Social Security Disability:
Improving Notices to Denied Claimants
GAO-09-183R: Published: Jan 9, 2009. Publicly Released: Jan 9, 2009.
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.
Notices sent to denied claimants may provide inconsistent and sometimes misleading information about the evidence obtained. Our review of a sample of electronic folders with initial determinations revealed, in some cases, that notices provided claimants with a confusing list of reports from medical sources that did not clearly indicate the medical evidence the Disability Determination Services (DDS) used to reach its determination. In response to DDS requests for medical records, some providers responded that they have no records, either for the individual or the period in question. In some cases, the notice sent to these claimants may include only those providers who actually submitted medical records. However, some notices include all providers who responded to the medical records request. By also including those providers who responded that they have no records, without distinguishing between these varied responses, SSA is providing additional information that may confuse claimants. Federal regulations require that notices providing an unfavorable determination to a claimant discuss, in understandable language, the evidence used to reach a determination on the claimant's case. SSA, however, instructs DDSs to include lists of all medical sources that respond to DDS requests, whether or not they provided medical evidence. SSA does not instruct staff to distinguish between sources that provide medical evidence and those that do not. Moreover, the notices typically go so far as to state that the denial was based on input received from specific providers, even those who could not produce any records. Thus, applicants may lack information needed to follow up with specific providers who may have relevant records.
Recommendation for Executive Action
Status: Closed - Implemented
Comments: 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.
Recommendation: 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.
Agency Affected: Social Security Administration