It has come to light that the majority of claims processors at the Department of Veterans Affairs have failed to follow procedures on disability claims that involved requesting medical opinions or disability exams; leading to delays and denials for Veterans across the United States.
Earlier this month, the VA’s top watchdog said that 68% of processors did not properly handle any section of the claims process that requests the aforementioned; they also did not include information deemed to be relevant in 38% of requests – furthermore, they did not include details those examiners would need to make recommendations in 19% of the requests.
As part of the claims process, VA examiners use information that was provided by processors to help in their determination of a Veteran’s disability and whether it is covered.
“These failings can lead to inaccurate medical opinions, incorrect decisions on Veterans’ claims, delayed decisions for Veterans, and wasted resources,” said the OIG’s Office of Audits and Evaluations.
The VA processes 1.5 million disability claims each year, providing over $80B in benefits to 25% of the nation’s 19 million Veterans.
These claims processors are also trained to identify which application(s) require an opinion or an exam.
They will also write requests for medical opinions, and errors, at any stage in the process – which can be a bottleneck in terms of getting claims processed, as they can lead to delays or rejections.
As of September 3rd, 2022, the Veterans Benefits Administration – the portion of the VA that handles all compensation and benefits was processing over 635,000 claims, with over 152,000 being backlogged.
To rectify this situation, the VA is actively working to hire more than 2,000 new employees. They are also now attempting to automate their system to hopefully expedite claims for health conditions commonly diagnosed in Veterans.
The VA has also stated that they have plans to upgrade the VBA’s electronic systems to process claims in a more efficient manner.
They are also working to develop a course that would improve training and medical opinion requests and they are also in the process of modifying their existing quality review checklist to ensure opinions get an adequate amount of attention.
VA Secretary Denis McDonough said the department will reduce its claims backlog to below 100,000 by 2024.
To reach that goal, claims processors are working overtime, setting a record in February having processed more than 7,000 claims a daily for four straight weeks.
