of the first. The third step of getting an attorney means you are serious and really need this, thus the approval in step four. Jimmie Grimes Posted November 8, 2004 8:32 AM