Social Security:

Selective Face-to-Face Interviews With Disability Claimants Could Reduce Appeals

HRD-89-22: Published: Apr 20, 1989. Publicly Released: Apr 25, 1989.

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In response to a congressional request, GAO provided information on certain aspects of the Social Security Administration's (SSA) appeals process, including: (1) the reasons for administrative law judges' (ALJ) high reversal rates for state disability determination services' (DDS) decisions; and (2) suggestions for improving the SSA appeal process.

GAO reviewed state DDS decisions for 1986, and found that: (1) ALJ reversed over 60 percent of DDS denials of benefits; (2) ALJ questioned benefit claimants extensively during hearings and determined that their functional capacity was more limited than DDS had determined; (3) most claimants appealed DDS decisions, and were often represented by attorneys on a contingency-fee basis; (4) ALJ generally requested medical advisers' and vocational experts' opinions and often sent claimants to independent physicians for medical examination; (5) ALJ usually reversed DDS determinations in cases involving older claimants; and (6) ALJ less frequently reversed determinations in cases where state DDS conducted personal interviews with claimants at the reconsideration stage of the appeal procedure.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: SSA believes that its comprehensive pilot project removes the need for the recommended separate demonstration project. SSA's pilot project includes five models: (1) a disability specialist position; (2) a claim-intake interview performed by a decisionmaker; (3) a predenial interview; (4) a reconsideration model; and (5) elimination of reconsideration. The first model is under way in Wilmington, Delaware, to test the use of a disability specialist position.

    Recommendation: The Secretary of Health and Human Services should direct the Commissioner of Social Security to initiate a demonstration project that would include interviewing selected categories of claimants at the reconsideration stage. Such a project would differ from ongoing demonstration projects by focusing on those categories of claimants most likely to be approved by ALJ. By interviewing specific categories of claimants at the reconsideration stage, the number of such interviews could be kept manageable. Through quality assurance reviews of the resulting decisions at the reconsideration stage, SSA could determine whether the interviews were resulting in unwarranted benefit awards.

    Agency Affected: Department of Health and Human Services

 

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