Articles from prior issues of The Advocate

January/February, 1998

Full Process Model
Presented by Terri Klubertanz, WI DDS, Ruth Black, GA DDS, Susie Pressley, PA DDS
by Al Kamnick, Illinois DDS


THIS TOPIC WAS COVERED WELL at the National Training Conference in Louisville, KY. Susan Daniels, Ph.D., (Associate Commissioner for Disability), Sue Davis, (Director of the Disability Process Redesign Team) and DDS Administrators Panel gave updates on the Full Process Model. This group shared their thoughts and feelings from their experiences of working with the model. Terri gave an overview of the model beginning with the Single Decision Maker. The Single Decision Maker no longer requires a doctor’s signature on a decision except for psychiatric denials and all disabled children’s claims. The doctor’s input is more of a consultant giving direction towards the correct decision than rubber stamping the completed decision. If the claim does not provide for an allowance, the claimant is entitled to a Pre-Decision Interview. This interview provides the opportunity for the claimant to meet with the decision maker before the decision is made. This provides time to explain the definition of disability, the medical evidence in file, the concept of duration, date last insured, etc. Also, the claimant is given the opportunity to submit additional medical evidence of record. As the reconsideration has been eliminated in the model, the claim would then proceed to the Office of Hearing and Appeals for the Administrative Law Judge’s decision. Between 4/97 and 12/97, thirty thousand cases will be processed by the designated cities. The Adjudicative Officer is assigned the case and can only make a fully favorable decision. Susie Pressley was an adjudicator for less than two years when she was introduced to this model. She has a backlog of 120 cases. She spoke most to the personal denial interview which is usually face-to-face but may be via telephone due to distance, nature of the impairment or potential for violence. The claimant is explained all aspects of reaching the decision and offered the opportunity to provide any additional evidence within 10 days. All SDM decisions are reviewed by DQB. Ruth Black has been affiliated with the DDS since 1973. Her focus was on the file was at the OHA level. The Adjudication Officer (AO) would review the file and order any additional testing that the ALJ might need to make the decision. The AO can only make a fully favorable decision. The claimant/representative may change the alleged onset which could provide for a fully favorable decision. If the AO cannot make a favorable decision, then the AO will prepare the summary of evidence to be presented to the ALJ for a decision. The concluding remarks covered some isolated statistics. Currently, it is taking DQB six weeks to process their reviews. In Georgia, it is taking about 88 days to process them through DDS. Wisconsin has processed 628 claims with a 51.6 allowance rate. Only 11 face-to-face personal denial interviews have been conducted. The balance of 159 were completed by phone. Again, it was pointed out that these are the earliest statistics and it is too soon to draw any conclusions.