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VII. Variation in DDS Decision Making

Contents:

Chart 1a-c: Variations in State Agency Initial Allowance Rates (FY 1980-2010) 
Chart 2: State Agency Initial Allowance Rates for DI and SSI by State (FY 1985 and 2013) 
Chart 3: Percentage of State Agency DI Awards by Basis for Decision (FY 1975-2012) 
Chart 4: Variations in Basis for DI Initial Awards (FY 2010) 
Chart 5: DI State Agency Initial Denials by Basis for Decision (FY 1975-2012) 
Chart 6: Percentage of State Agency Initial Denials Based on Non-Severe Impairment (FY 2012) 
Chart 7: Percentage of State Agency Initial Denials Based on Ability to Perform Usual Work (FY 2012) 
Chart 8: Percentage of State Agency Initial Denials Based on Ability to Perform Other Work (FY 2012) 
Chart 9: Percentage of Initial Level Claims with Consultative Examinations (FY 2013) 

 
Charts

Chart 1a: Variations in State Agency Initial Allowance Rates (FY 1980-2010)


Last Updated February 2012



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Chart 1b: SSI-Only Claims (1980-2010)

Last Updated February 2012



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Chart 1c: Concurrent Claims (1980-2010)

Last Updated February 2012



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State agency allowance and denial rates vary widely from State to State.  For example, in 2010 the percentage of cases decided favorably for DI-only applicants ranged from a high of 59 percent in New Jersey to a low of 34 percent in Tennessee.  For SSI-only disability claims in 2010, allowance rates ranged from 56 percent in Alaska to 24 percent in Mississippi.  For concurrent DI-SSI claims, allowance rates ranged from 40 percent in New Hampshire to 16 percent in West Virginia. The variation in allowance rates may reflect different characteristics of claimants or in the nature of industry in a particular area (e.g. mining, manufacturing, farming, etc.). 

 

Chart 2: State Agency Initial Allowance Rates for DI and SSI by State (FY 1985 and 2013)

Last Updated February 2015



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State agency initial allowance rates have also varied over time.  For example, Wyoming’s allowance rate increased by 14 percentage points between 1985 and 2013, while Wisconsin’s decreased by 17.7 percentage points.

 

Chart 3: Percentage of State Agency DI Awards by Basis for Decision (FY 1975-2012)

Last Updated February 2015

 

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Since 1983, the percentage of initial level DI cases awarded on the basis of meeting the medical listings has declined from 74 percent to 34 percent, while the percentage of cases awarded on the basis of equaling the listings has remained relatively flat.  The percentage based on vocational (or functional) evaluation has more than tripled, rising from 18 percent of all initial DI awards in 1983 to 58 percent in 2012.  This increase corresponds to an increase in the number of DI cases where musculoskeletal and mental impairments were alleged and vocational evaluations are more likely to be required for these cases.  Further, there were many policy changes in the 1980s stemming from court cases and legislation that directly affected how decision-makers assessed functional capacity.

 

Chart 4a: Variations in Basis for DI Initial Awards: Meets the Medical Listings (FY 2012)

Last Updated February 2015

 

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Chart 4b: Variations in Basis for DI Initial Awards: Equals the Medical Listings (FY 2012)

Last Updated February 2015



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Chart 4c: Variations in Basis for DI Initial Awards: Vocational Factors (FY 2012)

Last Updated February 2015



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These charts show the variation among State agencies in the basis for awarding benefits.  For example, in 2012, Hawaii made 59 percent of its initial DI awards on the basis that the claimant met the medical listings, while New York made only 29 percent of its awards on that basis.  On the other hand, New York made 67 percent of its DI awards based on vocational factors, while Hawaii made only 32 percent of its awards on that basis.



Chart 5: DI State Agency Initial Denials by Basis for Decision (FY 1975-2012)

Last Updated February 2015

 

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The reasons for denials by State agencies have varied widely over the years.  Denials for non-severe impairments went from 8 percent of denials in 1975 to 43 percent in 1981 to 20 percent in 2012.  Some of the decline in not severe determinations in the mid-1980s may have been the result of several circuit court cases that challenged how SSA was applying the standard.

Initial denials based on vocational factors showed significant variation until about 1995.  Denials for ability to perform the claimant’s usual work went from 44 percent of denials in 1975 to 19 percent in 1981 to 29 percent in 1995 and then leveled off at about 30 percent through 2011 before dropping to 23 percent in 2012.  Denials for ability to perform other work – the most complex and judgmental denials – went from 18 percent in 1975 to 11 percent in 1981 to 33 percent in 1995 and then remained at around 35 percent through 2011 before going up to 41 percent in 2012.

 

Chart 6: Percentage of State Agency Initial Denials Based on Non-Severe Impairment (FY 2012) 

Last Updated February 2015



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One of the early steps in the sequential evaluation of disability is the determination of whether an impairment is severe.  For DI and concurrent DI-SSI applications, denials for this reason in 2012 ranged from 9 percent of all denials in Wisconsin to 28 percent in Maine.  For SSI adult applications, denials for this reason ranged from 2 percent in North Carolina to 21 percent in Mississippi.

 

Chart 7: Percentage of State Agency Initial Denials Based on Ability to Perform Usual Work (FY 2012)

Last Updated February 2015



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At a later step in the sequential evaluation of disability, the disability examiner determines whether the claimant can perform his or her usual work.  For DI and concurrent applications, denials for this reason in 2012 ranged from 7 percent of all denials in Indiana to 36 percent in Montana.  For SSI adult applications, denials for this reason ranged from 2 percent in Arkansas to 17 percent in Oklahoma.

 

Chart 8: Percentage of State Agency Initial Denials Based on Ability to Perform Other Work (FY 2012) 

Last Updated February 2015



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At the final step in the sequential evaluation, the disability examiner determines whether the claimant can do work other than his or her usual past work.  For DI and concurrent applications, denials for this reason in fiscal year 2012 ranged from 23 percent of all denials in Nevada to 69 percent in Wisconsin.  For SSI adult applications, denials for this reason ranged from 32 percent of all denials in Mississippi to 74 percent in Wisconsin.

 

Chart 9: Percentage of Initial Level Claims with Consultative Examinations (FY 2013)

Last Updated February 2015

 

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To supplement medical evidence of record or when such evidence is not available, DDSs purchase consultative examinations.  In fiscal year 2013, the use of consultative examinations for initial SSDI and SSI disability decisions ranged from 24 percent in Hawaii to 70 percent in Iowa.  The national average was around 42 percent.