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. System-wide fairness and consistency in decisions are also hard to achieve. Examiners’ rate of allowing disability claims to proceed vary widely within and across states. Roughly two-thirds of applicants are denied at the initial stage. Of those, over one-third file a request for reconsideration. Administrative law judges (ALJs) oversee the appeals process for disability insurance applicants. In 2018, an executive order changed the selection process for ALJs. This has prompted concerns that judges could be selected based on their political perspectives.

DETERMINATION OF DISABILITY: Policy

Program Integrity

In this policy: Federal

Policymakers should strengthen the Social Security Administration’s (SSA) program integrity efforts, with appropriate funding, to ensure that the disability determination process is accurate, timely, and efficient; that all eligible workers with disabilities continue to receive needed support from federal disability programs; and that any fraudulent activity is detected early and prosecuted appropriately.

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.

Improvements in disability determinations

In this policy: Federal

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 (including both forms in English and forms in other languages);
  • the accuracy of the assessment of an individual’s disability;
  • the impartiality of the selection process of all decision makers;
  • the consistency of these assessments across decision makers;
  • the promptness of the decision-making; and
  • the training provided to administrative law judges and disability determination examiners.

Advocates

In this policy: Federal

AARP supports exploring improvements in the application and appeals process for Social Security Disability Insurance 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.