The Role of Nonattorney Representation in the SSDI Determination Process: A Case Study of One Prominent Intermediary

Abstract

Intermediary organizations that provide nonattorney representation services to people applying for Social Security Administration (SSA) disability benefits are a prominent but understudied part of the disability landscape. A better understanding of these intermediaries and their clients can help to inform policies that influence the extent to which intermediaries support or impede SSA’s disability determination processes. This article describes how one prominent nonattorney intermediary screens potential clients and supports actual clients throughout the application process for Social Security Disability Insurance (SSDI) benefits. We describe the intermediary’s operations and the characteristics of its clients and compare the characteristics and outcomes of the intermediary’s awardees with all SSDI awardees. Our findings point to one important avenue through which people enter SSDI and suggest some policy options that could improve the entry process and identify employment supports that might serve as alternatives to SSDI.

Keywords

advocacy economics/social security

Intermediary organizations that provide nonattorney representation services to people applying for Social Security Administration (SSA) disability benefits (hereafter “intermediaries”) are a prominent but understudied part of the disability landscape. There is limited public information about the size, composition, and source of these intermediaries’ customer base or about the role these organizations play in the SSA disability programs’ eligibility process. As any other business, the typical intermediary will presumably seek to maximize profits; this may have positive or negative implications for SSA, depending on the intermediary’s actual business model. Ideally, intermediaries would help applicants to provide SSA with objective, complete information about their conditions, and dissuade those who do not meet SSA’s medical eligibility criteria from filing an application or pursuing an appeal after they are initially denied benefits. In this scenario, the burden on SSA of collecting documentation and making an accurate decision would presumably be lighter than if the client applied without representation. However, if intermediaries encourage applications from those who are likely to be ineligible, or if they help applicants to give SSA information that is biased toward allowances because it is subjective or incomplete, SSA will either have to do more work to make a correct decision or risk allowing cases incorrectly. A better understanding of these intermediaries and their clients can help to inform policies that influence the extent to which intermediaries support or impede SSA’s disability determination processes.

This article describes how one prominent nonattorney intermediary screens potential clients and supports actual clients throughout the application process. We do not disclose the intermediary’s identity for proprietary reasons. After providing background on the Social Security Disability Insurance (SSDI) program and on the role of representatives in SSA’s disability determination process, we describe the intermediary’s operations, including how the intermediary initially screens potential clients and how those clients eventually interact with SSA’s disability application process. We then describe our data and methods and review the characteristics of the intermediary’s clients, focusing on one cohort, to shed light on the circumstances of those who receive and pass the intermediary’s intensive screening process. Finally, we compare the characteristics and outcomes of the intermediary’s awardees with all SSDI awardees. This comparison provides context for how the characteristics and outcomes of people who use nonattorney intermediary services may differ from the typical beneficiary. The analysis findings point to one important avenue through which people enter SSDI and may suggest some policy options that could improve the entry process and identify employment supports that might serve as alternatives to SSDI.

Background

An intermediary organization can provide important support for a prospective SSDI applicant during SSA’s disability determination process. SSA’s work history and medical eligibility requirements are complex and often require significant medical and other evidence from applicants. SSA also has a multi-level appeals process in which applicants might need additional support. This section reviews the SSDI eligibility requirements and application process, the stages of the disability determination process, and the role of nonattorney representation in that process.

SSDI Eligibility Requirements

SSDI primarily provides benefits to disabled workers who are “disability insured” because they have accumulated a sufficient work history in covered jobs to qualify. SSDI benefits were authorized by the Social Security Act Amendment of 1956. Along with the SSDI program, SSA also administers the Supplemental Security Income (SSI) program, which also provides assistance to people with disabilities. Although the definition of disability is similar in the two programs, SSI is a means-tested program, meaning that benefits are based on financial need. The intermediary supports applicants who are eligible for dual benefits; however, the majority are interested in applying for SSDI.

In addition to being disability insured, an individual must have a medical condition that meets SSA’s definition of disability. SSA considers a worker to be disabled if (a) the person cannot continue the work that he or she once did, (b) SSA deems that the person cannot adjust to other substantial work because of said medical condition(s), and (c) the disability has lasted or is expected to last for at least 1 year or to result in death.

To determine whether a medical condition is eligible, SSA maintains a list of both physical and mental impairments, also referred to as the “Blue Book,” which automatically qualifies an individual for SSDI, provided that the individual’s condition meets the criteria specified for a listing. If the person’s condition is not on the list, he or she may still be awarded benefits if SSA determines that his or her condition, or combination of conditions, is equally severe as an impairment in the list. Alternatively, a person can be found eligible if a condition limits his or her functioning so much that he or she cannot work in either the most recent job or in another substantial one. SSA applies age-specific medical-vocational guidelines to determine whether claimants older than 50 who do not meet the requirements of a medical list should be approved or denied. These guidelines take into consideration a disability claimant’s age, residual functional capacity, education, and work history. It is generally easier for older claimants to be approved because the guidelines account for the fact that it may be harder for older workers to learn new skills and to transition into new workplaces (Medical Vocational Guidelines, 2018).

