Alabama Disability Determination Service’s Business Process for Adjudicating Disability Claims
To assess the Alabama Disability Determination Service’s (AL‑DDS) business process for adjudicating disability claims. Our focus involved certain anonymous allegations made about AL‑DDS related to, among other things, (1) its purported pressure on medical consultants (MC) to increase their disability allowance rates; and (2) a process it allegedly used to circumvent the medical review of disability cases.
The Office of the Commissioner of Social Security provided the Inspector General a September 25, 2008 letter from an anonymous individual claiming to be a State of Alabama Medical Consultant at the DDS in Birmingham, Alabama. The letter raised various issues regarding AL‑DDS’ business process for adjudicating disability claims.
To view the full report, visit http://www.ssa.gov/oig/ADOBEPDF/A-08-09-29163.pdf
Based on interviews with 53 current and former AL-DDS MCs and review of instructions the DDS provided to some of them, we concluded that, at a minimum, a perception existed that AL-DDS pressured some MCs to increase their disability allowance rates. Several MCs told us the pressure to approve claims influenced their medical decisions.
We also identified a control weakness with AL-DDS’ use of a signature queue in which MCs signed required disability claim forms. One MC we interviewed acknowledged he signed his name on approximately 80 to 100 disability cases per day. Another MC stated he only performed a cursory review of each case in the signature queue and generally signed 30 disability cases per hour.
With regard to most of the remaining allegations, we received inconclusive or conflicting evidence. As a result, we were unable to determine whether these allegations were valid.
SSA needs to instruct AL-DDS to:
1. Adjudicate all disability determinations on the merit of evidence, without consideration of allowance targets or goals. In addition, AL-DDS should avoid all communications and other actions that personnel could interpret as pressure to approve disability claims.
2. Monitor the signature queue process to ensure compliance with policies and procedures, including the requirement to adequately review disability claims before final signature.
SSA agreed with the recommendations.