NADE petitions for a new disability claims process

Jeffrey H. Price, President
Post Office Box 243
Raleigh, North Carolina 27602-0243
Phone 919.212.3222 or
800.443.9359, ext. 4056
Fax 919.212.3155

February 26, 2002

Ms. JoAnne Barnhart, Commissioner
Social Security Administration
500 E Street, S.W.
Suite 850

Washington, D.C. 20254

Dear Commissioner Barnhart:

On behalf of the National Association of Disability Examiners (NADE), I would like to express our appreciation for your willingness to take time from your busy schedule to meet with NADE’s executive officers last week. We are encouraged by your commitment to resolve the issues that confront the disability program and we renew our pledge of support to assist in that endeavor.

We agree that prototype does not represent the future for the disability claims process. However, we believe that there were successful components in that process and these components can be utilized in a new model that emphasizes customer service delivery but recognizes the necessity of being affordable. As we promised, NADE has developed a design for a disability claims process that emphasizes these factors. It places additional emphasis on more early contact with the claimant. We believe this is the focal point of good customer service and adds quality to decision making. We are pleased to submit this proposal for your consideration.


Jeffrey H. Price
Jeffrey H. Price, President
National Association of Disability Examiners

cc: Martin Gerry, Deputy Commissioner for Disability and Income Security Programs
Linda McMahon, Deputy Commissioner for Operations
Ken Nibali, Associate Commissioner for Disability
Social Security Advisory Board
Social Security Subcommittee, U.S. House of Representatives

NADE Proposal for New Disability Claims Process

1. Intake of new disability claims at the Social Security Field Office would not be significantly altered from the current practice with the following exceptions:

a. Greater emphasis would be placed on the inclusion of detailed observations from the claims representative.

b. The claimant would be provided with a clear explanation of the definition of disability by the claims representative. The definition would also appear on the signed application.

c. SSA’s web site should clearly indicate that this is a complex process that would be better served if the claimant filed the application in person at the Field Office.

d. Quality review of the Field Office product would be added to demonstrate SSA’s commitment to build quality into the finished product from the very beginning of the claims process.

e. SSA’s outreach activities would combine education with public relations. The Agency’s PR campaign would remind potential claimants of the definition of disability with the same degree of enthusiasm as the Agency’s efforts to encourage the filing of claims.

f. Greater emphasis would be placed on claimant responsibility.

2. DDS receipts the new claim and assigns the claim to a disability examiner. The Disability Examiners initiates contact with the claimant to:

a. The Disability Examiner will verify alleged impairments, medical sources and other information contained on the SSA-3368.

b. The Disability Examiner will provide a clear explanation of the process and determine if additional information will be needed.

c. The Disability Examiner will inform the claimant of any need to complete additional forms, such as Activities of Daily Living questionnaires.

3. Expand the Single Decision Maker (SDM) concept to:

a. Include more claim types

b. Allow more disability examiners to become SDMs

c. Standardize national training program for all components of the disability process

d. Establish uniform criteria for becoming SDMs

e. Standardize performance expectations for all components of the disability process

4. If the initial claim is denied by the DDS, the denial decision will include an appeal request with the denial notice that the claimant may complete and return to the DDS.

a. The requirement for a clear written explanation of the initial denial will remain a major part of the adjudicative process.

b. Process Unification rulings should be reexamined and, if necessary, modified to clarify how the initial disability examiners should address credibility and other issues.

c. Claimant responsibility will be increased in the new process

5. The denied claim will be housed in the DDS for the duration of the period of time the claimant has to file an appeal. During this period of time, claims could be electronically imaged (with adequate resources – this would further the electronic file concept).

6. The appeal of the initial denial will be presented to the DDS. Upon receipt of the request for an appeal, the claim will be assigned to a new disability examiner. Under this proposal:

a. This appeal step would include sufficient personal contact to satisfy the need for due process.

b. The appeal decision, if denied, would include a Medical Consultant’s signature.

c. The decision would include findings of fact.

d. There would be a provision to include an automatic remand to DDS on appeals for denials based on failure to cooperate.

7. The record should be closed at the conclusion of this appeal (including allowing sufficient time for explanatory process before the record closes).

8. Appeal to the Administrative Law Judge must be restricted to questions of law rather than de novo review of the claim.

a. The DDS decision needs to have a representative included in the hearing to defend the decision.

b. There must be an opportunity to remand to DDS but such remand procedures must be carefully monitored to prevent abuse and remands should only occur for the purpose of correcting obvious errors.

9. There needs to be a Social Security Court to serve as the appeal from OHA decisions.

a. The Social Security Court will serve as the final level of appeal.

b. The Social Security Court will provide quality review of ALJ decision.

c. The Appeals Council would be eliminated, limiting the total number of appeal steps within SSA to three. Appeals beyond the ALJ level would be presented to the Social Security Court.

d. The Social Security court would be restricted to rendering only a legal decision based on the application of the law.

This proposal is submitted to SSA following the unanimous vote of NADE’s Board of Directors on February 23, 2002 to endorse this design for a new disability claims process.

