State auditors frowned on the amount of time it took for the Social Security System (SSS) to process the death, disability and retirement (DDR) claims of beneficiaries.
In its 2014 audit report, the Commission on Audit (COA) said the delay deprived the members of their benefits at the time most needed.
“Evaluation of the processing time of Benefit Payments – DDR, sample DDR payments processed at the three NCR [National Capital Region] Regional Processing Centers disclosed that the processing time from filing date to check date (approval of payment) ranged from at least two months to as high as six months,” the auditors said.
They were referring to the three processing centers in major areas in the National Capital Region – Dil-iman, Pasig, and Makati.
In 2012, the number of processing units were reduced to centralize the processing of claims and make it more efficient.
According to the audit report, out of 1,030 sample paid claims from January to December 2014, 649 had a two-month processing time, 255 had three months, 94 had four months, 30 had five months, and 2 had six months.
Most of these were retirement claims.
There were 9,614 DDR claims for processing at the three centers as of December 31, 2014 broken down into 3,359 in Diliman, 3,873 in Makati, and 2,382 in Pasig, based on the audit report.
A table on the status of the claims as of year-end 2014 which was in the same report showed that a total of 2,344 claims were for evaluation, 2,612 were returned/rejected by processors, 319 were under “Additional documents requested by Processor,” 3,845 were for proof list review, and 494 were re-turned by reviewer to processor.
“The foregoing table showed various major procedures/activities performed in the processing of DDR claims. We noted that the Manual of Procedures of DDR Workflow and other related issuances failed to set specific time slots or deadlines to activities as per their importance to achieve prompt service to the members/claimants,” the auditors said.
According to SSS’ comment in the audit report, the pending workload of the processing centers con-sists of claims with the following status: for evaluation, on-going evaluation, for re-evaluation, re-turned by reviewer to processor, and for review.
Claims that are for evaluation are those already at the processing center’s inbox but not yet assigned to processor; on-going evaluation means the claims were already assigned to the processor, claims for re-evaluation are those returned by the branch, Records and Information Management Department (RIMD), or filer to the processing center after compliance; those returned by the reviewer to the pro-cessor are claims returned for correction, and; claims for review are those that undergo review after batch validation.
“Claims returned to the branches, RIMD or to the filer for correction or submission of additional docu-ments cannot be considered as pending workload as there is no control when the claim will be re-turned back to the PC. When these claims are returned back to the PC, the claim status is ‘for re-evaluation,’” the SSS said.
As of June 23, 2015, the pending workload in the three NCR processing centers totaled 5,984 broken down 2,912 in Diliman; 1,338 in Makati, and; 1,734 in Pasig, according to the SSS.
Of the 5,984, claims totaling 1,682 were for evaluation as of June 23, 2015 while 1,250 were under eval-uation, 951 were for re-evaluation, 539 were returned to the processor, and 1,562 were for review.
According to the Processing Time Report (PTR) submitted by the Benefits Administration Department (BAD), the average processing time of retirement claims fell by 76.89 percent in 2014 compared with 2013.
Likewise, the processing time of death claims fell by 21.30 percent and that of disability claims fell by 44.67 percent.
“The processing time of DDR claims were reduced in 2014 compared to 2013 as shown in the PTR sub-mitted by the BAD. However, the SSS Citizens Charter firm commitment is a 10-day processing time in its delivery of services with regard to DDR claims,” the auditors said.
The 10 working days cover the time from receipt of claim to check date.
“Hence, there was considerable delay in the processing of DDR claims that runs counter to the SSS ob-jective of providing the needed benefits at the time most needed by members/beneficiaries,” the auditors said.
As a recommendation, the audit team told the SSS to fast-track the processing of pending claims in order to immediately serve the claimants’ needs.
In addition, the auditors told the SSS to “Set deadlines to activities as per their importance in the DDR Workflow to further expedite the processing of DDR benefit claims,” and to study the establishment of more processing centers in order to decongest the workload of the three NCR Processing Centers.
The SSS commented that the processing of DDR claims slowed down because of the transition from the manual system to the new DDR Workflow System, the lack of manpower complement, and the “abnormal” trend of inputs from the branches.
“As can be noted, the transition took place not only for the people doing the job but also on the appli-cation systems and the procedures. The employees of the branches and the Processing Centers (PCs) have to familiarize themselves with the new system – from the inputting of the transaction in the DDR processing module, scanning/uploading of application and supporting documents, retrieval of scanned documents, evaluating/processing using review of digital proof list,” the SSS said.
