Disability Programs:

SSA Has Taken Steps to Address Conflicting Court Decisions, but Needs to Manage Data Better on the Increasing Number of Court Remands

GAO-07-331: Published: Apr 5, 2007. Publicly Released: Apr 5, 2007.

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The Social Security Administration's (SSA) Disability Insurance and Supplemental Security Income programs provided around $128 billion to about 12.8 million persons with disabilities and their families in fiscal year 2005. Claimants who are denied benefits by SSA may appeal to federal courts. Through current initiatives, SSA is attempting to reduce the number of cases appealed to courts and remanded back to SSA for further review. In addition, there have been long-standing concerns about how SSA responds to court decisions that conflict with its policies. GAO was asked to examine: (1) trends over the past decade in the number of appeals reviewed by the courts and their decisions, (2) reasons for court remands and factors contributing to them, and (3) SSA's process for responding to court decisions that conflict with agency policy. GAO reviewed SSA data and documents on court decisions, remands and SSA's processes and interviewed agency officials and stakeholders on data trends, reasons for remands, and SSA processes.

Between fiscal years 1995 and 2005, the number of disability appeals reviewed by the federal district courts increased, along with the proportion of decisions that were remanded. More disability claims were remanded than affirmed, reversed, or dismissed over the period, and the proportion of total decisions that were remands ranged from 36 percent to 62 percent, with an average of 50 percent. Remanded cases often require SSA to re-adjudicate the claim, with the result that--along with the passage of time and new medical evidence--the majority of remanded cases result in allowances. According to SSA officials and outside observers, a range of errors prompted by heavy workloads is responsible for court remands of SSA's disability determinations, but data that would confirm or clarify the issue are incomplete and not well-managed. SSA has only recently begun collecting data on remands, and we found these data to be incomplete. Additionally, this information is collected by two different offices that have created somewhat different categories for the data, making some of the information inconsistent and possibly redundant. Meanwhile, SSA has acknowledged the need to reduce remands and, in 2006 along with other initiatives, introduced new decision-writing templates to improve efficiency and reduce errors. SSA has a process in place for determining whether appellate court decisions conflict with the agency's interpretation of disability statutes or regulations and has taken steps in recent years to align its national policies with appellate court decisions. For example, officials and stakeholders attributed a downward trend in appellate court decisions that conflict with agency policy to significant policy changes instituted by SSA in the mid-1990s. In addition, for those cases where the agency acceded to conflicting appellate court decisions by issuing acquiescence rulings within the related circuits, we found that about half of the rulings issued were eventually replaced with national policy. Moreover, GAO found that the timeliness of acquiescence rulings had improved since 1998, when SSA established a timeliness goal of 120 days.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To ensure the agency has accurate and well-managed information to use in identifying corrective actions for reducing remands, the Commissioner of SSA should take steps to ensure the reliability of data on reasons for remands.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: SSA reported that an update of its Case Processing and Management System (CPMS) in June 2007 required a mandatory input of the "remand reason" codes on all pending Appeals Council and court remands, thereby improving the completeness of data on reason for remands. CPMS can now generate reports for all pending Appeals Council and court remands by month at the national, regional, or hearing office level. Further, the Office of Appellate Operations (OAO) implemented the Appeals Review Processing System (ARPS) on March 3, 2008, providing the ability to track and run reports on Appeals Council remands, including reports on reason for remand using the coding provided by the Office of the General Counsel (OGC). By late 2009, OAO was able to run reports on court remands worked in OAO division offices, thereby replacing OGC as the tracker of these data. In July 2010, court remand data were being collected and some data had already been shared with the Office of the Chief Administrative Law Judge. By July 2011, SSA provided us with software documentation showing that OAO's ARPS had a mandatory field requiring SSA official to enter a reason for remands for each case, as well as a data report from this system showing a number of reasons for remands to cases.

    Recommendation: To ensure the agency has accurate and well-managed information to use in identifying corrective actions for reducing remands, the Commissioner of SSA should coordinate agency data collection on remands and ascertain how best to use this information to reduce the proportion of cases remanded by federal courts.

    Agency Affected: Social Security Administration

    Status: Closed - Implemented

    Comments: In June 2009, SSA reported that the Office of Disability Adjudication Review (ODAR) and the Office of General Counsel formed a working group to develop a plan to ensure the reliability of remand data, coordinate the collection of remand data, and improve the legal sufficiency of hearing decisions to reduce the proportion of cases remanded by the courts. In January 2011, in an effort to improve the overall quality of disability decisions made by all SSA adjudicators (including at the hearing appeals level), SSA established the Division of Quality within the Office of Appellate Operations to provide oversight of the decisions. According to SSA, the Division of Quality is responsible for establishing a plan for using data on court remands, among other information, to improve disability decisions. In 2010, in an effort to further enhance the consistency of decisions and minimize the number of remands in accordance with the above recommendation, ODAR implemented the Findings Integrated Templates (FIT) and began collecting data on the occurrence of remands for cases that were developed using this tool.

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