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Social Security Disability: Improving Notices to Denied Claimants

GAO-09-183R Published: Jan 09, 2009. Publicly Released: Jan 09, 2009.
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Highlights

On December 17, 2008, GAO issued a report concerning our findings on the Social Security Administration's (SSA) collection of medical evidence in the disability determination process. In the course of our review, an issue arose that was outside the scope of our work but is important to how SSA communicates its disability determinations to claimants. During this review, we examined a limited random selection of electronic folders for initial disability determinations for fiscal year 2007. The folders included notices sent to each denied claimant to explain the reasons for the denial of their claim and the evidence used to make the determination. Our findings related to these notices and current SSA policy regarding them is the subject of this report. This report also contains a recommendation that warrants SSA management's consideration.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Social Security Administration In order to provide claimants clearly understandable information concerning the evidence used as a basis for SSA's denial of their disability claims, SSA should modify its guidance to require that notices to claimants identify medical sources in a manner that clearly distinguishes (1) sources that provided requested medical evidence, (2) sources that responded to the request but did not provide evidence, and (3) sources that did not respond.
Closed – Implemented
Although SSA agreed with the recommendation, it noted that implementing it will require more study and some programming changes in computer systems. As of July 2011, SSA had not amended the pertinent guidance concerning these decision notices. In FY12, SSA reported that the cost for changing the numerous current Disability Determinations legacy systems to identify sources in a manner that clearly distinguishes sources that provided medical evidence versus sources that responded without records is cost prohibitive, especially as they are devoting resources to developing the new common disability case processing system (DCPS). SSA Headquarters components (Office of Disability Determination (ODD), Office of Disability Systems (ODS), Office of Open Government (OOG) and Office of Disability Programs (ODP)) are working together to ensure the DDS decisional notices are clear to the reader and consistent within DCPS. In late 2012, SSA began beta testing its new disability case processing system in the Idaho DDS and was to implement in the Illinois DDS in June 2013. According to SSA, as a part of this new system, the medical providers that respond to a DDS medical request will default to the personal decision notice. If a medical provider does respond to the request but does not provide medical information, this info is not automatically included in the personal decision notice, but the system does allow the DDS examiner to manually enter the information to the notice. While it is now possible to include this information in the personal decision notice, SSA could better serve disability claimants if it made it a policy to always include this information when applicable.

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Topics

AccountabilityAid for the disabledClaimsClaims processingDisabilitiesDisability insuranceElectronic recordsEligibility determinationsFederal regulationsFormsInformation disclosureInformation managementMedical information systemsMedical recordsPeople with disabilitiesProgram managementRecords managementPolicies and procedures