Applying for SSDI and the Right to Representation

A person can apply for SSDI directly through the SSA website, by phone, or in person at a Social Security office. The application requires several pieces of documentation, including a work history, such as a W-2 form, and evidence of the medical condition, such as medical records, laboratory and test results, and medication.

Under Titles II, XVI, and XVIII of the Social Security Act, a person may also appoint an attorney or another third-party representative to help them through the application process and in their interactions with SSA (2017). The passage of the Social Security Protection Act of 2004—made permanent in 2010—allowed nonattorney advocates to be paid as attorneys are paid by using a portion of the claimant’s back payments owed by Social Security. A representative can be anyone who meets SSA’s requirements and abides by SSA’s rules of conduct and standards of responsibility (Rules of conduct and standards of responsibility for representatives, 2018). Today’s nonattorney representatives can therefore range from nonprofessionals (family members and friends), employees of nonprofit organizations, or employees of for-profit organizations. Several prominent for-profit organizations, in particular, have emerged, and they hire nonattorney claimant representatives specifically to help claimants in the application process. The organizations include, for example, Advantage 2000, Allsup, Disability Benefits Alliance, and The Advocator Group (Social Security Advisory Board, 2012, and industry sources).

To appoint a representative, a claimant must sign a written notice (Form SSA-1696-U4) and file it with SSA. The form also indicates whether and how the representative would like to be paid—by the claimant, directly by SSA out of a claimant’s past-due benefits (known as a direct payment), or by a third party such as an insurance carrier. Fee agreements between a claimant and a representative are on a contingency basis, meaning that the representative will only be paid if the person is awarded benefits. If SSA awards benefits to a claimant, a representative (attorney or nonattorney) is paid up to 25% of SSDI back payments, and this amount cannot exceed US$6,000. A representative may act on a claimant’s behalf in a number of ways, including helping the claimant complete the disability application, obtaining and submitting evidence in support of a claim, and supporting the claimant during the appeals and hearings processes.

The Stages of the SSDI Determination Process

There are up to five stages in the SSDI determination process, beginning with the initial level, followed by up to four levels of appeals (SSA, 2018b), as described below. Generally, claimants must file for any type of appeal within 60 days of when they receive SSA’s decision.

Initial: This filing launches the SSDI application process and SSA’s review of the initial claim. The applicant fills out the initial application and submits it to SSA. An SSA employee verifies disability-insured status and, if verified, sends the application to an SSA-funded, state-operated Disability Determination Service (DDS). A DDS examiner collects additional medical evidence and initially determines medical eligibility. SSA ultimately effectuates or denies the application based on the information provided by the DDS.

Reconsideration: In most states, claimants who are denied at the initial level can file for reconsideration, which involves a complete review of the claim by a DDS examiner who was not party to the initial decision. SSA considers all the evidence submitted when the original decision was made in addition to any new evidence.

Administrative Law Judge (ALJ) Hearing: Applicants denied at the reconsideration level may ask for a hearing, which will be conducted by an ALJ—an SSA employee who had no part in either the original decision or the reconsideration.

Appeals Council Review: If a claim is denied by an ALJ, the claimant may request a review by the Appeals Council (AC). The AC can affirm, modify, or reverse the ALJ’s decision, or remand (return) the case to the ALJ for another review.

Federal District Court Review: In the final level of review, an applicant can file a lawsuit in a federal district court.

Current Knowledge of the Role of Representatives

The literature on the role of representatives in the SSDI application process is limited, but there is some evidence that their role is growing. Representatives (attorney or nonattorney) have commonly been involved at the ALJ and AC levels of review, but evidence suggests that they have become increasingly involved at the initial stage of the disability determination process. A report by the U.S. Government Accountability Office (2014) showed that the proportions of DI claims for which a representative was present at the initial stage increased between 2004 and 2013 from almost 100,000 claims (about 8% of claims) to more than 413,000 claims (about 20% of claims). Attorney representation accounted for two thirds of the cases, and nonattorney representation accounted for the rest. Among initial claims, attorney representation is more likely when claimants are older, English speaking, or have conditions that are relatively hard to document. In terms of outcomes, there is some evidence that cases involving attorneys take longer to process and are less fully documented in terms of having lower “Quick Disability Determination” scores, a metric that SSA calculates to identify claims for which an allowance is highly likely and medical evidence is readily available. Furthermore, although cases represented by an attorney are more likely to be allowed, they are also more likely to be denied for insufficient evidence (Hoynes et al., 2016).

