Railroad Retirement Board:

Review of Commuter Railroad Occupational Disability Claims Reveals Potential Program Vulnerabilities

GAO-09-821R: Published: Sep 9, 2009. Publicly Released: Oct 8, 2009.

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In fall 2008, a series of news reports revealed the relatively high number of workers at one commuter railroad--the Long Island Rail Road (LIRR)-- who have applied for and been approved for occupational disability benefits by the U.S. Railroad Retirement Board (RRB). According to RRB officials, a number of federal agencies, including the Federal Bureau of Investigation, Social Security Administration, and the Department of Health and Human Services, have launched investigations in response to issues raised. In addition, the New York Attorney General's office is conducting a criminal investigation.

Our analysis identified some notable differences between claims filed by LIRR workers and those filed by other commuter rail workers that reveal potential program vulnerabilities, as illustrated by the following examples: (1) LIRR workers applied for occupational disability benefits at a rate of 12 higher than workers from the other commuter railroads in fiscal year 2007. However, RRB approved all commuter rail workers and the same rate- nearly 100 percent. (2) Nearly all LIRR worker claims were for musculoskeletal impairments, such as lower back problems, compared to about half of workers from other commuter railroads. (3) We observed in our review of claims from LIRR and Metro-Norther Railroad that most LIRR workers who filed claims provided RRB with medical evidence from one of three doctors. We did not observe these same patterns for Metro-North Railroad. In our prior work, we found that numerous claims with evidence from the same doctors can be an indicator of potential fraud or abuse. In addition, while RRB maintains data on claimants' doctors in paper claims files, these data are not currently in a format that facilitates analysis or allows the agency to detect unusual patterns. We found that RRB has not analyzed occupational disability data by railroad or performed other analyses that could have enabled the agency to identify such unusual patterns in occupational disability applications from LIRR workers. RRB implemented a five-point plan, in October 2008, to enhance its oversight of LIRR claims, which includes ordering its own medical examinations for all LIRR claimants to supplement medical evidence provided by the claimants and conducting continuing disability reviews for all LIRR annuitants who were age 54.5 and younger as of October 21, 2008. While RRB officials stated that it is too early to assess the effect of the plan on disability decisions, the agency has approved nearly all of the occupational disability claims decided under the plan as of April 30, 2009.

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