2008 Annual Report of the SSI Program

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C. HISTORICAL ALLOWANCE DATA
At the end of 2007, 84 percent of SSI recipients were receiving benefits based on a determination of dis­ability or blindness. Claims are filed at a local Social Security office and claims requiring an evaluation of disability are sent to the State Disability Determination Services (DDS) for a decision. Initial DDS deci­sions that are unfavorable to the applicant may be appealed. Historically, all appeals were initiated at the DDS level with a request for reconsideration of that initial denial. Persons denied at the reconsideration level could then apply to the Office of Disability Adjudication and Review (ODAR), formerly known as the Office of Hearings and Appeals (OHA), for a hearing before an Administrative Law Judge (ALJ), and if dissatisfied with the hearing decision could request a review by the Appeals Council. Those dissatisfied with the Appeals Council’s action could seek further relief via the Federal court system. This appeals pro­cess is still in effect for the majority of new applicants.1 However, since the mid-1990s SSA has con­ducted small pilots testing revisions to this process and introduced a modification of this process that has been utilized in 10 States for applications filed on or after October 1, 1999. Under this revised process, the first level of appeal of an initial determination is a request for hearing before an ALJ, thereby eliminating the reconsideration step.
Such a process of application and appeal can, in some cases, span several years. However, before 1993, the only data available on the disability determination process resided in files compiled at each separate stage of the process and only captured various point-in-time snapshots. A complete picture of the disabil­ity determination process can be fully understood only by compiling a longitudinal database from adminis­trative records at all levels of appeal. Beginning in 1993, such a longitudinal database (the “Disability Research File”) was constructed by SSA’s Office of Disability Programs to assist the agency in under­standing and managing this process. In constructing this database, some problems were encountered due to inconsistencies in the data collected from all the respective levels of appeal. The following sections present some additional details and qualifications essential to a complete understanding of the resulting data. Following these technical notes are tables based on the Disability Research File which show the lat­est available summary of results on disability determinations under title XVI.
1. Technical Notes on the Disability Research File
Methods used to build the title XVI Disability Research File—The “base” file for the title XVI research file is the Supplemental Security Record (SSR). This “base” file is matched against records from various other administrative sources, including transactions from the disability determination (SSA-831) files, Social Security number identification records and earnings data, and ODAR case control data.
The process used to build this research file is cumbersome, involving about 200 steps, and generally requiring 2 to 4 months to complete. Much of this complexity flows from the fact that the file is assembled based on filing date cohorts, even though many of the source files do not contain a filing date. The three most recent calendar year cohorts are completely reassembled from the basic data sources. Older calendar year cohorts are updated to reflect activity since the last time the file was built. Since the process is so time consuming, the research file is updated only annually (usually beginning in July). Therefore, research file data are not yet available for claims filed in 2007.
Methods used for estimating results (through February 2008) for claims filed in 2007—Although decision counts are available for 2007 filers (from many of the “source” files), those counts do not translate directly into the claims/appeals counts included in the following tables, due to the consolidation of multiple trans­actions (and application of claims-based tolerance rules) which occurs when the research file is built.
To prepare preliminary estimates of results (through February 2008) for 2007 filers, we started from the latest available transaction data, such as the SSA-831 data, and took into account recent years’ experience of the relationship between corresponding earlier transaction data and the resulting claims/appeals data in completed research files. Estimates of ODAR appeals activity are taken from a file which tracks individual claimants, rather than individual claims. Therefore, this may result in a slight undercount of ODAR activ­ity.
While we believe that the methods used are reasonable, it must be emphasized that the resulting estimates may prove to be of limited reliability, especially in light of the fact that the estimates give results only through February 2008, whereas the final research files will reflect information through June 2008. Actual data for 2007 will be available to replace these estimates in the 2009 Annual Report.
2. General Considerations
Some general points that apply to tables V.C1 and V.C2 are as follows:
Data for 1988-2006 filers are as of August 2007 for decisions at the DDS and OFedRO levels. Results for those years’ filers have been updated to include results at the hearing and Appeals Council levels and Federal courts through September 2007.
Data for 2007 filers are preliminary estimates as of February 2008, and reflect larger numbers of claims still pending. February 2008 data on number of claims appealed may be too low because larger numbers of claimants are still within the period allowed for filing an appeal (i.e., larger numbers of recently denied claimants who have not yet filed an appeal may appeal before the time limit runs out).
Remaining appeals will affect the results. Since allowances are generally processed more quickly than denials, we expect that the percent allowed will ultimately be lower as all cases are processed.
In certain pilot activities and under the revised process introduced October 1, 1999 in 10 States, initial denials can be appealed directly to ODAR without a separate reconsideration step. As a result the appeals of initial denials shown in these tables include cases which will not receive a decision at the reconsideration level.
 
