Articles from prior issues of The Advocate

July/August, 1996

SSA REDESIGN: A DESIGN FOR DISASTER
A Position Paper by the South Dakota Assn. of Disability Examiners

THE SOCIAL SECURITY ADMINISTRATION (SSA) HAS received extensive criticism regarding prolonged case processing times, differences in the number of allowances at each level and the cost o f administering the program. To deal with this criticism a task force was put together to “REDESIGN” the system. We as Disability Professionals and members of the South Dakota Association of Disability Professionals believe that the Redesign Process has MAJOR FLAWS. Disability Professionals, congressional Leaders, Governors, the General Accounting Office and most importantly, Disabled Americans have all voiced concerns about how Redesign will negatively impact efficiencies, timeliness, delivery of service and dramatically increase costs. Since 1954, SSA has been required by law to have the states make medical and vocational decisions regarding who is disabled for Social Security Administration purposes. If a claim is denied by the states at the INITIAL and RECONSIDERATION levels, the claim may be appealed to the Administrative Law Judge (ALJ) level. At the ALJ level it becomes federal jurisdiction. It currently takes at least a YEAR(!) to get an ALJ decision while nationally a DDS Professional provides the claimant with a decision in less than 70 days on average. In South Dakota, a decision is made within an average of 45 days. The ALJs and the DDSs use entirely different methods to adjudicate claims. ALJs use court precedent and the discretion of the individual judges, whereas DDSs strictly apply SSA medical criteria. SSA scrutinizes DDS work but has virtually no controls on how the ALJs apply the program and to whom they allow disability benefits. This is the reason for the great disparity of the allowance rates in the ALJs (75%) and the DDS (25% INITIAL and 10% RECONSIDERATION). The lack of timely decisions, the disparity of allowance rates, and skyrocketing costs are the major flaws in the Disability Process. This is a nightmare to those applying for benefits and a major source of embarrassment to state disability professionals. To address the huge ALJ backlogs, the Federal Government has created a pilot program which introduces the new position of ADMINISTRATIVE OFFICER (AO). Not only does this involve an increase in wages, but AO’s are paid thousands of dollars in the form of very generous per diem. It also adds another layer of federal bureaucracy and great expense to the taxpayer. Under the Redesign Plan a new player is brought into the game-the DISABILITY CLAIMS MANAGER (DCM). DCMs would be responsible for the claim from beginning to end, replacing the Disability Examiner and SSA Claims Representative (CR). At first glance, this might appear to be a cost and time saving initiative, BUT we believe it will actually increase costs and processing times. Where will these DCMs come from? CR’s with limited knowledge of the medical/vocational aspects of the disability program will receive a very short training course that has not yet been formulated. DISABILITY EXAMINERS receive a minimum of 2 years training and on the job experience before being able to function independently. CRs and other federal employees with very minimal knowledge of the disability program will be given an $800 per month raise to perform a job that is already being done by state agency professionals at half the wage (SD DDS Professionals at less than one-half the wage). Is the creation of the DCM rational in terms of better processing of disability claims? We don’t believe so! SSA has spent over 40 years developing a specialized position in state agencies. Redesign will jeopardize the very core of the disability program, which is the highly trained and experienced State Disability Examiner. State Agencies are still trying to determine the goal of the Redesign Disability Program. WHAT DOES SSA WANT? Do they want the decision based on subjective complaints of disability (ALJ/AO method) OR objective medical findings as defined by statute (DDS method)? If the goal is to allow claims on subjective complaints, the state agencies are capable of performing this task at a much lower cost and in a more timely fashion, thus better serving the disabled and the taxpayer. We believe there is a problem with the disability process as it currently exists, but the proposed “redesign” does not address this. Major FLAWS, as we see things, do not exist in the INITIAL and RECONSIDERATION stages, but at the ALJ level. We believe that the way the ALJs (and AOs) adjudicate claims must be changed to be consistent with SSA directives in order to save the integrity of the program. The redesign process with its DCMs, instead of dealing with the flaws, will wreck the part of the process that is basically sound. The real losers are the general public. The end result is expected to be a massive influx of people on the SSA Disability rolls at a cost of billions of dollars a year, a massive increase in cost of administering the program and a general loss of integrity of the program. Those representing the American people and those advocating STATES EMPOWERMENT have serious reservations about the direction redesign is going. SSA HAS NOT come up with a FASTER, CHEAPER OR MORE RELIABLE system with which to do business.