From The Social Security Administration’s Processing of Priority Cases, a report by Social Security's Office of Inspector General (OIG):
... Each year, SSA identifies at least 200,000 (10 percent) of the initial disability applications as priority cases. SSA identifies priority cases for expedited processing through a combination of automated and manual means. Policy requires that SSA develop and process cases identified as priority expeditiously.
We reviewed 668,352 claimants whose initial disability applications SSA selected for priority processing. We also reviewed 153,964 claimants who had initial disability applications that may have been eligible for priority processing.
Generally, SSA properly identified, expedited, and processed initial disability applications that qualified as a priority case. SSA’s selection of cases for priority processing was proper for over 96.1 percent of claimants we reviewed.
However, SSA did not expeditiously develop and process initial disability applications for 11 (6.1 percent) of 180 sampled claimants. Delays occurred because SSA did not always monitor the processing of the 11 cases that were selected for priority processing to ensure they were processed expeditiously. Further, SSA’s policy does not specify overall processing timeframes and/or goals for priority cases. As a result, we estimate SSA delayed case development and processing for 40,844 claimants with priority cases.
12 comments:
Many cases in this category have mandated waiting periods
of three to five months so this results in delays.
Cases oftentimes such as metastatic cancer have onset issues. Delays occur because the person could have an earlier than alleged onset due to possible UWAs or the fact that only the sources from when the metastasis was identified is mentioned. Also NCPS often does not consider the phone calls made as an action. Phone calls made to locate the person. Get their current status. Work history etc. NCPS identifies what it calls no action and immediate action cases over a certain number of days old. But in many cases actions were taken. I wonder if they relied on NCPS for their conclusions
@9:19
I've never heard of a mandated waiting period (outside of the 12 month durational requirement, which wouldn't be a mandated delay anyways). Is there a POMS on that?
Strokes may not have been in this study but they had a waiting period before DDS could make a decision. In the case of strokes some recover soon and others never do but they both may be in bad shape the first few months when the claim is filed. Strokes may not be included in priority cases but some disabilities that are included may be treated similarily.
@12:53 Sure but that's a medical determination as to whether the condition has or is likely to persist 12 continuous months. Why would DDS impose an administrative requirement to fail to make a decision for any length of time at all? What if the claim is SSI and the claimant dies (not due to the stroke necessarily, car accident, violent crime, suicide, etc.)?
Let's look at a common scenario- an employed, married worker is diagnosed with terminal cancer. They call SSA to schedule a disability appointment. Once the appointment comes, the claimant answers honestly- they are still working full time until they get too sick to continue, because they need the insurance from their job and their family depends on them. Denied for SGA (work over the limit).
Fast-forward weeks/months. The worker is now too sick to continue working. They file for disability, and SSA's procedures work perfectly. Their spouse's income makes them ineligible for SSI. They get an appointment within the next two days (required in TERI cases), the disability claim is taken and sent to DDS as a priority case with a TERI flag. DDS does their job right, and has a decision (approval) within 10 days. SSA's FO does their job again, and adjudicates the claim the next day. The Payment Center does their job on time (try saying that out loud with a straight face) and sets up the MBR (Master Benefit Record).
Absolutely none of that matters. Because you know who didn't do their job? Congress. Mr/Mrs Cancer Patient has the same five month waiting period as any other applicant, because Congress doesn't give a shit about terminal patients. And Congress doesn't have to tell these people with a straight face that if they stay alive for two years, then they will get Medicare.
So OIG can kick rocks here. Speed of processing these claims does nothing, because it just means the claimant waits longer at another arbitrary roadblock put in place by a Congress who just wants these cancer patients to die already so they don't get payouts from the Trust Fund.
DDS does not impose waiting periods SSaA listings do. Three months after a stroke , spinal cord injury cardiac event and five months for liver failure. ….for this we need the findings throughout the five months. If they die before that we are required to get death certificate or hospital records to tie the death to the impairment
@12:47 Sure, but then it's just a finding that the listing is not satisfied. And my example was as to SSI, where the death of the claimant generally ends the claim (surviving spouse is a thing, but most marital relationships disqualify SSI for other reasons), unlike DIB. So delaying processing a claim for listing purposes is extremely disturbing.
@208pm What's disturbing about seeing if a person is just temporarily disabled vs disabled for at least a year?
Prioritization of claims for SSA Disability processing is a method of structured biases. If a minority of overall cases are prioritized, the majority suffer because they are not treated equally. This may be sensible if the prioritization helped the most needy claimants, but that is not how it works at SSA.
For example, people with Compassionate Allowances benefit from special processing. But, is that fair to everyone else, and how are these conditions chosen? Is there bias in choosing which scenarios constitute "Compassionate Allowances"?
Would it be better to have one process for everyone?
@921pm I don't think they'd need the Compassionate Allowance program if DDS wasn't so backed up. DDS would work everything timely and see compassionate allowances and TERI cases and be able to process them right away. But since there's a multi-month backlog, I see a reasonable need to push through cases that will likely be allowances.
Most of SSA problems are related to a lack of manpower.
A case is not held to see if a Listing is met if it can other wise be allowed However the rules re waiting are also applied to RFCs. Back when this study was done even if we established a sedentary RFC, we might have had to document that his job 13 years ago as a jack hammer operator was not at a sedentary level.
@11:56pm While I understand your point about prioritizing likely allowances, Compassionate Allowances are unfair. Unlike TERI or QDD claims, CAL conditions are selected by a group of SSA Executives, at the behest of advocates who pressure the SSA to prioritize their members over the general public. While these people may have dire conditions, the designation of CAL conditions is biased. The results are not surprising. The conditions disproportionately affect white males, and the designation is made by white males. SSA lacks diversity in this area, and favors advocacy groups with the deepest pockets. The result is a faster path to allowances for those who have the influence. All others suffer.
Another group mentioned in the audit is Veterans with 100% Permanent and Total Disability. These people already receive $4,000month from the VA https://www.va.gov/disability/compensation-rates/veteran-rates/, and are encouraged to apply for SSA Disability Benefits (not SSI because of their income). SSA prioritizes them, even though they have low allowance rates. These are not claimants who will be allowed or in dire need of assistance, yet they are prioritized over everyone else.
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