To our knowledge, there is no published literature on how for-profit intermediaries operate or on how their clients fare in the application process. This is partly because the data on outcomes by types of nonattorney intermediary are limited, as SSA does not collect data by type of nonattorney representative (Social Security Advisory Board, 2012). This is a key limitation of the data because nonattorney representatives may reflect a diverse range of professional backgrounds and business approaches, which could result in significantly different outcomes. The goal of this article is to fill this knowledge gap by examining the administrative data of a large for-profit intermediary.

The Intermediary’s Business Model

To shed light on the intermediary’s business model, this section describes their core operations. It begins with the intermediary’s screening process, an integral part of the intermediary’s business model, and continues by describing how representation works and the intermediary’s fee structure.

Screening Process

To become a client of the intermediary, an individual must first engage with the intermediary and go through a two-part screening process, which involves a series of questionnaires to assess the individual’s eligibility for and likelihood of receiving SSDI. Interested individuals can approach the intermediary and ask to be a client at any point in the SSDI application process except at federal district court level.

The first portion of the screening process is designed by the intermediary to identify people who are likely to meet the medical lists in the Blue Book and the work history requirements for SSDI. Examples of screening metrics include the following: age (Is the individual 21 and up to full retirement age?); work history (Has the person worked at least 5 of the last 10 years and paid FICA [Federal Insurance Contributions Act] taxes?); medical condition (Is the person unable to work in any capacity because of a mental or physical condition that is expected to last at least 12 months or result in death?); medical evidence (Is the individual under the care of a health care professional who can confirm the severity of medical condition[s]?); and/or Compassionate Allowance eligibility (Does the potential claimant have a medical problem that SSA considers a Compassionate Allowance?); and current work (Is the claimant currently working?).

If the individual successfully moves past the preliminary screening, he or she then moves on to the second part of the screening process, which involves completing an assessment that gathers more extensive data necessary to confirm probable eligibility and to complete the SSDI application. The questionnaires that make up the assessment are generally organized by medical information, work history, and activities of daily living. Throughout the assessment, the intermediary may determine through the more detailed information that the likelihood of SSDI award is low and therefore decline the individual as a client. The intermediary may also use the assessment to identify potential dual claimants—individuals who are likely to be eligible for SSI, Veterans disability benefits, or various other disability benefits.

Nonattorney Representation by the Intermediary

Once the intermediary determines that the individual has passed the two-step screening process, the person then can decide whether to hire the intermediary to represent him or her. If the individual chooses to do so, then the individual officially becomes a client of the intermediary. As SSA allows only individuals, not an intermediary organization, to represent a claimant, the actual representative is an employee or an associate of the intermediary. The representatives are generally hired by the intermediary on a contract basis, and they are typically paid a flat fee per case. For clients who apply SSDI at the initial or the reconsideration levels, representatives handle applications remotely from the intermediary’s main office. The intermediary also has employees across the country who represent claimants at hearings. If a claimant appeals for a hearing before an ALJ, the intermediary assigns his or her case to a local representative who will continue to develop the appeal. The local representative prepares vocational and medical evidence, helps the claimant (in person or via telephone) to get ready prior to the hearing, and appears with the claimant at the hearing.

The Intermediary’s Fee Structure

The intermediary receives its fees from two sources. The first source is directly from individual claimants who are awarded SSDI with the intermediary’s assistance. In these cases, the intermediary participates in the fee administration process, which is managed by SSA and in which SSA releases the representation fee to the intermediary and the retroactive SSDI payment, minus the fee, to the individual. The intermediary compensates SSA for providing the direct payment service. The second source for fees is the long-term disability insurance (LTDI) carrier, if any. Under the typical group LTDI coverage plan, the carrier agrees to pay the claimant’s fee for representation if the individual is determined to be eligible by the intermediary and then successfully obtains SSDI benefits. This option is especially important, as the intermediary helps its clients to coordinate requirements across both public and private disability benefits. Many LTDI plans have specific provisions that can require claimants to also apply for SSDI, because the LTDI plans’ benefits are reduced dollar for dollar by SSDI payments (Anand & Wittenburg, 2017). Intermediary representatives, like all other representatives, are paid on a contingent basis; if the client is awarded benefits, the representative from the intermediary is paid up to 25% of the client’s SSDI back payments, an amount that cannot exceed US$6,000, or the representative is paid a flat, pre-negotiated fee on behalf of the claimant by the LTDI carrier.

