House Committee Issues Report Critical of Disability Review Process

The Social Security Administration's (SSA) Social Security Disability (SSD) applications review process is backlogged. If an individual is denied SSD benefits at an initial determination and a reconsideration, that individual can request their case be reviewed by an Administrative Law Judge (ALJ). The average time to get a hearing before an ALJ is more than a year. This hearing backlog is being reviewed by a number of committees and one has now issued its assessment.

U.S. House Committee on Oversight and Government Reform

Representative Darrell Issa (R), Chairman of the U.S. House Committee on Oversight and Government Reform, called hearings to review problems with the ALJ level of the disability appeals process. The Committee issued their report on December 18, 2014, entitled Misplaced Priorities: How the Social Security Administration Sacrificed Quality for Quantity in the Disability Determination Process.

The Committee “focused its oversight on problems within the disability appeals process, the part of the process during which Administrative Law Judges (ALJs) review appealed cases and decide whether or not to award benefits.” ALJs are directed by the SSA to decide between 500 and 700 cases per year in order to reduce the massive backlog of pending cases. The only metric that the SSA evaluates ALJs on are the number of cases an ALJ processes in a year.

Committee's Determinations

The Committee determined that the “SSA made no effort to monitor whether its ALJs were issuing policy-compliant decisions prior” to outside inquiries. The SSA began focused reviews of some ALJs in 2011. The Committee analyzed these reviews and determined “every focused review found deficiencies in ALJ decision-making and compliance with federal disability law. Several problems permeate these reviews, including inadequate use of vocational experts, poor assessments of an individual's ability to work, improper evaluation of claimants with a history of drug and alcohol abuse, overreliance on claimant representatives' briefs for ALJ decisions, and inadequate hearings with claimants.”

“The complexity of federal disability law, combined with extensive medical records in the average case file and the increasing subjective nature of claimants' claims, create significant challenges in determining whether or not an individual is eligible for disability benefits.” The Committee noted that ALJs are required to go through five steps when making a disability determination. The first four steps put the burden on the claimant to prove whether they are working at the time of evaluation, is earning more than the SSD monthly limit, do the claimant's impairments interfere with their basic work-related activities, do the claimant's impairments meet the SSA list of medical criteria, and whether the claimant can return to their past employment. If the claimant gets through the first four steps of review, then the fifth step requires an evaluation of whether the claimant can do “any job in the national economy appropriate for the claimant given his or her impairments, education, past relevant work experience, and age.”

The Committee determined that the ALJs were not reviewing files adequately, not using vocational experts to determine if a claimant could work in the national economy, and not reviewing claimants drug and alcohol abuse history. Adding this determination with the large number of cases the SSA requires ALJs to decide in a year, the Committee decided that many decisions were of inadequate quality and damaging to the disability program as a whole.

The Committee suggested capping the maximum number of decisions as ALJ can issue in one year to 600 decisions and review “the amount of time it takes ALJs to properly review evidence, hold hearings, issue decision instructions, and review and sign a decision. The Committee also suggested that the SSA should initiate quality reviews of all existing ALJs.

While this report is highly critical of the ALJ appeal step of the SSD application process, the application process for SSD benefits is still dependent on a lot of documentation.  If the SSA incorporates some of these suggestions into its working plan that will mean a claimant's documentation will be examined even more closely than ever. Having an attorney assist you with your documentation can help your claim process. If you are considering applying for disability benefits, contact our experienced attorney to assist you.