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Retirement Planning > Social Security

Improve Catastrophic Condition Screening Process: Witnesses

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Witnesses told members of Congress earlier this week that Social Security Disability Insurance managers should do a better job of helping workers and others use a special SSDI program aimed at workers with a catastrophic health conditions.

The program, the Compassionate Allowance program, has helped about 50,000 people per year with severe medical problems qualify for SSDI benefits quickly since it came to life in 2008, according to Kathryn Larin, a director at the U.S. Government Accountability Office.

But the process for deciding which conditions make an applicant eligible for the Compassionate Allowance program is unclear, and disability claim reviewers seem to have some trouble identifying which SSDI claimants qualify for the Compassionate Allowance program, Larin testified Wednesday, at a hearing on the SSDI program organized by the House Ways and Means Committee’s Social Security subcommittee.

(Related: States Roll Out 529 Plans for Disability Expenses

Getting the Compassionate Allowance screening right is important because that program and a related program, the Quick Disability Determination Program, “provide people with disabilities facing devastating illnesses the security of knowing that they and their families have income to rely on, and remove one worry people face during a very challenging, scary time,” Larin said.

SSDI and Private Disability Insurance

Issuers of private individual and group disability insurance have a strong interest in efforts to strengthen the SSDI program. Some take SSDI claim determinations into account when conducting their own disability insurance claim reviews, and many group disability programs wrap around SSDI benefits. A private issuer may deduct the monthly SSDI benefit amount from the amount of benefits it sends a claimant.

Members of Congress and SSDI managers have worried for years about the solvency of the SSDI program.

Members of Congress, SSDI managers and claimants have worried about delays in claim processing, and in disputes that lead to appeals that can take years to resolve.

Capitol (Photo: Thinkstock)

(Photo: Thinkstock)

The witnesses at the hearing held Wednesday included Larin; Bea Disman, the acting chief of staff for the Social Security Administration; Lisa Ekman, a representative from the National Organization of Social Security Claimants’ Representatives; Elizabeth McLaren, bureau chief for Iowa Disability Determination Services; and Marilyn Zahm, president of the Association of Administrative Law Judges.

House Ways and Means streamed the hearing live on the web. The committee has posted a recording of the hearing, and written versions of the witnesses’ testimony, here.

Condition Spelling

Disman said the Social Security Administration now makes 225 conditions, such as multiple sclerosis and many cancers, eligible for the Compassionate Allowance program. The agency is adding three more conditions to the list Sept. 16. The three additions are congenital myotonic dystrophy, vanishing white matter disease, and Kleefstra syndrome.

Another witness, Ekman, testified that the Compassionate Allowance program appears to be succeeding at improving the claim process for eligible workers.

One Social Security Administration study has shown that about 82,000 applicants were found eligible for the Compassionate Allowance and Quick Disability Determination programs in 2008 and 2009, Ekman said.

The Social Security Administration awarded benefits to about 93% of those claimants without the claimants having to file appeals, and the agency eventually awarded benefits to 96% of all Compassionate Allowance and Quick Disability Determination claimants, Ekman said.

About one-quarter of the 76,000 claimants who received benefits without having to file an appeal died within three months of filing their applications. More than 70% had died by June 2015, at the end of the period covered by the data used in the study.

The Social Security Administration uses software to sift SSDI applications for hints that applicants might qualify for the Compassionate Allowance program.

One problem is that the screening software may miss eligible conditions if applicants use the wrong term, or misspell a term, McLaren said.

In one case, for example,  GAO investigators found that disability claim reviewers missed a case eligible for the Compassionate Allowance program because the applicant used the term “leiomysarcoma” on a claim, rather than “leiomyosarcoma.”

Another problem is that patient advocates aren’t sure how to get a condition on the Compassionate Allowance eligibility list, or how the Social Security Administration handles recommendations for conditions to put on the list, McLaren said.

— Read Social Security to Be Depleted in 17 Years: Trustees on ThinkAdvisor.

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