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OIG Reports on the Effect of Late Submission of Medical Evidence at the ALJ level

Date: 
06/19/2008

On October 29, 2007, the SSA issued a notice of proposed rulemaking (NPRM) that stated "Our program experience has convinced us that the late submission of evidence to the [Administrative Law Judge] significantly impedes our ability to issue hearing decisions in a timely manner." The NPRM listed a number of potential changes to the appellate process, including (1) requiring at least 75 days' notice for hearings and (2) requiring the submission of evidence at least 5 days before the hearing to ensure the Administrative Law Judge has time to review the evidence. Subsequent to the NPRM, the Commissioner requested that the Office of the Inspector General evaluate and document the extent to which delays in the submission of evidence affects the timeliness of the hearing and appeal process. RESULTS OF REVIEW OIG determined that that the Case Processing and Management System (CPMS) information being used by the Office of Disability Adjudication and Review (ODAR) to monitor the timeliness of medical evidence did not indicate the late submission of medical evidence before hearings was a significant issue at hearing offices. ODAR managers identified two points in the hearing process affected by the late submission of medical evidence by claimants and their representatives before the hearing: hearing postponements (where the hearing is scheduled for a later date) and post-hearing development (where evidence is reviewed after the hearing). When OIG reviewed these two points of the hearing process, it found that about 0.2 percent of hearings were postponed annually as a result of late medical evidence and about 1.8 percent of the workload currently in-process was significantly delayed after the hearing due to late medical evidence. However, when OIG reviewed all medical evidence delays in the hearing process, in addition to claimant-related issues before the hearing, it found that as much as 7.2 percent of the workload currently in-process was significantly delayed because of late medical evidence. "However, since the majority of these medical evidence issues occur before the claimant's hearing is scheduled, they are neither directly associated with the medical evidence problems noted in the October 2007 NPRM nor likely to be remedied by the hearing process changes proposed in the notice."

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