The problems do not end with the approval and payment of a claim. Careless handling and ineffective monitoring result in continued payment to claimants who are no longer eligible for benefits. There is a critical need for a method to determine the medical status and wage earning capacity on a periodic basis, so that only those who are legally entitled to benefits receive them. Although I agree with administration officials that the ever-increasing number of claims require increased personnel, this alone is not the answer. As stated in a recent GAO study on this program, there is minimal "management-level review of the quality of decisions by claims examiners". I want to take this one step further and state that there is a need for effective organization and direction in the District offices so that a higher level of service can be provided to those who need the assistance. Perhaps automated or computerized systems should be installed to assist those who are charged with the responsibility of processing these cases. In summary, we are faced with the serious deterioration of a very important federal program which is intended to serve those individuals in need. At this point, the Department of Labor is not able to adequately fulfill its responsibility in this area. Additional personnel are mandatory and their training can no longer be "on-the-job". An intensive program must be instituted to ensure qualified examiners. New methods to expedite accurate determinations for any individual submitting a claim must be explored. Effective follow-up procedures have to be implemented All of these areas must be examined....and now. Although I have only spoken of the Federal Employees' Compensation Act, many of my comments would apply to the Black Lung Benefits Act as well. Although my office does not handle a great number of these claims, my experience has been that again there is delay after delay in processing claims. My recommendation would be to create a process for making a determination on these cases that protects the U.S. Government and is timely to benefit the Federal worker. Mr. Chairman, I have invited some of my constituents to this hearing to speak with you about their personal experiences in attempting to have their cases resolved by the Office of Workers' Compensation Programs. They have been confronted with many of the problems which I have just discussed. They are: Mrs. Darlene R. Snider 2900 Old Dominion Boulevard Mrs. Susan D. Patton 5477 Sheffield Court #153 Mr. Clarence S. Evans 5470 Bradford Court #232 Alexandria, Virginia 22311 We sincerely appreciate the opportunity to present our views on this very important problem. We earnestly solicit the committee's help. Mr. HARRIS. I think the operation of the Federal workers' compensation program deserves the attention of this committee and, frankly, every member who supported the act. It probably doesn't do much good for this Congress to pass laws to deal with hardships, with human difficulties and then have it administered in a way where oftentimes the disabilities and problems that bring the person to the agency are, instead of being alleviated, exacerbated by the frustration and the terrible blockades that there are, the barriers there are, to pursuing their claims. Presently with regard to the Federal workers' compensation program, there are fifty cases pending in my office. These constitu ents contact us after usually a minimum of six months of trying to get some sort of response from the agency administering this program. After my involvement, after my personal staff's involvement in these cases, our average is an additional eight months before the claim is acted upon. We have had case after case where the claimant has contacted the agencies over and over again only to find out that the file was lost, the documents that they submitted were lost some two or three months ago and the agency has never told them. At that point they have to get duplications of their documents, resubmit them and literally start over again. There isn't a member, of course, who has not had experience in working with various federal agencies on behalf of their constituents to help expedite or get proper consideration of a claim. I can assure you, representing the Eighth District of Virginia, comprised of Alexandria, Fairfax and Prince William just across the river here that I have had adequate experience with respect to working with such agencies. On the basis of that experience, I would tell you that this situation is of a nature and of a magnitude that deserves our attention and deserves action on the part of the committee and all those involved to correct it. I have asked three specific cases to come before you this morning, Mrs. Darlene Snider, Mrs. Susan Patton and Mr. Clarence Evans. Mr. Chairman, I would appreciate very much if, instead of just hearing my overall view of it, if you could hear the example of three live, specific cases, telling what they have had to go through with regard to this. I can assure the chair and members of the committee that these are not unique cases, these are very usual cases, indicating the performance of the agency. Mr. GAYDOS. On behalf of the committee I can assure you they will be treated properly and I am sure they will give us testimony that will be most meaningful. I do understand you may have to leave. You can leave with the full assurance that they will be treated properly and with great courtesy. Mr. HARRIS. I have every confidence. Mr. MILLER. Now that we have heard what you have to say, I want to compliment the gentleman. My of us have asked our staff about this problem. It is almost unbelievable. I think the point Mr. Harris makes-he talks about setting up different systems and bringing in computers-perhaps that will be helpful, but I think it is also clear in a day and age when everyone calls for smaller government it may be better to go out and hire adequate staff. The people we work with seem to be very cooperative but they are just swamped. They are unable to keep track of what is going on. It seems to me when you see the problems they cause for our constituents who are filing these claims and the delays and the mysteries that it is far more