Recommendation 2013-1, “Improving Consistency in Social Security Disability Adjudications,” identifies ways to improve the adjudication of Social Security disability benefits claims before administrative law judges and the Appeals Council, suggests changes to the evaluation of opinion evidence from medical professionals, and encourages the agency to enhance data capture and reporting.
Social Security Disability Adjudication
Project Stages:1. Gather ideas - Completed
2. Select ideas - Completed
3. Council approval - Completed
4. Picking a researcher - Completed
5. Committee consideration - Completed
6. Back to the council - Completed
7. Consideration by the full conference - Completed
8. Implementation - Current
Background: The Social Security Administration (SSA) administers the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. Under these programs, the process for determining whether a claimant is disabled has several steps.
State agencies make initial disability determinations using federal guidelines. If benefits are denied, claimants may request reconsideration. If benefits are denied after reconsideration, claimants may request a hearing before a federal Administrative Law Judge (ALJ). Individuals whose claims are denied by an ALJ may appeal to the SSA’s Appeals Council, which is the final step in the administrative process. Individuals who disagree with the final administrative decision may pursue appeal through a federal district court, court of appeals, and the Supreme Court.
Although ALJs must follow SSA’s regulations, they maintain independence and SSA has limited ability to review their work and address questions of compliance with policy and procedure. SSA strives for consistent and accurate application of regulations and policies at all levels of adjudication, and is concerned about the program costs associated with awarding benefits to claimants who are not disabled, as well as the unequal application of justice for claimants who should be awarded benefits but are not because of improper application of agency policy. The agency is also concerned that the federal courts may be interpreting SSA rules in a manner inconsistent with their intent, resulting in inappropriate remands of cases. Both of these issues pose potential program costs and administrative challenges.
The Administrative Conference of the United States (Conference) is working with SSA to study the SSDI and SSI programs and recommend improvements. The study provides an independent review that analyzes the role of courts in reviewing Social Security disability decisions and considers measures that SSA could take to reduce the number of cases remanded to it by courts. The study also addresses significant observed variances among ALJs in decisional outcomes, length of hearings, and application of agency policies and procedures, and analyzes the benefits of video hearings in the context of reducing agency burden and improving outcomes.
Project Details: Through this study, the Conference reviews adjudication in the SSDI and SSI programs and recommends improvements. The study uses empirical methods and gathers and analyzes data regarding the programs. The study particularly addresses the following issues:
- The impact of SSA’s treating physician rules on the role of courts in reviewing SSA disability decisions. The study considers measures that SSA could take to reduce the number of cases remanded to it by courts.
- The role of the SSA Appeals Council in reviewing cases to reduce any observed variances in ALJ’s decisional outcomes, hearing lengths, and application of agency policies. Legal and empirical consideration is given to the efficacy of an expansion of the Appeals Council’s already existing authority to conduct more focused reviews of ALJ decisions; how the Appeals Council can select cases for review; when review should take place (i.e. pre- or post-effectuation); and the scope and manner of review.
- Additional questions that may arise, as resources and time allow, and if agreed upon.