Social Security: Reforms in the Disability Determination and Appeals Process

GAO discussed efforts to improve the initial decisionmaking process regarding social security disability claims, and to explore reasons why the Social Security Administration (SSA) allowed many claims only after administrative law judge (ALJ) hearings. GAO noted that: (1) SSA quality assurance review data indicated a decline in the quality of state disability decisions, particularly those denying benefits; (2) the allowance rate for claimants appealing to ALJ increased in the last several years to about 63 percent; (3) while many factors attributed to the high ALJ allowance rate, face-to-face appearance was a significant factor; (4) a structural change offering all or most claimants face-to-face meetings with adjudicators at the initial decision level could be costly; (5) proposed legislation aimed at eliminating the reconsideration level of appeal left such unanswered questions as the resulting appeal rates of denied disability claimants, the related impact on ALJ work loads, and SSA costs and resource implications; (6) the elimination of reconsiderations would likely increase the ALJ work load and could add between $100 million and $200 million in administrative costs per year; and (7) SSA could offset some of the additional costs with savings resulting from the elimination of earlier case reviews at the reconsideration level.