Data and Overview of the Analysis

The data underlying our analysis is based on the intermediary’s administrative data and published SSA statistics on the SSDI program. The intermediary’s administrative data, which are available from 2006 to 2016, include the universe of information on each client starting at the screening process, such as demographic and socioeconomic data, referral sources, relevant dates, medical condition(s), and the outcome at each stage of the process. We compiled available statistics on the SSDI program for the same period, using multiple iterations of the Annual Statistical Report on the SSDI Program (SSA, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017a, 2017b, 2018a, 2018b).

We began our analysis by examining and tracking the cohort of individuals who approached the intermediary in 2013 to determine who seeks these services and who in this group ultimately applies for and is awarded SSDI. We decided to analyze the 2013 cohort because this is the most recent cohort for which the outcomes for individuals in the cohort had been determined at the time of our analysis; that is, they had been awarded SSDI or, if denied, their window to appeal had expired. We also compared the outcomes of this cohort to outcomes for the full 2013 SSDI applicant pool. We then use historical data between 2006 and 2016 to illustrate how the characteristics of the intermediary’s clients and awardees have changed over time. To shed light on how the intermediary’s clients may differ from the overall SSDI population, both cross-sectionally and over time, we provide a comparison of the characteristics of the intermediary’s awardees to all SSDI awardees over the same time period.

2013 Intermediary Cohort

This section presents a close-up of the 2013 intermediary cohort, including information on outcomes at each stage of the intermediary’s screening and representation process, referral sources—how potential clients came to know about the intermediary, cohort demographic and diagnostic characteristics, outcomes at each stage of SSA’s determination process, and a high-level comparison of outcomes for the intermediary cohort with outcomes for the overall 2013 SSDI applicant pool.

Screening and Representation Outcomes

Figure 1 lays out the intermediary’s screening process and the outcomes of those who became the intermediary’s clients. In total, 142,563 people approached and were screened by the intermediary in 2013. Among this cohort, slightly less than one third (29.6%) of the applicants were accepted as the intermediary’s clients, including 18.5% who applied for SSDI via the intermediary, and 13.6% who were eventually awarded SSDI benefits. We do not know the extent to which the 70% of clients not accepted by the intermediary, or the 37% of those accepted who did not apply for SSDI via the intermediary, applied for SSDI or were awarded benefits in other ways. Once they were working with the intermediary, some clients fell out of the SSDI process for a variety of reasons: for example, they may have returned to work or passed away, they might not have been able to provide the necessary medical evidence any longer, or they may have moved to a different representative. Of the intermediary’s clients who started the SSDI application process, approximately three quarters were eventually awarded benefits. In the 2013 cohort, there was considerable variation across states in the proportion of potential clients who were accepted as clients, ranging from 14.5% in the state with the lowest proportion to 43.8% in the state with the highest proportion. Conditional on acceptance, the percentage of accepted clients who applied for and were awarded SSDI benefits was relatively similar across states (55.8%–71.8% and 40.4% to 58.5%, respectively). There were no apparent regional trends.

Figure 1.

Screening and representation outcomes for members of the intermediary’s 2013 cohort, as of December 2016.

Referral Sources

Table 1 shows how potential clients in the 2013 cohort came to know about the intermediary. Each column consists of individuals included in each of the four “bubbles” in Figure 1. For example, the first column shows the distribution of referral sources for all 142,563 potential clients who approached the intermediary in 2013. More than half of these individuals contacted the intermediary because they learned about the company through the company’s advertising on the internet or marketing materials. Approximately 15% were referred to the intermediary by a family member or friend. Slightly less than one quarter of the potential clients were referred through their employer or an LTDI carrier. LTDI companies refer their clients who are collecting LTDI benefits and whom the insurer believes may not return to work, and employers may refer those who are not covered under an LTDI plan.

Table 1.

Referral Sources of the Intermediary’s 2013 Cohort.

Referral source (%)	Potential clients	Clients	Clients
	Potential clients	Clients	SSDI applicants	SSDI awardees
	N = 142,563	N = 42,131	N = 26,432	N = 19,398
Family or friends	14.7	5.1	6.6	5.8
Advertising	55.6	5.2	5.8	4.2
Disability organization	0.2	0.2	0.2	0.2
Health care provider or professional	3.0	4.4	5.4	5.0
LTDI or employer	23.0	77.5	72.3	76.3
Other	3.4	7.6	9.7	8.5

Note. Source of data is administrative data from the intermediary. Characteristics are those measured at the time of screening when possible. The percentages calculated reflect only of the number of individuals who responded. Percentages may not sum up to 100 due to rounding. SSDI = Social Security Disability Insurance.

