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Improving the Reconsideration Appeals Process

The Social Security Administration (SSA) is reinstating the reconsideration level appeals process for the 10 prototype states by the end of 2020. In an attempt to discuss solutions for improving the reconsideration level process, the SSA held a live three-hour National Disability Forum on November 28, 2018. Here are a few solutions the experienced panel offered that seemed appealing:

  • Provide Social Security Disability representatives and disability claimants access to the electronic file at the initial and reconsideration level

  • Allow Social Security Administration adjudicators to inform the claimant which evidence is needed to decide the case

  • Improve the utilization of Social Security Administration employees to obtain medical evidence more efficiently

As a former Office of Hearings Operations (OHO) adjudicator, it was news to hear most or all of Social Security Disability representatives didn’t have access to the electronic file at the initial and reconsideration levels. This certainly explains why there are often numerous duplicates and irrelevant evidence included in the file at the hearing level. As Christopher Muzzulli with the National Association of Disability Representatives (NADR) pointed out, allowing Social Security Disability representatives and disability claimants to see the file earlier in the process would reduce unnecessary development, improve processing times, and save both the SSA and disability claimants money.

It’s not uncommon for a Social Security Disability adjudicator to know which evidence is needed to make a decision by the time they have reviewed the disability case. Lisa Ekman with National Organization of Social Security Claimants’ Representatives (NOSSCR) suggested SSD adjudicators be allowed to communicate with disability claimants and SSD representatives regarding which evidence is necessary to make a decision. This clear communication between disability claimants, SSD representatives, and the SSA can lead to a reduction in unnecessary development, improved processing times, and save both the Social Security Administration and disability claimants money—thus leading to increased public trust in the process.

Let’s consider an example of this level of communication at the hearing level. A senior Social Security Disability attorney contacts the SSD representative prior to the Administrative Law Judge’s (ALJ) hearing, requesting specific evidence needed to decide the case. This efficiency allows an On-The-Record decision to be made in a shorter amount of time. Even if a senior SSD attorney is unable to pay the claim, the fully developed record can expedite the Administrative Law Judge’s decision-making process. Certainly, creating a more collaborative relationship between SSA and disability claimants/SSD representatives at the initial and reconsideration levels provides a better opportunity to create a fully developed record, improves the disability adjudicative process, and builds public trust.

Fortunately, the Disability Determination Services has a medical professional relations office who builds relationships with the medical community. Trudy Lyon-Hart with Social Security Administration indicated this SSA employee can build relationships and get medical evidence submitted to the file in an efficient manner. When necessary, you can hire such an SSA employee to obtain necessary medical evidence. However, the SSA employees requesting medical evidence have other responsibilities and duties as well. This vital role needs to be specialized, targeted to build relationships and receive medical evidence more efficiently so decisions can be made faster, earlier in the process, and based on a fully developed record.

Implementing just these three solutions could immensely improve the disability adjudication process. The question is, when will we get started?

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