“With regard to the application systems, just like any other new system, there is a transition time be-fore all the functionalities of the systems can be perfected and the efficiency of systems’ interface can be stabilized,” it added.
The SSS added that not all of the employees of the old processing centers were transferred to the Central Processing Division (CPD) when the CPD was reorganized.
“There were employees who opted to remain with the branches/other units. Thus, the number of employees who handled the processing of claims under the old system is not on the same level as when the new system was implemented,” it explained.
The SSS also said that when it began the implementation of the new DDR in last quarter of 2012 up to the early part of 2013, “[i]nputs arrived at the PCs in bulk so much so that they were not able to handle the volume.”
But processing time eventually improved by 2014 when the trend of inputs normalized and employees became more familiar and proficient with the new system and procedures, the SSS said.
It added that it is continuously enhancing the system, regularly monitors the workload of the pro-cessing centers to ensure workload balance, bought more computers and printers, made gradual staff-ing of the DDR Section of all the processing centers, and rendered overtime services, among other ini-tiatives it undertook to expedite the processing of DDR claims.
“As discussed above, the NCR PCs are not actually congested with workload. If the trend of inputs from the branches will be normalized, full manpower complement will be provided and the required system enhancements will be put into place, the PCs will be able to handle the workload. Be that as it may, the capacity of the PCs will be evaluated periodically and the creation of additional PCs will be done, if warranted,” the SSS said.
But the auditors maintained their observation.
“We take note of the various factors in the slowdown in the processing time of DDR claims and the ac-tions taken to address them, but we reiterate our stand that such slow processing deprived the mem-bers/beneficiaries of the benefits at the time most needed and the prompt and efficient service they need,” the auditors said.
They likewise found delay in the processing of DDR claims upon audit of selected SSS Foreign Repre-sentative Office (SSS-FRO).
The auditors reviewed sampled applications for benefit claims for September to December 2012, March to May 2013, and January to March 2014 in the SSS-FRO in London, United Kingdom and found “that it took considerable number of days to check the completeness of documents from the date of receipt of applications of benefit claims…to the date the SSS Head Office (SSS HO) received said appli-cations.”
“Review further revealed that it took another 19 to 519 days for the SSS HO to completely process and settled the benefit claims. The waiting period of members reaches as long as 519 days which deprived the members of the benefits at the time most needed,” they said.
The submission of incomplete documentations was the most common reason for the long time it took to process the claims, according to the audit report. These claims undergo a re-evaluation once the additional documents are submitted.
As a recommendation, the audit team told the Representative Office (RO) to evaluate the complete-ness of documentary requirements and accuracy of the member’s personal information before transmitting applications in order to prevent unnecessary delay in processing claims.
The office was also told to keep an updated tracking record to facilitate the monitoring of the status of applications and to transmit benefit claim applications to the SSS HO at least twice a month.
“There was no comment on the observation from the RO,” the audit report said.
Also, the auditors reviewed sampled applications for benefit claims for June 2012 to July 2014 in the Milan, Italy FRO and found that it took 15 to 69 days for the claims to be forwarded to the SSS HO.
“Notwithstanding the considerable numbers of days in FRO Milan before forwarding to SSS HO, there were 24 applications returned due to incomplete documentary requirements and discrepancy on the member’s data. We noted however that the documentary requirements or discrepancy can be viewed through on-line SSS Milan Employee Static Information thus applicants can be advised to sub-mit them before forwarding the application to SSS HO,” they said.
The audit team likewise recommended the RO to properly screen applications before forwarding them to the SSS HO in order to lessen or eliminate cases where applications are returned because of incom-plete documentations or non-compliance with the new policies.
In response, the office explained that “Claims are paid to right beneficiaries/members in the right amount and at the least possible time when all the documentary requirements are submitted and evaluate the documents to the best of their ability but the processor of the SSS HO requests for addi-tional documents, clarifications or even investigation.”
The office added that all the pending claims were returned to receiving branches because the claims were not compliant with the new rules and procedures in 2012.
In closing, the auditors said, “As an audit rejoinder, the delayed release of benefits to SSS members and/or beneficiaries would run counter to the SSS objective of providing the needed benefits at the time most needed. Hence, the existing procedures need improvement to fully serve the members and/or beneficiaries.”
Employees covered under the SSS are entitled to benefits in case of death, disability, retirement, sick-ness, and maternity.