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1994.09.07 : Social Security Disability Procedures

Contact:  Phil Gambino or Tom Margenau       (410) 965-8904
Wednesday, Sept. 7, 1994
          
           SOCIAL SECURITY OVERHAULS DISABILITY PROCEDURES


     Social Security Commissioner Shirley S. Chater today announced
plans for a new, user-friendly and cost-effective disability
application process that, when fully implemented, will represent the
most sweeping procedural changes ever instituted in SSA's 38-year
history of processing disability cases.  

     "One of my major goals," Commissioner Chater stated, "is to
provide world class service to all our customers.  We simply are not
able to do that with the current disability procedures that were
established, in large part, during the 1950s."  

     Chater indicated those procedures are characterized by
"excessive delays, endless paper shuffling and bewildering
procedures."  

     "All those problems can be eliminated with the comprehensive
procedural changes I am announcing today," Chater said.

     Some of the major changes in the new disability claims process
that Chater announced today include:

o    personalizing the process by assigning one employee who is   
     knowledgeable about the case to be the principal contact;

o    allowing disability applicants to become more directly   
     involved in the claims process by showing them ways they can   
     help obtain medical evidence to support their case;

o    eliminating an interim appeal step so that a person whose   
     claim is denied can immediately file for a hearing; and

o    empowering an "adjudication officer" with the authority to   
     approve a claim on appeal if the evidence warrants it before   
     the claim reaches the hearing judge.

     According to Chater, the plan, when fully implemented, will
reduce the number of employees required to handle a disability claim
from 26 to eight, and reduce the time it takes to process that claim
from 155 days to no more than 60 days.  In the event the claim is
appealed, it also will reduce the number of people who would have
handled the case from 45 to 14 and reduce the time it takes to
process that administrative appeal from two years to about five to
seven months.

     Chater recently created a Disability Implementation Task Force
that has already begun the extensive planning needed to make the new
disability process a reality.  The changes are expected to be made
over a period of five years beginning later this year.   

     "We are committed to moving as quickly as possible, but such
fundamental changes cannot be made overnight," Chater cautioned. 
For instance, some aspects of the plan will require extensive
research and testing before implementation.  Other proposed changes
will require legislative action and many changes will be implemented
through the regulatory process to allow for public comment before
implementation.  

     Although the two disability programs administered by SSA--the
Social Security Disability Insurance program and the Supplemental 
Security Income (SSI) program for low-income individuals--accounted
for less than 20 percent of SSA's 45 million beneficiaries last
year, the claims processes for these two programs required the use
of more than half of SSA's administrative budget of $4.9 billion.  

     In addition, SSA has reached a critical juncture:  applications
for disability benefits have reached all time highs, the level of
service provided to the American public is unacceptable, and
additional administrative resources are unlikely in an era of
federal spending limitations and competing social spending
priorities.   

     "What we need," Commissioner Chater said, "is radical change--
to rebuild the procedures from the ground up--in order to produce
dramatic improvement in customer service."

     Ten months ago, Chater put together a "disability reengineering
team" comprised of some of SSA's most experienced and knowledgeable
disability experts, including representatives of SSA's field offices
and the state agencies that make initial disability decisions for
Social Security.  Following the release of a preliminary report in
March, they sought public comment and presented Commissioner Chater
with a final report incorporating those comments last month.  

     "I am extremely proud of the team's work," Chater said. 
"They've put together a plan that cuts red tape, eliminates layers
of bureaucracy and, most important, allows the disability applicant
to become more involved in the process."

                              #  #  #

(See attached fact sheet for more information)
                        SOCIAL SECURITY'S PLAN
                 FOR A NEW DISABILITY CLAIMS PROCESS


Background:  The Social Security Administration (SSA) has released a
plan to dramatically improve the agency's disability determination
process.  When fully implemented, this new process will facilitate
better and faster service for the millions of individuals who apply
for Social Security and Supplemental Security Income disability
benefits each year.  The new process is not intended to affect
individuals currently receiving disability benefits.  A copy of a
full report describing the new process and the extensive work SSA
did to develop it can be obtained by calling 1-410-966-8255 or by
writing to SSA, Disability Process Reengineering Project, P.O. Box
17052, Baltimore, Md. 21235.

