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Social Security Claims Processing

ELECTRONIC DISABILITY CLAIMS PROCESSING

By: Pitt Dickey - Attorney

Electronics claims processing with the SSA - A common question from a person applying for Social Security Disability Insurance Benefits is how long is it going to take to decide my claim? It can easily take well over a year for most claims to be decided in North Carolina. This column will take a look at what the Social Security Administration (SSA) is planning to do to speed up the process by the use of the Internet and computer technology. Currently the system is essentially based on paper. 

The applicant for disability benefits files a paper application at a local SSA District Office. The majority of the SSA records are paper. The SSA writes to medical providers to obtain medical records on claimants. The medical providers then mail back paper copies of medical records. All of these documents are then collected in the claimant’s claim file. As you can imagine, this is a whole lot of paper that has to be obtained, sorted, filed and then reviewed.


The SSA is going to try to implement a new system in which all of the claim documents will be scanned electronically into an electronic case file. This new system is called the Accelerated Electronic Disability initiative - AeDib. North Carolina is going to be one of the pilot project states trying the system out. In theory the system sounds great. 

Under AeDib people will be able to file their disability claims on line, medical providers can email their medical records to the SSA and various decision makers at SSA and at state Disability Determination Services will all have access to the claimant’s electronic file. Under the current paper based system, a decision maker has to have actual physical possession of the file to access information on the claimant’s medical conditions.

The plan is to start in N.C. in January 2004 with a pilot project using the new AeDib system. On 24 July 2003 the U.S. General Accounting Office issued a report to Congress that expressed multiple concerns that this new AeDib system may have serious flaws and may actually increase the length of time to process claims. 

The SSA disability system is huge. The GAO report stated that in 2002 the SSA paid out about $86 billion to approximately 10 million disabled beneficiaries. There are over 1300 field offices called District Offices where people file their initial application for disability benefits. 

There are 54 state Disability Determination Services that are the agencies that actually obtain and review the medical records on the applicants for disability. The Disability Determination Services (DDS) is the agency that makes the first two decisions as to whether to approve a claim. 

If the DDS denies the claim twice then the claimant can appeal to an Administrative Law Judge for a new hearing on the disability claim. The Federal government pays 100% of the costs of the DDS agencies however the employees of DDS are actually state employees making medical decisions based on federal guidelines.

In 1992 the SSA tried to go to a paperless claims processing plan called Reengineered Disability System (RDS). This project was intended to make the whole process from claim filing to decision-making automated. 

Unfortunately after spending 7 years and $71 million that program was abandoned as unworkable in 1999. Before RDS, each field office claims representative was processing 5 case interviews a day. After RDS was implemented the claim’s representative rate dropped to 3 case interviews per day.

The new plan, AeDib will allow the various components of SSA and DDS to stop using one paper claim file per claimant. All of the claimant’s information will be put in an electronic folder that can be accessed by all of the appropriate SSA and DDS personnel who need to work on the claim file. Medical records will be scanned into the electronic file that can be viewed by the caseworkers. 

The public will be able to file disability claims on line and to file medical reports on line with the AeDib system. The Office of Hearings and Appeals that hears appeals of denials of claims by the DDS will also be able to have access to the claimant’s electronic disability file. 

The GAO noted that the SSA had completed many tasks but a great deal of work remained to be completed before the system is scheduled to become operational in January 2004. The GAO report stated that the SSA has not tested and evaluated pilot projects to see if the system actually works. The pilot projects are supposed to be implemented in December 2003, which doesn’t give the SSA much time to work the kinks out of the system to go national in January 2004. 

The GAO noted that the DDS agencies reported that the SSA had not fully involved the DDS agencies in designing the system. The National Council of Disability Determination Directors advised the GAO that due to the lack of input from the DDS agencies they were concerned that the AeDib might actually cause delays in the processing of claims due to computer problems. The GAO also noted that the SSA had not completed a risk assessment to identify the circumstances that increase the probability of failing to meet project goals.


In short, don’t hold your breath that the AeDib will be in place in January 2004. However ultimately the SSA will have an electronic system in place that should expedite the decision-making in the disability process. The SSA has an enormous amount of work to do but is determined to bring the case evaluation into the computer age. If you are interested in seeing the actual GAO report it can be obtained on line at www.gao.gov/cgi-bin/getrpt?GAO-03-984T  

Notice: Since Social Security Disability is directed under Federal law, the information in this column will apply anywhere in the United States.  However each Office of Hearings and Appeals and District Office have their own ways of doing things as does the various Federal District and Circuit Courts.   I have kept this column primarily dealing the the mechanics of how the Social Security District Offices and Office of Hearings and Appeals evaluates disability claims. 
- Pitt Dickey

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over twenty years. He practices with the firm of Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place and can be reached at 910-485-8020 or at pitt@smithdickey.com . Or at the firm web site of www.smithdickey.com .

Copyright © 2002 Pitt Dickey - Used with permission

 

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