Tuesday, January 28, 2014

The Electronic Claims Analysis Tool (eCAT)

The electronic claims analysis tool (the “eCAT”) is an internet application that the Social Security Administration (“SSA”) uses. The purpose of the eCat is to document a disability adjudicator’s analysis to ensure that all SSA policies are considered during the disability adjudication process. The goal was to foster uniformity so applicants would be treated the same regardless of where they lived. The eCAT produces a Disability Determination Explanation that documents the detailed analysis and rationale for either allowing or denying a claim. The SSA has been using the eCAT nationwide since 2009. 

In July 2011, the Office of the Inspector General (the “OIG”) issued a report on “The Effects of the Electronic Claims Analysis Tool.” The OIG noted that one of the SSA policies that the eCAT is designed to consider during the disability adjudication process is whether a consultative examination (“CE”) is needed to get more information about a claimant’s impairment(s) and level of functioning. If so, then the OIG stated that “the examiner should ask the treating sources to perform the examination.” The OIG cited POMS, DI 22510.010 as authority, but there are a slew of other regulations that also require that a treating source be used as the “preferred source” for conducting a CE. The OIG did note that some exceptions to the rule apply, such as where the treating source informed the DDS he/she did not want to perform CEs or did not respond to the request for evidence or answer whether he/she would be willing to perform a CE, if needed. 

On March 20, 2013, during Congressional Hearings held by the Ways & Means Committee, the SSA testified that disability adjudicators are required to use eCAT, which is designed to aid in the documenting, analyzing, and adjudicating the disability claim according to SSA regulations. Thus, it is perfectly clear that the eCAT is supposed to ensure that disability adjudicators comply with SSA policies, in particular, asking treating sources to conduct CEs. 

Despite the aforementioned, in every Disability Determination Explanation that I have reviewed, the disability adjudicator has stated that a CE is needed, but has failed to ask the treating source to perform it, and no exception to the rule has applied. Is the eCAT designed poorly, or are disability adjudicators simply refusing to comply with the SSA policy and the eCAT? Since the SSA spent a lot of money on eCAT, you would think that it would be designed to ensure that a disability adjudicator complies with a simple and unambiguous policy – asking treating sources to perform CEs.

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