SSA will move quickly to begin implementing the new process.  Some
new process features, involving research and changes to regulations
and computer systems, necessitate a phased-in approach.  Other new
process features can be implemented in the near-term and, when
combined with special short-term initiatives to address case
backlogs, will result in better service for individuals currently
filing for disability benefits.  As implementation progresses, SSA
will seek input from employees, consumers, advocates, and medical
and legal experts, will test and refine all process changes, and
will conduct a full and open dialogue with all interested parties. 

Key Features Of The New Disability Determination Process:

Better Applicant Access and Service:  SSA will accept applications
and appeals from individuals in the manner that best suits their
needs--through toll-free telephone service, face-to-face meetings in
local offices, the mail, electronic mail, or with the assistance of
third-parties.  SSA will  accommodate applicants with special needs. 
Throughout the initial application process, applicants will deal
primarily with a single disability claim manager who will be both
fact-finder and decision-maker on their claim for benefits,
resulting in more personalized service.

More Applicant Participation:  SSA will be more consumer-oriented,
and will share comprehensive information about the disability
program and the disability determination process with applicants for
benefits.  In addition, SSA will show applicants who are able (and
their families) how to help SSA obtain complete and timely evidence
to decide their claims.


Efficient Evidence Collection:  All disability determinations will
be based on accurate supporting evidence.  SSA will use information
available from treating sources whenever possible and will only
collect information that is essential to the decision-making process
on each individual case.  Evidence collection will be simplified
through use of standard formats, electronic interfaces with
providers, incentive fee arrangements with providers, and also the
informed participation of the applicant.

Simplified Disability Determination Methodology:  SSA is not
proposing any changes to the definition of disability as described
in existing law, but the methodology used to determine if an
applicant meets eligibility criteria will be simplified.  Extensive
research and testing will be necessary to refine key elements of the
simplified disability methodology.

Predecision Contact:  When evidence in the claim file does not
appear to support the approval of an initial claim, SSA will notify
the applicant before making a decision.  The applicant will be told
what evidence is currently being evaluated and will have an
opportunity to submit additional evidence and/or talk further about
his/her claim.

Process Streamlining:  SSA's current four-step administrative
process will be streamlined to two levels.  Applicants who receive
an initial claim denial (level one) will have 60 days to request a
hearing before an independent Administrative Law Judge (level two). 
An employee called the adjudication officer will provide applicants
(and/or their representative) with an explanation of the hearing
process and will work to obtain any new evidence and to narrow the
issues in the claim.  The adjudication officer will have authority
to issue a revised favorable decision before the hearing if the
evidence warrants.

Comprehensive Quality Assurance Program:  The new disability
determination process will have a comprehensive quality assurance
program that includes an increased investment in education and
training for employees, a systematic case review process, and
ongoing tracking of customer satisfaction regarding the service they
receive.  Also, to ensure consistent determinations, all employees
will use a single reference source containing all substantive
policies as guidance in making disability decisions.

Technology As Enabler:  Expanded use of information technology will
be a vital enabler of the new disability determination process. 
SSA's disability case processing computer system will be seamless,
comprehensive, and standardized with all employees utilizing the
same hardware and software from all locations.  Expert systems
integrated into the software will facilitate claim intake, evidence
development, and case adjudication.  The disability claims file will
be virtually paperless, and modern business aids such as FAX,
electronic mail, videoconferencing, and document imaging will be
routinely utilized by employees, applicants, and evidence providers.

SSA's New Disability Claim Process Will:

o    Be user-friendly, accessible and customer-focused, and ensure
     that benefits are paid to all eligible individuals as quickly
     as possible.  Case processing times will be cut in half once
     the new process is fully implemented;

o    Provide complete and accurate consumer-oriented information to
     applicants throughout the process and allow individuals who are
     able to be full partners in the processing of their claim;

o    Utilize modern technology and highly skilled and trained
     employees to deliver high-quality service in an accountable,
     cost-efficient manner;

o    Implement a comprehensive quality assurance program that
     continually strives to improve operational excellence and the
     level of service that disability applicants receive; and 

o    Use educational and training opportunities to enrich employees'
     jobs, increase their job satisfaction and quality of work life.

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