The distribution of referral sources differs substantially for those accepted as clients. Notably, more than three quarters of those who were accepted were referred through their employer or a long-term disability agency. This is partly because individuals receiving LTDI benefits already have an established disability, and they were referred by their LTDI carrier because the carrier believed that the claimant might be eligible for SSDI. Only 5.2% of the clients listed the internet or company public relations materials as the referral source. Thus, a very large share of those who engaged with the intermediary through the company’s internet advertising or marketing materials were not accepted as clients. The distribution of referral source among SSDI applicants and awardees is similar to that of the clients.

Cohort Characteristics

We measured the demographic and medical characteristics of the cohort at the time of the screening (see Table 2). The sample in each column corresponds to each of the bubbles in Figure 1. Potential clients can list multiple impairments during the screening process. The impairment categories are therefore not mutually exclusive. Among potential clients, there were slightly more women than men (52.7% vs. 47.3%). About one quarter of the potential clients were age 44 to 54, and another quarter were 55 to 64. The most common diagnosis among potential clients was related to disorders of the musculoskeletal system and connective tissue (46.9%). The second most common diagnosis was related to mental and behavioral disorders (34.9%), with endocrine, digestive, and kidney disorders being the third (24.1%). Approximately half of the 2013 cohort was married at the time of screening.

Table 2.

Characteristics of the Intermediary’s 2013 Cohort.

	Potential clients	Clients	Clients
	Potential clients	Clients	SSDI applicants	SSDI awardees
Characteristics	N = 142,563	N = 42,131	N = 26,432	N = 19,398
Sex (%)
Female	52.7	50.9	51.5	50.0
Male	47.3	49.1	48.5	50.0
Age group (%)
Unknown	7.4
Younger than 18	1.8
18–24	6.8	0.5	0.4	0.2
25–34	15.6	6.3	4.9	3.1
35–44	17.5	14.9	13.5	9.7
45–54	24.8	32.6	33.5	31.8
55–64	24.0	44.0	46.5	53.9
65 and older	2.3	1.6	1.2	1.3
Diagnosis (%)
Mental and behavioral disorders	34.9	34.1	43.6	40.8
Neurological system and sense organs	20.4	22.8	27.0	27.4
Musculoskeletal system and connective tissue	46.9	50.5	56.1	54.8
Endocrine, digestive, and kidney disorders	24.1	27.5	34.1	36.1
Circulatory system	14.7	17.3	19.3	21.1
Respiratory system	11.8	13.8	16.9	18.3
Skin and subcutaneous tissue	2.6	2.8	3.2	3.3
Neoplasms and cancers	13.9	18.4	17.4	19.4
All other disorders	9.8	8.1	6.9	7.3
Marital status (%)
Married	49.0	57.3	59.3	61.4
Single	24.2	16.1	14.8	13.1
Divorced	19.0	19.7	19.7	19.5
Other	7.9	6.8	6.3	6.0

Note. Source of data is administrative data from the intermediary. Characteristics are those measured at the time of screening when possible. The percentages calculated reflect only the number who responded. Percentages may not sum up to 100 due to rounding. Percentages of diagnoses do not sum to 100 because more than one diagnosis can be reported. SSDI = Social Security Disability Insurance.

The characteristics of clients, applicants, and awardees are markedly different from those of the entire pool of potential clients. In particular, clients who make it past the screening process tend to be older individuals who are subject to less stringent eligibility rules. The awardees in the cohort tend to be even older; more than half of them are aged 55 to 64. Compared with the potential client base, awardees are more likely to report any type of disorder. For example, 54.8% of awardees reported a musculoskeletal system and connective disorder, compared with 46.9% reported by potential clients. However, the rank of the most common three disorders among awardees remained the same, with disorders related to musculoskeletal system and connective tissue being the most common (54.8%), followed by mental and behavioral disorders (40.8%), and endocrine, digestive, and kidney disorders (36.1%). The proportion of awardees who were married at the time of screening is also higher (61.4%) relative to the potential client base (49.0%).

Cohort Outcomes

Of the intermediary’s clients in the 2013 applicant cohort, most were seeking representation at the initial level. Close to 90% were seeking representation at that level, 6.9% were seeking representation at the reconsideration level, and 3.5% were seeking representation at the ALJ hearing level. Figure 2 shows a more detailed breakdown of outcomes for each of these subcohorts. Among clients who first sought representation with the intermediary at the initial level, 53.8% were awarded benefits, and 41.5% appealed at the reconsideration level. Among those who appealed, 12.4% were allowed, and 56.3% appealed at the ALJ hearing level. The percent allowed at the ALJ hearing level was substantially higher; two thirds of the clients at the hearing level were allowed, and 17.0% went on to the AC. Only 1.1% of the latter were allowed, however. The rates of appeals and awards were mostly similar among clients who first sought representation from the intermediary at the higher stages except that a higher proportion of clients—20.2%—were awarded at the reconsideration level among those who first started with the intermediary at that level.

