In a recent report, the U.S. Government Accountability Office (GAO) recommended that the Social Security Administration require its staff to provide more useful denial notices to claimants seeking disability benefits. In particular, the GAO is recommending that the notices:
identify medical sources in a manner that clearly distinguishes (1) sources that provided requested medical evidence, (2) sources that responded to the request but did not provide evidence, and (3) sources that did not respond.
The recommendations came after the GAO discovered in the course of its study of the collection of medical evidence in the disability determination process that notices sent to denied claimants sometimes provided inconsistent and misleading information about the evidence obtained. In some cases, the notices provided claimants with a list of reports from medical sources without clearly identifying which report was used to reach a determination. In other cases, the notices sent to claimants included only those providers who actually submitted medical records, while in still other cases, the notices listed all providers who responded, including those who did not actually provide medical records.
The GAO reviewed a random sample of 100 electronic folders out of approximately 2.3 million cases. Among the 100 folders, there were 34 in which one or more sources provided no record response. In 24 of those cases, the claimants received less than a fully favorable decision. In other cases, the lists of reports received did not include the providers who responded that they did not have the requested evidence.
Federal regulations require that a written notice of claims denial must provide, in clear language, a statement of the case setting forth the evidence on which the determination is based (Regs. §404.904 and §416.1404(a)). Internal SSA guidelines require staff to list all medical and nonmedical sources that respond to information requests but not to list unresponsive sources (POMS §DI 26530.020(B)(1). However, as the GAO notes:
including those sources without specifying that these sources did not provide medical evidence fails to provide claimants a transparent and understandable discussion of the evidence. By distinguishing between the different sources and the content of their responses, SSA could provide claimants clearer, more understandable information about the evidence on which SSA's determination was based and, perhaps, better inform a claimant's decision whether to request an appeal.
In response, the SSA stated that it generally agreed with the GAO, however, it said that implementing the recommendation will require more study and some changes to computer systems. In particular, the SSA stated that implementation of the recommendation would require modification of legacy computer systems in a number of states, working with all 50 states to make changes, and a considerable investment of IT (information technology) funds (GAO-09-183R, January 9, 2009).
Visit our News Library to read more news stories.