Public Safety Officers' Benefits Program: Improvements Made but Information on Performance Goals Still Needed
Released: 2016-04-26T00:00:00

Letter

Background

The PSOB program provides death, disability, and education benefits to eligible public safety officers and their families in the event of the officer’s death or permanent and total disability in the line of duty. To qualify for program benefits, claims must be associated with an officer who worked for a public agency in one of the following official capacities: rescue squad or ambulance crew; employee of the Federal Emergency Management Agency (FEMA) who is responding to a federally declared disaster or emergency; state, local, or tribal officials who are working in cooperation with FEMA during a federally declared disaster or emergency; or fire or police department chaplain.

Eligible survivors—including spouses, children, and surviving parents— may qualify for death benefits if an officer’s death was the direct and proximate result of an injury sustained in the line of duty. To qualify for disability benefits, the public safety officer has to be permanently and totally disabled as the direct result of catastrophic injury sustained in the line of duty that permanently prevents the individual from performing any gainful work. An officer’s spouse or children may also qualify for education benefits only after the officer’s eligibility for death or disability benefits has been established.

The PSOB program is administered by the PSOB Office, a unit of the Bureau of Justice Assistance within DOJ’s Office of Justice Programs. At the time of our 2009 report, it employed a total of 10 staff, including the program director. In fiscal years 2006 through 2008, a total of 1,632 PSOB claims were filed through this office. The majority, or about 57 percent, were death claims; about 32 percent were education claims; and about 11 percent were disability claims.

As we reported in 2009, claimants were required to submit documentation to the PSOB Office for each type of claim. Typically, the officer’s employer (i.e., the state or local agency for which the officer worked at the time of death or disability) assisted with filing death and disability claims on the officer’s behalf, while claimants generally file for education benefits on their own. Advocacy organizations may also have assisted. Upon receipt of all the required documentation, a PSOB benefits specialist reviewed the claim and its supporting documentation and drafted an initial determination on whether to approve or deny the claim. This draft determination was then reviewed by a senior benefits specialist, the PSOB director, and the Office of Justice Program’s Office of the General Counsel (referred to in this testimony as the “legal review” or the “attorneys’ review”) before a final determination was rendered.

Furthermore, some death claims were reviewed by a contracted pathologist and all disability claims were reviewed by independent medical reviewers of various medical specialties and subspecialties who provide additional information as to whether claims meet medical standards for eligibility. A claim may have gone through different phases of the process multiple times if at any phase DOJ officials determined that more information may be needed to make a determination.

In 2009, GAO Identified Issues with Timeliness of Claims Processing, Program Awareness, and DOJ’s Monitoring of Program Performance

Death and Education Claims Were Processed Faster Than Disability Claims

Based on the sample we used for our 2009 report, we estimated that the PSOB Office closed and approved the different types of claims at varying rates. Specifically, the office closed 78 percent of death claims and approved about 80 percent of those closed claims that were initiated in fiscal years 2006 through 2008. For education claims initiated over the same period, the office closed and approved all of those claims. In contrast, only 31 percent of disability claims were closed during the period we reviewed. Moreover, we could not reliably determine their approval rate due, in part, to the significantly longer time frame to process disability claims (see fig. 1)

With regard to the first phase of the claims process—length of time between the date of death or disability and when the PSOB Office began to process the claim— we reported in 2009 that the average length varied significantly by type of claim. Specifically, the average length was 7 months to a year for death claims, 4 to 6 years for disability claims, and 7 to 10 years for education claims associated with approved death claims. PSOB officials told us that several factors may affect the length of this phase of the claims process, including claimants’ difficulty with obtaining necessary documentation to prove eligibility and lack of awareness about the program.

Similarly with regard to the second phase of the claims process—length of time between the date the PSOB Office received the claim to sending a final determination letter to the claimant—our 2009 report found that the average length also varied by type of claim. Specifically, the average length of time was 4 to 6 months for education claims, 9 to 13 months for death claims, and 17 to 26 months for disability claims (see fig. 2).

