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Legion challenges VA on claims accuracy

Sep. 12, 2013 - 11:12AM   |  
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The nation’s largest veterans’ group is challenging the Veterans Affairs Department’s record of accuracy in deciding benefits claims.

VA has been telling lawmakers that its performance is improving. In fiscal 2011, VA says it made the correct decision on 83.3 percent of the claims it processed. In fiscal 2013, the accuracy rate climbed to 87.3 percent from Oct. 1 through mid-July and has jumped to more than 90 percent for the last three months.

The 2.4 million member American Legion, the nation’s largest veterans’ group and a partner with VA in processing claims, says these accuracy claims are “inconsistent with our Regional Office Action Review visits nationwide, where errors are found routinely in over half of the cases reviewed,” according a statement prepared by Vera Jones, director the Legion’s veterans affairs and rehabilitation division.

The higher error rate was discovered in a review of cases chosen by VA employees, not by the Legion, Jones said. In cases where the Legion represents a veteran before the Board of Veterans’ Appeals, the Legion “successfully argues that VA has either erred or failed to properly develop claims in over 70 percent of claims,” she said.

Jones’ statement, provided Wednesday to the House Veterans’ Affairs Committee’s disability assistance panel, feeds a belief among veterans that a VA effort to speed the processing of claims could lead to more errors.

Legion National Commander Daniel Dellinger provided a statement Tuesday to a joint meeting of the House and Senate Veterans’ Affairs committees that also raised questions about the accuracy of claims. Some review teams have discovered errors in two-thirds of claims reviewed at regional offices, Dellinger said.

Dellinger said part of the problem could be that the people processing claims are under immense pressure to work quickly. He suggested VA could alter how it measures performance by judging not just how many claims are done on time but “also completing them without errors.”

“By stressing accuracy as a measure of equal quality with speed of adjudication, VA can promote a culture among employees to get the job done right the first time, thus reducing the backlog,” Dellinger said.

VA is processing claims faster than ever, completing more than 1 million this year. The backlog of claims, defined as those pending before VA for more than 125 days, is about 460,000, down 25 percent from its peak in March and its lowest level since March 2011, Thomas Murphy, VA’s compensation service director, told the disability assistance panel.

Murphy appeared before the panel to talk about an initiative to speed claims processing by encouraging veterans to submit so-called “fully developed claims,” in which a veteran gathers most of the required information in order to reduce the burden on VA.

Fully developed claims are completed, on average, in 123 days, “less than half the time it takes to make a decision on a traditional claim,” he said.

VA has a goal of 98 percent claims accuracy, which VA leaders said they intend to meet by the end of 2015 through a combination of better training of claims workers, changes in processing procedures and increased reliance on electronic claims. The end of 2015 also is when the backlog of claims will be eliminated, VA officials said.

Responding to the Legion’s testimony, VA spokeswoman Victoria Dillon said “accuracy on claims decisions is now over 90 percent with 96.7 percent accuracy for medical issues within the claim.”

“More than 100,000 veterans are receiving decisions on their claims each month,” Dillon said. “VA has completed over a million claims in each of the last three years, historical levels never before reached.”

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