Figure 2.

Breakdown of outcomes for the intermediary’s clients in the 2013 cohort who applied for SSDI, as of December 2016.

Outcomes for the Intermediary Cohort Relative to the Overall SSDI Population

To determine how the intermediary’s clients fared relative to the overall SSDI applicant pool, we examined the number and allowance rates of clients who were represented by the intermediary at each level of the determination process and compared theses values with all disabled worker applicants in 2013 (see Table 3).

Table 3.

Outcomes of the Intermediary’s Clients in the 2013 Cohort Relative to the Overall SSDI Population.

Level of process	Sample	Number (%)	Percent allowed^a
Initial	All	1,661,436	33.0
Initial	Intermediary	23,700 (1.4%)	53.8
Reconsideration	All	657,565	8.6
Reconsideration	Intermediary	11,657 (1.8%)	13.6
ALJ hearing or higher	All	404,848	54.5
ALJ hearing or higher	Intermediary	7,618 (1.9%)	66.4

Note. Sources of data are administrative data from the intermediary and the “Annual Statistical Report on the Social Security Disability Insurance Program, 2016—Outcomes of Applications for Disability Benefits (Tables 61-63).” For the entire applicant pool (“All”), data for the initial and reconsideration levels are current through June 2016, and data for the hearing level or above are current through July 2016, with a number of applications pending. For the intermediary sample, data are current through the end of 2016; SSA has made all decisions for this cohort. Numbers in parentheses represent the percentage of the intermediary’s clients out of all applicants. SSDI = Social Security Disability Insurance; ALJ = Administrative Law Judge; SSA = Social Security Administration.

Percent allowed is calculated without taking into account subsequent rounds of appeal.

We found that the allowance rate among the intermediary’s clients was higher at every stage of the determination process, most notably at the initial and reconsideration levels. At the initial stage, the allowance rate among the overall SSDI worker population was 33.0%, whereas the allowance rate among the intermediary’s clients was more than 60% higher, at 53.8%. The allowance rate was lower for both the intermediary and the overall population at the reconsideration stage, but it was still substantially higher for the intermediary cohort (13.6% vs. 8.6%). The difference in allowance rates was not as large at the hearing level or higher (66.4% vs. 54.5%). In total, the allowance rate for the intermediary’s clients was 45.1%, whereas it was 30.3% for the entire 2013 applicant cohort. However, this allowance rate was calculated without accounting for subsequent rounds of appeals. If we do account for these appeals—as shown in Figures 1 and 2—the final allowance rate for the 2013 cohort would be approximately 75%.

The intermediary’s caseload represented approximately 1% of all SSDI applicants and appellants: 23,700 of the intermediary’s clients applied for SSDI at the initial level in 2013, which represents approximately 1.4% of the entire SSDI applicant pool; 11,657 clients appealed at the reconsideration level through the intermediary, representing 1.8% of all appellants at that level. Finally, 7,618 clients hired the intermediary to represent them at the ALJ hearing or higher, which is 1.9% of all appellants at those levels.

Characteristics of the Intermediary’s Awardees and SSDI Awardees: 2006 to 2016

To characterize the role of the intermediary in the overall SSDI landscape, we provide some additional statistics on the intermediary’s awardees in relation to all SSDI awardees, both cross-sectionally and over time. To make the comparison with all SSDI awardees, we switched the focus of our analysis from the client/applicant cohorts to awardees in each calendar year, as SSA does not publish characteristics by applicant cohort. That is, we examined the number and characteristics of beneficiaries who were awarded SSDI in a given year, rather than the number and characteristics of those who applied in a given year.

As shown in the top 3 rows of Table 4, the proportion of all SSDI awardees who are clients of the intermediary has increased over time, from 1.4% in 2006 to 2.4% in 2016, peaking in 2013 at 2.5%. We also observed some state variation in the proportion of new awardees who were clients of the intermediary; in 2016, that proportion ranged from 1.3% in the state with the lowest proportion to 5.9% in the state with the highest proportion. To place this in perspective, the intermediary represented approximately 6% of all represented initial claims in 2013. We did a back-of-the-envelope calculation to arrive at this number. According to a report by the U.S. Government Accountability Office (2014), more than 413,000 initial claims (about 20%) in 2013 were represented. Attorney representation accounted for two thirds of the cases, and nonattorney representation accounted for the one third. The intermediary represented 23,700 claims in 2013, amounting to less than 2% of all initial claims, about 6% of all initial represented claims, and 17% of nonattorney-represented cases.

