The Government Accountability Office has found the Railroad Retirement Board's vetting procedures for total disability claims inadequate.
Among its findings, the GAO said the RRB lacks an independent review of claims, giving internal claims examiners "sole discretion" over approving a claim. Between 2008 and 2012, one-quarter to one-third of total and permanent disability claims were approved without an independent review, the GAO said.
That's a breach of the generally accepted standards for internal controls within federal government agencies, the GAO's report said.
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In recent years, the FBI has investigated false disability claims of over $1 billion made by railroad workers.
In determining the eligibility of a total and permanent disability claim, the RRB is supposed to use the same criteria as the Social Security Administration in assessing Disability Insurance claims. The claimant's physical or mental injury must have lasted at least one year or is expected to result in death, and the injuries must prevent the claimant from working.
But the GAO report found that the RRB does not evaluate the accuracy of assessments on the disability claims, nor does the board regularly monitor the claims process. Current performance standards assess the timeliness of the claims assessments, but not the accuracy of actually determining when a claim is eligible for disability benefits.
The GAO also faulted the RRB's efforts to monitor fraud, even after the exposure of high-profile fraudulent claims shed light on the board's inadequate controls. Not only has the board failed to implement new practices to its oversight, staff in field offices report having no recollection of the fraud awareness training that RRB officials said the agency has adopted.
When interviewed by the GAO, some staff in district offices said it was not their responsibility to identify potential fraud.
The GAO's report recommends the RRB use more timely earnings and wage information to determine a claimant's eligibility.
Comprehensive revisions to its supervisory reviews were also recommended, as well as developing metrics to track the accuracy of claims decisions, and the development of fraud awareness and training policies.
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Nick Thornton
Nick Thornton is a financial writer covering retirement and health care issues for BenefitsPRO and ALM Media. He greatly enjoys learning from the vast minds in the legal, academic, advisory and money management communities when covering the retirement space. He's also written on international marketing trends, financial institution risk management, defense and energy issues, the restaurant industry in New York City, surfing, cigars, rum, travel, and fishing. When not writing, he's pushing into some land or water.
