Social Security Disability Insurance (SSDI) case outcomes depend heavily on which examiner handles the case, especially at the initial determination level.
Nicole Maestas, an analyst at RAND Corp., Santa Monica, Calif., made that argument today at a hearing on SSDI program claim decisions organized by the House Ways and Means Social Security subcommittee.
The subcommittee has been holding a series of hearings on the SSDI program, which has been plagued by large caseloads, slow case determination times, a high reversal rate at the claim appeal level, and reports of employee burnout.
Private individual and group disability insurance insurers care about the fate of SSDI because many private disability insurers coordinate the benefits they pay with SSDI benefits.
RAND has found that 59% of SSDI applications now come from applicants complaining of musculoskeletal disorders or mental impairments, Maestas said, according to a written version of her remarks posted by the committee.
Even after adjusting for a variety of case characteristics, such as the applicant’s age and type of health problem reported, the standard deviation for examiner case allowance rates is about 6 percentage points, Maestas said.
That means that, for 15% of the examiners, claim approval rates are 6 percentage points higher than for the average examiner.
About 5% of the examiners have approval rates that are more than 12 percentage points higher than for the average examiner.
At the initial determination level, the percentage of applicants who might have received a different result if they had started with a different examiner could be as high as 60%, Maestas said.
Because the Social Security Administration (SSA) gets and responds positively to so many SSDI appeals, the appeals process reduces the power of the “first examiner” effect, but, even after adjusting for the effects of the appeals process, it looks as if 23% of the applicants might have ended up with a different outcome if they had started with a different examiner, Maestas said.