Table 4.

Characteristics of the Intermediary’s Awardees and All SSDI Awardees, 2006–2016.

Characteristics	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Intermediary	11,120	13,414	17,679	19,237	20,393	22,805	23,529	21,320	17,730	17,766	17,097
All	798,675	804,787	877,226	970,696	1,026,988	998,979	960,206	868,965	778,796	741,478	706,448
%	1.4	1.7	2.0	2.0	2.0	2.3	2.5	2.5	2.3	2.4	2.4
Women (%)^a
Intermediary	51.2	51.4	51.7	52.4	51.2	50.8	51.4	50.9	49.2	48.0	46.7
SSA	46.8	46.7	46.8	46.3	45.9	45.9	46.7	47.1	47.0	47.4	47.1
Age 55—FRA (%)^a
Intermediary	46.1	48.8	47.9	47.7	49.2	51.4	52.3	55.1	59.0	62.8	63.8
SSA	40.8	38.0	38.2	38.2	39.2	42.3	43.5	45.8	48.2	49.7	50.8
Monthly SSDI benefit ($)^b
Intermediary	1,383	1,409	1,440	1,513	1,520	1,537	1,592	1,661	1,773	1,768	1,737
SSA	1,038	1,054	1,115	1,120	1,129	1,189	1,204	1,222	1,257	1,270	1,293
Intermediary awardees: diagnoses (%)^c
Mental and behavioral disorders	16.7	17.2	18.4	20.1	21.1	22.8	23.7	23.0	21.3	16.9	15.0
Musculoskeletal system and connective tissue	34.1	33.6	35.1	37.3	38.8	43.7	45.8	44.9	43.6	41.9	39.6
Neoplasms and cancers	12.1	13.5	13.1	12.7	13.6	13.5	14.7	16.2	17.8	18.9	19.4
SSDI awardees: primary diagnosis (%)^d
Mental and behavioral disorders	23.2	22.8	22.8	22.3	21.3	19.2	18.0	16.8	15.9	15.1	14.6
Musculoskeletal system and connective tissue	28.2	29.0	30.0	31.2	32.5	33.8	35.4	35.9	36.1	36.3	36.6
Neoplasms and cancers	10.3	10.1	9.6	9.3	9.0	9.2	9.5	10.0	10.7	11.2	11.4

Note. Sources of data are intermediary administrative data and Annual Statistical Reports on the Social Security Disability Insurance program. The year column refers to the year in which award decisions were made. For example, the 2006 column refers to clients whose award were decided in 2006. SSA = Social Security Administration; SSDI = Social Security Disability Insurance; FRA = full retirement age.

Annual Statistical Report on the Social Security Disability Insurance program, 2016, Table 39. ^bAnnual Statistical Report on the Social Security Disability Insurance program, 2016, Table 43. Amounts are inflated adjusted to 2017 dollars. ^cClients of the intermediary could report more than one diagnosis. ^dAnnual Statistical Report on the Social Security Disability Insurance program, 2016, Table 40. Diagnoses for SSDI awardees refer to the primary diagnosis for which they received benefits.

We also compared the intermediary’s awardees to the general SSDI awardee population on a number of dimensions, including several demographic characteristics, the most common impairments, and monthly SSDI benefit amounts (see Table 4). We analyzed the differences between the two groups of awardees and found two key noteworthy differences. First, awardees represented by the intermediary tend to be older than the overall awardee population. Second, awardees represented by the intermediary receive higher benefit amounts on average. This could be a result of the fact that the intermediary’s clients are older, so they may have higher earnings and longer earnings histories. In addition, a substantial portion of the intermediary’s clients are referred by LTDI carriers; the fact that they had LTDI as a fringe benefit suggests that they have a history of higher-than-average earnings. Awardees represented by the intermediary also have a higher prevalence of musculoskeletal disorders. However, the intermediary allowed respondents to report more than one medical condition, so the distributions of impairments reported by the intermediary and the primary impairment reported by SSA are not directly comparable.

For both SSA and the intermediary, the average age of awardees has been increasing over time, which may be a reflection of the aging of the baby boom generation. Inflation-adjusted benefit amounts have remained on a fairly stable upward trajectory for both awardee groups, which could also be explained, in part, by the aging of the baby boom generation.

The percentage of intermediary awardees who reported a musculoskeletal diagnosis increased over time, peaking in 2013, before falling back to 39.6% in 2016. Among SSDI awardees, the most common primary diagnosis is related to musculoskeletal disorders, which increased continually from 28.2% in 2006 to 36.6% in 2016 and remains the most common primary diagnosis among awardees. As musculoskeletal conditions are more common among older SSDI applicants, this finding is likely to related to the increase in the typical client’s age.

