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An Operational Approach to Eliminating Backlogs in the Social Security Disability Program

by Gerald Ray and Glenn Sklar

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Introduction

Applicants seeking disability payments from the Social Security Disability Insurance (SSDI) program reside in every state and congressional district. While there may be varying levels of political support for the program, the authors believe that as long as the Social Security Administration (SSA) administers the program, the agency should provide timely service at all levels of the administrative process to applicants who file and appeal claims with the agency. This paper will describe effective ideas and techniques that SSA can employ to reduce claim processing times for claimants awaiting a hearing and decision on their disability claims.

The process of seeking disability payments begins when an applicant files a claim. Generally, the applicant’s claim is initially adjudicated by the Disability Determination Service (DDS) responsible for the state, district, or territory in which the applicant resides. The applicant, or claimant, may request reconsideration of the initial determination in most areas of the country if dissatisfied with the determination issued by the DDS and may request a hearing if dissatisfied with the reconsideration determination.1 The agency provides the claimant an additional administrative appellate step, the filing of a request for review of the hearing decision with the Appeals Council, if the claimant is dissatisfied with the hearing decision. Thereafter, a claimant may appeal to federal district court.

Agency processing of a request for hearing is multi-staged and usually includes the gathering of additional evidence, the scheduling of expert witnesses, the scheduling of a hearing, the holding of the hearing, the drafting of the hearing decision, and the issuance of that decision. Different staff members are actively engaged in different parts of this process, so an inventory of cases at each step in the process is necessary to keep the staff fully engaged and productive. Increasing queues at any of these steps can be considered a backlog. Similarly, backlogs can develop at the next step in the appellate process, when dissatisfied claimants appeal hearing decisions to the Appeals Council. Simply put, backlogs in the Social Security disability program are created when the available staff is insufficiently productive to keep pace with receipts and pending workload levels, which can cause claimants to wait an inordinately long time to have their cases heard and decided. 

Regulatory and due process requirements build some time into the process to ensure that claimants receive timely notice of agency actions relating to their cases, ample time to submit evidence and briefs, and sufficiently advanced notice to plan for attendance at the hearing. The point where the number of disability claims awaiting adjudication exceeds a reasonable pending inventory and becomes a backlog is not precise but rather is dependent upon the number of adjudicators available to process the claims and the length of time considered reasonable for claimants to wait before being granted a hearing or receiving a decision. Some judgment related to the reasonableness of the average wait time is necessary in assessing whether a backlog exists. Currently, the agency calculates the hearing backlog to be the number of cases in excess of the number of cases it anticipates it can process within 270 days. 

In recent years, the number of claimants awaiting a hearing peaked at more than one million, with wait times exceeding 1,000 days in some SSA hearing offices.2 Applicants trapped in extensive backlogs risk losing homes, vehicles, and/or private health insurance. If applicants attempt to work, they may compromise their likelihood of prevailing on their claim. If they do not work while they wait for a decision, they may face potential economic calamity. After spending a year or two in a queue for disability benefits, the job prospects of denied disability applicants may suffer.  

Backlogged applications also are more expensive to adjudicate and process. With the passage of time, backlogged cases often accumulate significant amounts of additional medical evidence, including duplicative evidence, thereby complicating review of the claim prior to hearing. Waiting applicants may actually age into more generous adjudication criteria, as SSA regulations have discrete cut points at various ages (e.g., 55 years old) that enhance entitlement prospects.3 In such instances, delays directly translate into Federal benefit awards. In short, the faster applications move at the hearing level, the better it is for all parties, including the applicant, the Federal Government and the taxpayers. 

The authors believe that backlogs in the SSA disability program historically have arisen from five principle causes:

  • Economic or Demographic Factors – surges in unanticipated receipts due to economic downturns and/or demographic shifts;
  • Litigation – court precedent and class action litigation that resulted in the re-adjudication of claims, either by court decree or by issuance of new policy guidance to conform agency adjudication with court precedent;
  • Insufficient Staffing – prolonged periods of inadequate staffing, sometimes caused by inadequate funding but sometimes exacerbated by delayed hiring or improper positioning of existing staff;
  • Loss of Productivity – declines in productivity, which have had multiple interrelated causes; and
  • Programmatic changes – legislation that expanded the potential universe of recipients or significantly altered the way in which claims are adjudicated.

The causes of backlogs are varied and, to some degree, created by circumstances that are not entirely within the direct control of the agency. This paper will focus on recommended solutions the agency could adopt and implement to reduce current backlogs, mitigate their effects on the disability claimant population, and retard the creation and growth of backlogs in the future while continuing to produce high quality work products. Many of these ideas have a proven track record as they were developed and implemented successfully by the authors while running the Office of Disability Adjudication and Review and the Office of Appellate Operations within SSA. This paper will address the various ideas in five parts:

  • Staffing, Performance Management, and Training – a description of how thoughtful allocation and management of staff and improved training techniques can enhance productivity.
  • Decisional Support Tools and Data Analytics – a description of the development of various decisional support tools and how their use can enhance productivity by standardizing case review processes, and a description of how data analytics can uncover hidden problems in case adjudication. 
  • Case Screening Initiatives – a description of how the use of differentiated case management, queueing theory, and naïve Bayes analysis can improve productivity.
  • Quality Assurance Efforts – a description of how quality assurance and direct feedback to employees about the quality of their work can change behaviors, promote improved quality, and prevent and detect fraudulent conduct.
  • Policy and Computational Law – a description of how policies can be designed to better promote common understanding of the policies by adjudicators, simplify case adjudication, and enhance opportunities for applying natural language processing to disability adjudication. 

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1 SSA tested the elimination of the reconsideration step in the appellate process in ten states. In those states, claimants dissatisfied with the initial DDS determination could directly file a request for hearing. The testing ended in five states in January 2019 and is scheduled to end in the remaining states in June 2020. See 20 CFR 404.906 and 416.1406, 64 FR 47218 and 83 FR 63965. Federal Register notices available at https://www.federalregister.gov/documents/1999/08/30/99-22421/modifications-to-the-disability-determination-procedures-disability-claims-process-redesign, and at https://www.federalregister.gov/documents/2018/12/12/2018-26803/modifications-to-the-disability-determination-procedures-end-of-the-single-decisionmaker-test-and. Last visited April 5, 2019.

2 The Office of the Inspector General published a graphical representation of the growth in the pending workload at the hearing level from 1993, when 357,564 claimants had pending requests for hearing, to 2016, when 1,114,079 requests for hearing were waiting in the queue. See https://oig.ssa.gov/sites/default/files/audit/full/pdf/A-05-16-50207.pdf, at page 1. Last visited January 26, 2019.

3 See 20 CFR 404.1563 and 416.963.