Prototype States

Before a case for Social Security disability benefits may be filed in federal court, applicants must give the Social Security Administration (SSA) an opportunity to review the claim and render a final agency decision. Administratively, there are typically four stages of review: initial determination, reconsideration, hearing before an administrative law judge, and review by the Appeals Council. SSA denies most applicants upon initial determination and reconsideration but approves approximately two-thirds of applicants at the hearing level, where claims are adjudicated by the Office of Hearings Operations.

The initial determination in each state is made by Disability Determination Services (DDS), which applies strict guidelines set forth in the Programs and Operations Manual (POMS). If a claim is denied initially, most states have a reconsideration process which allows a different person at DDS to review the case again before a claimant may file a request for a hearing.

However, in 1997 SSA introduced a redesign program to bypass the reconsideration process, allowing applicants to file a request for a hearing immediately after the initial determination in ten states, including New York, Pennsylvania, Alabama, Michigan, Louisiana, Missouri, Colorado, Alaska, and parts of California. The intent was to achieve earlier decisions and shorter wait times. Yet, in a 2010 statement before the House Ways and Means Commission, SSA had found the opposite was true of its implementation in prototype states.

Recently, SSA has announced plans to reinstate the reconsideration process in those states, citing to data from a 2001 detailed study of the prototype as well as the need for a uniform process. Notwithstanding, the announcement spurred opposition from legislators in both parties, who criticized the 2001 data as obsolete and cite to shorter wait times in the prototype states since the inception of the redesign program. Without more recent data and analysis from SSA, it may be difficult to predict the likely effects. Still, others have suggested that such broad changes to our Social Security program ought to be handled by a duly appointed Commissioner confirmed by the Senate, though there has not been one since the Bush Administration.


https://www.ssa.gov/legislation/testimony_042710.html

https://waysandmeans.house.gov/social-security-subcommittee-questions-changes-to-social-securitys-disability-appeals-process/

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