Appealed Disability Claims

Despite SSA's Efforts, It Will Not Reach Backlog Reduction Goal Gao ID: HEHS-97-28 November 21, 1996

Americans who are denied benefits under the disability insurance and the supplemental security income programs may appeal to the Social Security Administration's (SSA) Office of Hearings and Appeals. In the last decade, however, the number of disability cases appealed to the Office has swelled by about 140 percent. As a result of the processing delays, claimants often wait more than a year for a final decision on their appeal. Although the Office has reduced its inventory of appealed cases during the past eight months, GAO found that SSA will not reach its goal of reducing its backlog to 375,000 by December 1996. SSA attributes its difficulties to start-up delays, overly optimistic projections of the number of appealed cases that would be processed, and an additional 37,500 appealed cases above the number that SSA expected during fiscal year 1995. Some SSA officials had expressed concern that the agency's aggressive goals to reduce the backlog of appealed cases could result in inappropriate benefit awards for some claimants and increase the allowance rate. SSA's statistics, however, show just the opposite. Since SSA's plan was initiated, the allowance rate has fallen from 75 percent in fiscal year 1994 to 69 percent through the third quarter of fiscal year 1996.

GAO found that: (1) OHA has made progress in reducing its inventory of appealed cases, but SSA will not reach its goal of reducing this backlog to 375,000 by December 1996; (2) activities under the plan's key initiatives allowed OHA to dispose of about 66,500 more cases than it would have had STDP not been implemented, but despite OHA's increased productivity, as of August 1996 its backlog of appealed cases was about 3 percent higher than in November 1994; (3) since STDP was initiated, the allowance rate has decreased from about 75 percent in fiscal year (FY) 1994 to about 69 percent through the third quarter of (FY) 1996; and (4) SSA has not completed any analysis of the accuracy of STDP decisions or clearly established to what extent, if any, STDP has affected OHA's allowance rate.

Recommendations

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