Officials explained that disability claims were generally more challenging and may have taken longer to process than death and education claims, in part because eligibility was based on adequate medical documentation from the claimant and an independent medical review by Bureau of Justice Assistance contractors. Disability claims decisions were also three times more likely to be appealed than death claims, which also contributed to longer processing times.

We were unable to identify which steps of the claims process were most time-consuming because the claims files in the sample we reviewed in 2009 did not include reliable documentation regarding when claims passed through each step of the process. For example, the PSOB Office did not consistently document the dates of the attorneys’ reviews nor did it document the dates of the contractors’ medical reviews. However, based on our sample, we found in 2009 that the overall length of time from occurrence of death or disability to the claimant’s receipt of a final determination took an average of 16 to 21 months for death, 60 to 92 months (or 5 to about 7.5 years) for disability, and 96 to 126 months (or about 8 to 10.5 years) for education claims. At the time of our report, most of these claims were being processed on paper but the PSOB office had plans to and subsequently implemented an automated information management system in an effort to help ensure efficient claims processing and improve available data on claims.

In 2009, Public Safety Organizations In Selected States Expressed Concerns about Program Awareness, Difficulties Establishing Eligibility, and Perceived Long Wait Times for Benefits

In 2009, we reported that state and local officials from police and fire department and other public safety officer organizations did not always know about PSOB program benefits, particularly disability and education benefits. In particular, representatives of 15 of the 44 organizations we spoke with mentioned a lack of awareness about disability and education benefits, while officials from another 6 organizations were concerned that their constituents had a general lack of knowledge of the PSOB program. The general lack of awareness tended to pose a particular problem among smaller rural and volunteer departments. The lack of awareness also had an adverse effect on some claimants. For example, an official representing a local police officers’ union mentioned that a local police department unfamiliar with the disability benefits did not seek benefits on behalf of a severely and permanently disabled officer until the officer happened to seek educational assistance for his child. Officials from some public safety officer unions and the PSOB program said that they were more focused on promoting awareness of death benefits. Officials from the five selected states we reviewed in 2009 also told us that submitting all the necessary paperwork to prove eligibility was difficult and could be time-consuming. For example, according to local officials we interviewed, the application process could be delayed by long wait periods to obtain accident reports, medical records, and birth records. In one case, an official from a firefighters’ employee association in New York stated that an officer’s family had to wait 6 months before they could submit a death claim. Outdated beneficiary forms could have also delayed claims processing, and Office of Justice Programs officials acknowledged that sometimes the PSOB Office lost claim files. PSOB officials noted that they planned to address this concern by automating the claims process using an online application form.

In 2009, officials most frequently expressed concern about perceived long wait times for receiving benefits and also reported difficulties obtaining information about claims status. A local police department official explained that relatively long wait times for PSOB benefits can impose a financial burden on families. A few state and local officials also expressed concern that the PSOB Office did not inform claimants or agencies of how long the claims process was expected to take. PSOB officials told us that the program provided information on what stage the claim was in the review process but not the estimated time frames for processing claims because they varied widely based on each claim’s circumstances.

DOJ Did Not Monitor PSOB Program Performance in 2009

At the time of our 2009 report, the PSOB Office had not followed government guidelines for performance monitoring. All federal executive branch agencies are required by the Government Performance and Results Act of 1993 (GPRA) to set strategic goals, measure performance, and report on the degree to which goals were met in an effort to ensure government accountability and enhance public awareness about agencies’ accomplishments. Agencies are also subject to the Federal Managers’ Financial Integrity Act of 1982, which requires that they establish and maintain systems of administrative controls. GAO and the Office of Management and Budget have established guidelines for implementing these two acts. The guidelines include establishing goals and performance measures, monitoring progress—including collecting reliable data on program outcomes—and communicating program operations and outcomes to relevant stakeholders such as Congress and the public, including program participants.

