Determination of Disability

Background

Disability determinations are inherently complex. Some factual determinations for Social Security Disability Insurance can be straightforward. But 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 by the president changed the selection process for ALJs. This has prompted concerns that judges could be selected based on their political perspectives.

DETERMINATION OF DISABILITY: Policy

DETERMINATION OF DISABILITY: Policy

Program Integrity

Policymakers should strengthen the program integrity efforts of the Social Security Administration (SSA). Adequate funding is needed to ensure that the disability determination process is accurate, timely, and efficient. All eligible workers with disabilities should continue to receive needed support from federal disability programs. Any fraudulent activity should be 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

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

Policymakers should improve the application and appeals process for Social Security Disability Insurance and Supplemental Security IncomeThe SSI program was designed to reduce poverty by providing basic cash support to people with low income and assets below certain thresholds who are aged, blind, or disabled.  disability benefits. For example, demonstration projects that provide assistants, or advocates, to those applying for benefits or appealing decisions should be explored.

Monitoring

Any changes to the determination and appeals process should ensure the following:

  • Beneficiaries and applicants should be afforded due process rights to challenge agency decisions prior to losing benefits or appeal any adverse initial applications.
  • Eligibility determinations and continuing disability reviews should be made in a fair, consistent, and timely manner.