Explanation of New Disability Claims Process Proposed by NADE

NADE considered various alternatives to the current disability claims process before deciding on this process as representing the hope for a claims process that truly provided good customer service while protecting the trust funds against abuse. It was our intent to develop a vision for what the total program should look like and not just the DDS piece of the puzzle. We believe in the concept of “One SSA” and our proposal is submitted based on the belief that all components within the disability program should be united in the commitment to providing good customer service at an affordable price. Quality claimant service and lowered administrative costs should dictate the structure of the new disability program.

The critical elements identified in the NADE proposal are:

” The expansion of the Single Decision Maker concept to all DDSs and expanding the class of claims for which the SDM is able to provide the decision without medical or psychological consultant input. Continuing Disability Review cases (CDR’s) and some childhood and mental cases can easily be processed by SDMs.

” More early contact with the claimant by the DDS to explain the process and to make the process more customer friendly. The Disability Examiner is able to obtain all necessary information while clarifying allegations, work history, and treatment sources. The claimant is educated about the process so they know what to expect.

” Housing the initial claim folder on denied claims in the DDS pending receipt of an appeal of that denial. This will effectively eliminate significant shipping costs incurred in transporting claims from the DDS to the Field Office and then back to the DDS. Costs of storage in the DDSs would be significantly less than the postal fees incurred by SSA in the current process. Housing the claims at the DDS instead of the Field Offices could save as much as $20 per claim in shipping costs. It will also reduce processing time by eliminating a hand-off. ” Closing the record after the appeal decision is rendered. NADE believes that closing the record prior to any subsequent ALJ hearing is critical to generating consistency, providing good customer service, restoring public confidence and reducing the costs of the disability program. Without it, there will continue to be two programs, one primarily medical and one primarily legal, with two completely different outcomes. We are unclear as to the degree of personal contact that would be required to satisfy the due process requirement at this appeal level and would defer to SSA the decision as to how much contact is needed and how the requirement could be met. Is a face-to-face hearing necessary or can a phone interview suffice? Even the former, conducted in the DDS, would be substantially less costly than the current hearing before the ALJ. The DDS hearing would allow the claimant to receive a much more timely hearing than the current process allows. NADE also believes that the role of attorneys and other claimant representatives would be significantly diminished as the opportunity for reversal of the DDS decision would be lowered substantially. The DDS hearing would be an informal hearing, lessening the impact attorneys have at this level.

” NADE believes that the current 60 day period granted to claimants to file an appeal should be reexamined in light of modern communication and greater ability of claimants to file appeals more quickly. Reducing the time allowed to file an appeal would produce cost savings to the program and aid the claimant in obtaining a final decision much more quickly.

The additional costs incurred by the DDSs in this new process would be paid for from monies reallocated from OHA and from the cost savings created by less folder movement between the DDSs and the Field Offices. Political decisions will have to be made to reallocate these funds and these decisions will not be popular. Because of turf guarding by the various components within SSA and a general unwillingness to accept change, NADE believes that the victim in past efforts to develop a comprehensive disability claims process has been the claimant. The question must be asked, “Who do we serve, ourselves or the claimant?”

NADE envisions a claims process that would reinforce the medical decision made by the DDS and limit the OHA legal decision to addressing only points of law. NADE believes this proposal would produce a high level of consistency for the disability decisions rendered by the DDSs while significantly reducing the opportunities for OHA to reverse DDS decisions. This would help restore public confidence in the system, provide good service to the claimant and reflect good stewardship since the entire process should prove to be less costly than prototype or the traditional process. The decision as to whether a claimant is disabled would rightfully remain primarily a medically based decision. Claimants who appeal the DDS decision to an ALJ would be entitled to hire legal counsel if they wish. Likewise, SSA would employ a legal representative to define the legal merits of the DDS decision. Each side would present legal briefs in support of their position, rather than appearing in person, and the ALJ would make the decision based on review of the claim file and the legal briefs. If necessary, the ALJ could be permitted to request that both sides appear in person but this should be only for rare circumstances. Unless the law was incorrectly applied, the DDS decision would be affirmed. Any appeal of the ALJ decision would be made to the Social Security Court and either side could appeal.

The proposal is predicated on the assumption that sufficient staffing and resources would be made available to the DDSs. It is also predicated on the need for SSA to clearly define the elements that will satisfy the process unification initiatives. It is critical that SSA should provide clarification of what steps must be followed and provide the funds necessary. To minimize the need for additional resources, we believe the process unification rulings should be modified in accordance with the recommendations that have been proposed by various workgroups. Failure to adhere to this recommendation could result in the likelihood of additional lawsuits throughout the country that will make it mandatory for DDSs to adhere to regulations for which they are not funded. Such a situation would have serious consequences for the ability of the DDSs to provide good customer service and also meet the requirements established by the courts.

The current prototype experiment will conclude in four months. An exit strategy for those states involved in this experiment must be developed and a new process put into place that will avoid the necessity of SSA having to operate two distinctly different disability programs. Significant training and reallocation of resources will be needed. Therefore, it is imperative that decisions are made as soon as possible as to what course of action is deemed acceptable.

Thank you.