expensive than if we went out and hired an adequate work force. I think that is one of the points Mr. Harris makes in his written statement and I compliment him on it. It is not easy to go out and say we have to expand some of these departments, but some of them are so shorthanded in terms of increasing workload it is most difficult. We should also look at a system that allows the filing of cases. I think it is clear there is a manpower problem. I want to thank you for speaking out on it and bringing it to the attention of this committee. My staff is going crazy with these cases. We haven't a lot of them but they get so bogged down. I have gotten on the phone and done all the things a Congressman does and I think these people are really trying to help us, but they can't handle the workload. I thank you for your testimony. Mr. SARASIN. Mr. Harris, in your statement you point out the obvious deficiencies that do exist under the program. I think we have all had the same experience that you have had. Undoubtedly you have had a greater experience because of the larger number of federal employees in your district. You point to the need for better training and more staff. If we were to recommend more staff with better training, do you feel that would solve the problem or are there other deficiencies in the program? Mr. HARRIS. I think more personnel is essential, but I do not think that will solve the entire problem. I think our district office here is a bad example, but I have the impression it is a nationwide problem. I think there is definite evidence that a more sophisticated way of handling these claims is needed. Possibly computerization of the program should be considered. I think there is also the need for real management leadership from the top on this. I have an old saying that you can walk into any restaurant in town and just talk to one waitrees and have a pretty good idea of what the manager is like. I just think there is sufficient evidence here that you need some top-flight management experience brought to the program so that the additional personnel are utilized. Quite frankly, the way they are handling cases now, you could literally involve thousands of people in handing files to one another because they don't know where they are. This, I think, points to a need for really improved management practices of a modern businesslike nature so you are handling a large volume of claims in a systematic way. Mr. SARASIN. I assume that can be done. Certainly the private sector has done this. The private Medicare providers handle thousands of claims with computers and do it effectively. Are there other deficiencies though in the program itself? For example, in the 1974 amendments that were added to change the disability period which seemed to double the cost of the program, do you have any recommendations in that area? Mr. HARRIS. I don't. I feel that the program itself is properly constructed. I have no reason to believe I have no recommendations with regard to the changes in the substance of the program. I don't think there is any real way to evaluate how effective the program has been because of the manner of its administration. I think you have to have the current program administered correctly before you can make a proper judgment. Mr. SARASIN. Thank you, Mr. Chairman. Mr. GAYDOS. Do you find anything that would justify criticism of the substance of the law? Whether the law is too liberal, whether someone is taking advantage of the way the law is written, whether we need amendments, whether the personnel administering the law and processing the claims are or are not adequate. I presume there are many, many complaints that the law should be looked at and possibly amended. Mr. HARRIS. I have no such recommendations, Mr. Chairman. As I go over this law, I believe it is a good law. It is basically designed to help where help is deserved and where the government should have a role. As I said before, I believe you cannot adequately evaluate a program like this until it is properly administered. We have had no experience with having the program administered correctly at this point. Mr. GAYDOS. Mr. Myers. Mr. MYERS. I have no questions. I thank the gentleman for coming here. Mr. GAYDOs. Mr. LeFante. Mr. LE FANTE. I have no questions. Mr. ZEFERETTI. One of the things we found in New York was delays that occurred between the insurance carriers and decisions rendered by referees. This is an area in which we do want to get involved. As you say, at the district level we, the Congressmen, are the ones who can get on top of this and find out if the delays are real. The inconvenience and lack of attention to our constituents is real. I hope these hearings will bring this out. I welcome you here this morning. Mr. SARASIN. Mr. Chairman, if I may ask another question, the Government Operations Committee held hearings on the subject of the program last year. Apparently they had several findings to point out the reason for the increase in cost of the program. When the claimant was allowed to use his own physician, he was more sympathetic and found more of an injury than perhaps a government doctor would. They also found the 45-day period was a handy way to take a vacation. The effort to have people given extensive care when they normally had an out-patient service was referred to. Do you have any opinions on this? Mr. HARRIS. I have no evidence that the program is being misused in my district. I have a prejudice in favor of permitting the claimants, where practical, to use a private physician instead of having to go to a government-hired physician in all cases. I believe in the private-practice system and I hate to see it all funnelled to a government-provided physician. I have no evidence to indicate the program has been operating poorly from that standpoint. I think there are problems in the field of administration. I would urge that we give the program a chance by having it properly administered. Mr. SARASIN. Due to the fact that the program is evidently not being handled very well, do you have any thoughts about the possibility of federalizing the workers compensation system around the country which has also been suggested to the subcommittee? |