In 2009, we reported that DOJ had not set strategic goals and measures related to GPRA for the PSOB Office and therefore did not track or report such information to the public. As a result, the program had little accountability. Officials said that the program was not subject to strategic planning and goal setting because it was considered a payment program and its budget was largely mandatory. However, we noted that other federal programs that provide benefits after work-related injury and illness have established performance measures, such as ones for claims- processing timeliness, and reported their results publicly. While the PSOB program lacked GPRA-related strategic goals and performance measures, a 2004 Attorney General memorandum established two claims-processing goals. However, at the time of our 2009 report, the PSOB program director stated that the office did not track the memorandum’s first goal of processing claims within 90 days of receiving all necessary documentation because it lacked automated data that would have enabled the program to establish a baseline against which to gauge progress. As for the second goal, an official in the Office of Justice Programs’ Office of the General Counsel told us that their office had not established mechanisms to monitor whether the attorneys reviewed claims within 45 days of receiving all necessary documentation.

Our 2009 report concluded that a more focused and systematic approach to managing the PSOB program could help ensure that the office achieves its goal of effectively and efficiently administering benefits that honor the work of many public officers who are killed or injured in the line of duty. To strengthen PSOB’s accountability and enhance awareness of the program and its benefits, we recommended in 2009 that the Bureau of Justice Assistance establish appropriate performance goals and measures and use reliable data to monitor and publicly report on the program’s performance. DOJ agreed with these recommendations.

PSOB Office Has Taken Some Actions to Monitor Performance Since 2009, but a Recent OIG Report Identified Continuing Problems

DOJ has taken steps to implement program improvements. By 2014, we observed that the Bureau of Justice Assistance had posted two PSOB performance measures and related data on its public website in consultation with public safety stakeholder groups: average time for the PSOB program to receive basic required documents, and average time for the PSOB program to determine a claim. The Bureau subsequently posted additional performance measures on its public website, including average number of days to assign a PSOB Outreach Specialist and percentage of claims determined within 1 year. While posting data on these performance measures represents an improvement, as of April 2016, the Bureau of Justice Assistance has not taken the additional step of publishing performance goals—which specify the desired level of performance—for the PSOB program. We continue to believe that the Bureau of Justice Assistance should publish performance goals to help the public gauge how well the program is working and enhance stakeholder awareness of the program.

In addition, in its July 2015 report, DOJ’s OIG raised questions about claims processing times and performance measurement. Specifically, the report identified three primary factors that contributed to significant delays in processing death and disability claims: (1) claimants filing incomplete claims applications due, in part, to inadequate program guidance, (2) claimants and agencies being unresponsive to the PSOB Office’s request for additional information, and (3) the PSOB Office not adequately documenting the basis for its initial determination, which caused delays during the legal review phase. The OIG also determined that the PSOB Office had not reported annual and appropriate data on its performance measures and noted issues with the data’s reliability. For example, the OIG found the PSOB Office’s database was inconsistent and did not include data fields for important claims processing milestones, such as the date claimants submit applications and the PSOB submits claims for legal review. The OIG concluded that it did not believe that the PSOB Office’s database, as a management tool, was adequate to evaluate efficiencies in processing or to identify potential causes of timeliness problems. The OIG made four recommendations to DOJ to address these findings, and DOJ agreed with all four recommendations.

In conclusion, the work of GAO and the OIG highlights difficulties DOJ has encountered in working to improve performance measurement for the PSOB program. While DOJ has taken some steps to address these issues, continued attention is needed to help ensure accountability for achieving program goals.

Chairman Grassley, Ranking Member Leahy, and Members of the Committee, this concludes my statement. I would be pleased to respond to any questions you may have.

GAO Contact and Staff Acknowledgments

For further information regarding this testimony, please contact me at (202) 512-7215. Key contributors to this testimony were Holly Dye, Meeta Engle, Danielle Giese, Avani Locke, Lorin Obler and Almeta Spencer.

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