VA Must Fix the Claim Processing Process

The conclusion of this article is right on when he states:
"claims processors and the VA regional offices they work at should lose production credit when claims decisions are overturned on appeal. Penalizing poor work will force the VA to create effective training and drive claims processors to take training more seriously, resulting in a balanced mix of quantity and quality in claims processors’ work."

Full Article at: Fix the VA's claims process

By Paul J. Leaf

Thursday, January 7, 2010 at 12:04 a.m.

Veterans injured while on active duty receive disability benefits from the Department of Veterans Affairs. Unfortunately, significant deficiencies have hampered the VA’s system for processing disability benefits claims, as evidenced by the nearly 1 million claims pending before the VA, an average processing time of 162 days, a 60 percent overturn rate when claims decisions are appealed and a $4,000 range in states’ average disability pay awarded to similarly injured veterans."

"Claims processors must resolve an average of at least 3.5 claims per day. (This is a floor that VA regional offices can – and do – raise.) The time needed to process each claim varies with the number of injuries alleged therein. Even so, claims processors receive only one credit for deciding a claim whether it contains a single easy injury or seven complex injuries. This drives claims processors to ignore difficult, multi-injury claims. Additionally, claims processors lose no credit when their decisions are overturned on appeal, guaranteeing that quality is insufficiently emphasized in their work."

"A recent study found that fully-trained claims processors cannot properly rate 3.5 claims each day. Yet, if the standard goes unmet, claims processors and their managers may be fired. This unattainable quota has thus infected the VA with a culture that views anything that even temporarily slows claims processors’ output – including training and accuracy of claims decisions – as impediments to production. Indeed, some claims processors decide claims without necessary medical information because they receive no production credit for gathering missing evidence. And some VA managers limit claims processors’ ability to order medical exams required to evaluate veterans’ injuries."


"Finally, claims processors and the VA regional offices they work at should lose production credit when claims decisions are overturned on appeal. Penalizing poor work will force the VA to create effective training and drive claims processors to take training more seriously, resulting in a balanced mix of quantity and quality in claims processors’ work."

Leaf, an attorney at Kirkland & Ellis LLP in Los Angeles, does pro bono work in the area of veterans’ disability benefits claims.