 
Table V.C1.—Disabled Adult Claims: Disposition of Applications for SSI Disability Benefits by
Year of Filing 1 and Level of Decision
Calendar year
of filing
Total
claims
filed
 
 
Calendar year
of filing
Appeals of
reconsideration denials
 
 
Table V.C1.—Disabled Adult Claims: Disposition of Applications for SSI Disability Benefits by
Year of Filing 1 and Level of Decision (Cont.)
Calendar year
of filing
Total
claims
filed
Initial
decisions
pending
Total
initial
decisions
Appeal
decision
pending
No
appeal
pending
 
 
Calendar year
of filing
Initial
decision
pending
Appeal
decision
pending
No
appeal
pending
Appeal
decision
pending
No
appeal
pending
1 Data for claims filed in 1988‑2006 reflect results as of August 2007 at the DDS and OFedRO levels and as of September 2007 at the hearing and Appeals Council levels and the Federal courts. The numbers of total claims filed for 2004-06 are subject to change. Data for claims filed in 2007 are preliminary esti­mates as of February 2008. The ultimate numbers of allowances and denials are subject to change until all initial decisions have been completed and all appeals are final.
2 Percentage of decisions at this level.
3 Includes certain cases which can be appealed directly to the hearing level.
4 Percentage of denials at this level appealed to next level.
5 Includes cases reviewed by a Federal Reviewing Official (FedRO) as part of the DSI process.
6 Includes cases appealed to the hearing and Appeals Council levels and to the Federal courts.
7 Number of persons appealing beyond the reconsideration level.
8 Includes cases remanded to SSA from the Federal courts.
9 Percentage of decisions at this level. For years in which decisions are still pending, the preliminary percentage shown is expected to ultimately be lower as all cases are processed. This occurs because allowances are generally processed more quickly than denials.
10 Includes denied claims where the final administrative action was a dismissal of an appeal request (e.g., the appeal was not filed timely or the applicant failed to appear at the scheduled hearing).
 
Table V.C2.—Disabled Child Claims: Disposition of Applications for SSI Disability Benefits by
Year of Filing 1 and Level of Decision
Calendar year
of filing
Total
claims
filed
 
 
Calendar year
of filing
Appeals of
reconsideration
denials
 
 
Table V.C2.—Disabled Child Claims: Disposition of Applications for SSI Disability Benefits by
Year of Filing 1 and Level of Decision (Cont.)
Calendar year
of filing
Total
claims
filed
Initial
decisions
pending
Total
initial
decisions
Appeal
decision
pending
No
appeal
pending
 
 
Calendar year
of filing
Initial
decision
pending
Appeal
decision
pending
No
appeal
pending
Appeal
decision
pending
No
appeal
pending
1 Data for claims filed in 1991‑2006 reflect results as of August 2007 at the DDS and OFedRO levels and as of September 2007 at the hearing and Appeals Council levels and the Federal courts. The numbers of total claims filed for 2004-06 are subject to change. Data for claims filed in 2007 are preliminary esti­mates as of February 2008. The ultimate numbers of allowances and denials are subject to change until all initial decisions have been completed and all appeals are final.
2 Percentage of decisions at this level.
3 Includes certain cases which can be appealed directly to the hearing level.
4 Percentage of denials at this level appealed to next level.
5 Includes cases reviewed by a Federal Reviewing Official (FedRO) as part of the DSI process.
6 Includes cases appealed to the hearing and Appeals Council levels and to the Federal courts.
7 Number of persons appealing beyond the reconsideration level.
8 Includes cases remanded to SSA from the Federal courts.
9 Percentage of decisions at this level. For years in which decisions are still pending, the preliminary percentage shown is expected to ultimately be lower as all cases are processed. This occurs because allowances are generally processed more quickly than denials.
10 Includes denied claims where the final administrative action was a dismissal of an appeal request (e.g., the appeal was not filed timely or the applicant failed to appear at the scheduled hearing).
 
 

1
Implementation of the Disability Service Improvement (DSI) process began in the Boston region in August 2006. The DSI process eliminated reconsider­ation as the first level of appeal of an initial disability determination and introduced review by the Office of the Federal Reviewing Official (OFedRO) in its place. By final rule published in the Federal Register (73 FR 2411) SSA suspended new claims to the OFedRO level; this change was effective March 23, 2008 (73 FR 10381). For those initial disability appeals that had not been transferred to OFedRO on or before the effective date, the procedure for the first level of appeal reverted to that which was in place prior to August 2006; i.e., reconsideration. The DSI regulations also modified administrative appeal of an ALJ's decision or dismissal. These modifications remain in effect in the Boston region.


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