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Regulation and Compliance > Federal Regulation

Industry Asks For Role In Updating Disability Program

By Allison Bell

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The Social Security Administration is in the middle of a mammoth battle to streamline the notoriously slow, frustrating Social Security Disability Insurance claim determination process.

Each state has its own claim review culture, and many seriously disabled applicants who are in dire financial straits must spend years filing appeals to get benefits.

Private disability insurers have a keen interest in the success of the reform effort, because many use SSDI eligibility information in their own review process, and some try to coordinate private benefits payments with SSDI payments.

The Social Security Administration recently ended the public comment period for a proposed regulation introduced in July that would create a new, fast-track system for evaluating applicants who are “obviously disabled,” officials say.

Other provisions would establish a Federal Expert Unit that could help claim reviewers assess applicants, replace a state-level claim denial reconsideration process with reviews at the federal level, set up a national version of an electronic claim processing system that is now being tested, and limit applicants’ ability to add new information once an administrative law judge has made a decision.

Laura Favinger, an assistant vice president at UnumProvident Corp., Chattanooga, Tenn., and Rod Turner, a vice president at America’s Health Insurance Plans, Washington, have submitted comment letters suggesting that private insurers could play a role in strengthening the SSDI disability determination process.

Both Favinger and Turner recommend that the Social Security Administration consider turning to private insurers and their medical networks for help with developing the Federal Expert Unit.

Favinger emphasizes the importance of providing adequate compensation for the experts who would help with medical evaluations. “A thorough and appropriate medical review of even one complex case could result in the savings of unnecessary legal fees and other costs in aggregate over time,” Favinger writes.

At AHIP, Turner suggests that, with the consent of claimants, the SSA should find a way to use private disability insurers’ electronic claim files.

Turner also suggests that the SSA should consider working with private disability insurers to find ways to improve the health and protect the productivity of the aging baby boomers.

Many disabled people and lawyers who represent SSDI applicants have filed emotional comments through the Social Security Administration Web site opposing the proposed regulation because of the emphasis it places on getting all medical evidence to claim examiners before the determination process starts.

“The proposed section imposes an impossibly harsh burden on a claimant who is unable to navigate the maze of bureaucracy involved in obtaining medical records,” writes Michael Walters, a Fort Thomas, Ky., lawyer who represents SSDI applicants. “Unreasonable delays, usurious fees, and multiple letters to the same medical providers are an unfortunate reality of the process of obtaining medical records. To place that burden solely on an unrepresented claimant, with no recognition of the non-adversarial nature of the Social Security appeals process, and no acceptance of the duty to develop the record…is Kafkaesque.”

James Allsup, president of Allsup Inc., Belleville, Ill., a company that helps private disability insurers get individuals through the SSDI application process, says he is not sure how the proposed changes would work but welcomes the reform effort.

“This is the first legitimate attempt to at least begin to fix what’s wrong with the program,” Allsup says. “I think most of the proposed changes are very good.”

One thing the SSDI program needs is fundamental change in laws and regulations that discourage SSDI beneficiaries with clear-cut, serious disabilities from returning to work, Allsup says.

People with serious disabilities who make an effort to return to work need even more assurances than they already have that they will never have to go through the SSDI determination process again if their return-to-work efforts fail, Allsup says.

The text of the proposed SSDI reform regulation is on the Web at http://policy.ssa.gov/erm/rules.nsf/2f68da0351867ced85256b41006b1541/3112961b7090db578525704b00508cac!OpenDocument.

A proposed regulation introduced in July would create a new, fast-track system for evaluating applicants who are ‘obviously disabled’

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