Social Security Administration Targeted Denial Review
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The Social Security Administration (SSA) is responsible for the Nation’s two primary federal disability programs: Social Security Disability Insurance and Supplemental Security Income. Pursuant to statute, SSA usually sends claims for disability benefits to a state agency entitled the Disability Determination Services(DDS). Following SSA rules and guidelines, DDSs make the determination for SSA as to whether or not a claimant meets the disability criteria. We conduct this review to identify whether the DDS denial decisions were policy compliant and supported by the medical and vocational evidence in the case file.
This documentation describes a publicly available dataset containing information about the results of the review of denied disability cases adjudicated by the DDSs. The dataset includes annual data at the national level for federal FY 2013 and onwards.
SSA administers several programs that provide benefits to those who are both disabled and meet other program eligibility requirements. The process for determining whether a claimant is disabled is complex. Depending upon a particular claim SSA might evaluate, among other factors, medical evidence establishing a disabling condition, medical and vocational evidence determining whether a claimant maintains the capacity for work, the availability of possibly suitable employment, and severity and length of disability. For SSA purposes a claimant is either found disabled or not disabled as SSA awards disability benefits only for long term disability and not for partial or temporary disability. You can find a description of SSA’s disability programs at http://www.socialsecurity.gov/disability.
The DDSs’ primary responsibility is to make determinations for SSA on the issue of disability for claims filed by residents of the state or similar entity. However, states with heavy workloads might transfer cases to other state agencies or to a federal component, and states with available capacity may receive transferred cases from other state agencies.
The state agencies for Maine, New York, Michigan, Washington and Montana also process SSA disability claims for residents of Canada. In addition to the fifty states, a disability unit exists in the District of Columbia, Puerto Rico, Virgin Islands and Guam. The term “state agency” applies to these additional entities as well. Federal components handle disability determinations for any other residents not mentioned.
In this review, we include disability cases denied from 52 DDSs throughout the nation (all 50 States, the District of Columbia, and the Commonwealth of Puerto Rico). To select the cases, we use a statistical model to identify cases that match the profile for highly error-prone medically denied disability applications.
Field A: Federal Fiscal Year (FY), a federal fiscal year runs from October 1 through September 30.
Field B: Cases Reviewed, indicates the number of disability cases adjudicated by the DDSs and reviewed by the agency.
Field C: Cases Returned, indicates the number of cases returned to the DDSs by the agency containing a substantive error (i.e., an error that could result in a change in the determination of the case).
Field D: Return Rate, Field C (cases returned) divided by Field B (cases reviewed) expressed as a percentage. This is the percentage of disability cases returned to the DDSs containing substantive errors.
Field E: Decisions Reversed, indicates the number of cases in which the original decision is changed by the DDS after the case is returned by the agency.
Field F: Reversal Rate, Field E (decisions reversed) divided by Field B (cases reviewed) expressed as a percentage. This is the percentage of the cases reviewed in which the decision was reversed from denial to allowance.
Field G: Comments, contains any explanatory notes or comments