The percentage of the intermediary’s awardees who reported a mental and behavioral disorder increased from 16.7% in 2006 to a peak of 23.7% in 2012 and fell back down to 15% by 2016. In contrast, the percentage of SSDI awardees who had a mental or behavioral disorder as their primary diagnosis declined steadily, from 23.2% in 2006 to 14.6% in 2016. The percentage of SSDI awardees who had neoplasms or cancers as their primary diagnosis remained fairly stable over the period, whereas the percentage of the intermediary’s awardees who reported this type of disorder grew from 12.1% to 19.4%.

Discussion

Our analysis provides new insight into a pathway to SSDI through a prominent intermediary, which represents approximately 6% of all represented initial claims. We highlight several key findings. First, it appears that the intermediary has a screening process that turns away a substantial proportion of prospective clients and may be effective in screening out clients that are unlikely to be eligible for SSDI. The majority who retain the intermediary as their representative apply for SSDI and are eventually awarded benefits, and the allowance rates of the intermediary’s clients who apply are substantially higher than the average among all SSDI applicants. Second, the intermediary’s clients and awardees are a select population; they tend to be older, more likely to have access to LTDI through their employer, and the awardees receive higher benefits than SSDI awardees overall. Third, the intermediary is serving a small but growing share of SSDI awardees.

Compared with other forms of representation, the award rates of the intermediary are substantially higher. The overall allowance rate was approximately 75% among the intermediary’s 2013 cohort who applied to SSDI. By comparison, Hoynes et al. (2016) showed that attorney representation was associated with an allowance rate that was 1.23 percentage points higher at the initial level than the overall 30% rate using data from 2012 to 2014. The Social Security Advisory Board (2012) reports that the overall SSDI allowance rate for all represented claims ranged from 37% to 41% from 2007 to 2010, only modestly higher than the overall rate. In interpreting this finding, however, it is important to keep in mind that we do not know what happened to those individuals who were screened out by the intermediary (about two thirds of all potential clients) or to those who were screened in but ended up not using the intermediary’s services.

Our analysis also should not be interpreted as causal. Even if the intermediary’s screening process is a good predictor of determination outcomes, we do not know if the outcomes for those who were screened in would have been any different if they applied to SSDI on their own Information on the outcomes of individuals who were screened out by the intermediary and those who were screened in but ended up not using the intermediary’s services would provide a more complete picture of the intermediary’s role in the SSDI application landscape; it would also provide a better understanding of the potential to incorporate similar screening tools more broadly in SSA’s disability determination process.

Finally, it appears that intermediaries have the potential to play a role in early interventions that could steer prospective SSDI applicants toward return to work rather than to SSDI, as evidenced by a recent initiative of the studied intermediary with respect to SSA’s Ticket to Work (TTW) program. Under TTW, SSDI beneficiaries and SSI recipients receive a “ticket” they can use to enroll in employment services provided by certified employment network (EN) providers. SSA will pay the EN if the beneficiary reaches certain earning milestones. Starting in 2015, the intermediary has gathered information to determine each client’s potential interest in returning to work after receipt of an SSDI award. The intermediary then uses this information in the operations of a subsidiary organization that serves as an SSA-certified EN. In particular, the EN subsidiary provides TTW education, guidance, an Individual Work Plan, and return-to-work assistance, starting at the time of benefit award, to individuals who showed strong interest in returning to work at the time of the initial screening or who have short-term impairments. Presumably, the intermediary could use the same screening techniques to help prospective applicants in making decisions to stay in the labor force rather than enter SSDI. At the very least, intermediaries could refer them to appropriate support services. However, current policies—specifically representation fees based on retroactive payments and reimbursement for employment services under SSA’s TTW program that apply only to services delivered to beneficiaries—create incentives for intermediaries to focus on helping their clients to apply for and receive benefits before returning to work.

Footnotes

Acknowledgements

The authors would like to thank the staff at the studied intermediary for sharing their data and knowledge, and for providing input on the manuscript. We also acknowledge input received by David Stapleton, David Mann, and David Wittenburg at Mathematica on the research methods and manuscript.

Authors’ Note

The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA or any agency of the Federal Government. Neither the U.S. government nor any agency thereof, nor any of their employees, make any warranty, expressed or implied, or assume any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this article. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation, or favoring by the U.S. Government or any agency thereof.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research reported herein was performed pursuant to a grant from SSA funded as part of the Disability Research Consortium (Grant DRC 12000001).

ORCID iD

Dara Lee Luca

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