Determination of Disability

Background

Disability determinations are inherently complex. Although some factual determinations are fairly straightforward, others are difficult and require much judgment and analysis. Systemwide fairness and consistency in decisions are also hard to achieve. In fact, examiners’ rate of allowing disability claims to proceed vary widely within and across states. Applicants are provided several options for appeal, and many who eventually receive benefits are forced to pursue their claim beyond the initial stage. Roughly two-thirds of applicants are denied at the initial stage. Of those over one-third file a request for reconside

Determination of Disability: Policy

Program Integrity

In this policy: Federal

SSA should make changes to ensure that the right disability determination decisions are made as early in the process as possible and that any fraudulent activity is detected early and prosecuted appropriately.

 

AARP supports enhanced program integrity efforts, with appropriate funding, to ensure that the disability determination process is accurate and efficient (including shortened timeframes to receive a determination), and that all eligible workers with disabilities continue to receive needed support from the federal disability programs.

SSA should continually strive to improve the following aspects of the disability determination process:

  • the quality of the information and assistance available to applicants, at a minimum by making forms easier to understand (both forms in English and forms in other languages);
  • the accuracy of the assessment of an individual’s disability;
  • the consistency of these assessments across decisionmakers; and
  • the promptness of the decisionmaking.

SSA should improve training, feedback and guidance for administrative law judges and disability determination examiners, those involved both in initial determination and in continuing disability reviews.

Congress and SSA should work to address any fraud in the system by continuing and enhancing existing efforts to detect fraud and by increasing penalties for those found guilty of fraud.

Face-to-face interviews

In this policy: Federal

To improve the accuracy of decisions, face-to-face interviews should be conducted at the initial determination point.

Information

In this policy: Federal

SSA should ensure that SSDI claimants and beneficiaries receive the information they need to understand the disability insurance determination and review process.

Advocates

In this policy: Federal

 

AARP supports exploring improvements in the application and appeals process for SSDI and Supplemental Security Income disability benefits through demonstration projects that provide assistants, or advocates, to those applying for benefits or appealing decisions.

Monitoring

In this policy: FederalLocalState

SSA must remain vigilant as it implements future changes to the determination and appeals process. Beneficiaries and applicants should be afforded all the rights to which they are entitled, and eligibility determinations and continuing disability reviews must be made in a fair, consistent, and timely manner.