NATIONAL
VACCINE INJURY COMPENSATION PROGRAM
# |
Key
Outcomes |
FY 2004
Actual
|
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY 2008
Target
|
FY 2009
Target
|
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Expand availability of health care
resources to underserved, vulnerable, and special
needs populations |
26.
II.
A.1 |
Percentage of cases in which
judgment awarding compensation is rejected and
an election to pursue a civil action is filed |
0%
(baseline) |
0% |
0% |
0% |
0% |
0% |
0% |
0% |
|
26.
II.
A.2 |
Average claim processing time. |
738
days
(baseline) |
894
days |
1005
days |
834
days |
1213
days |
1337
days |
1433a
days |
1653
days |
|
26.
II.
A.3 |
Percentage of cases where
the deadline for the Rule 4(b) report is met
once the case has been deemed complete. |
75.3%
(baseline) |
83.7% |
80% |
82.4% |
83% |
89.3% |
86% |
86% |
|
26.
II.
A.4 |
Decrease the average time
settlements are approved from the date of receipt
of the DOJ settlement proposal. |
11
days
(baseline) |
18
days |
10 days |
11
days |
10 days |
9.6
days |
10
days |
12b
days |
|
26.
II.
A.5 |
Decrease the average time
that lump sum only awards are paid from the
receipt of all required documentation to make
a payment.
(Note: OMB approved this measure
change from the “date of the DOJ clearance letter”
to the above language. FY 06 data is only available
from May-September as the VICP database was
modified in May 2006 to capture data for this
revised measure.) |
5
days
(baseline) |
11
days |
5 days |
3
days |
5 days |
3.9
days |
5
days |
5
days |
|
Efficiency
Measure |
26.E |
Percentage of cases in which case settlements are completed
within 15 weeks. |
80%
(baseline) |
93% |
90% |
97.9% |
92% |
96.4% |
92% |
92% |
|
|
Appropriated Amount
($ Million)
(direct operations) |
$3.2 |
$3.1 |
|
$3.6 |
|
$4.0 |
$5.4 |
$4.5 |
|
Notes:
a The targets for 26.II.A.2. are increasing
because some claims have been stayed (i.e., the Court
has stopped the adjudication process at the request
of the petitioner) for several years and when they
are finally resolved, they will significantly increase
processing times.
b The increase in targets for 26.II.A.4.
reflect the maximum efficiency possible in view of
the inherent delays in the process.
INTRODUCTION
The purpose of the National Vaccine Injury Compensation
Program (VICP) is to equitably and expeditiously compensate
individuals, or families of individuals, who have
been injured by childhood vaccines, and to serve as
a viable alternative to the traditional tort system.
This Program=s performance measures focus on the timely
adjudication of vaccine injury claims and monetary
awards, and the extent that the VICP serves as a alternative
to the traditional tort system by ensuring that no
compensated claimant rejects an award, and elects
to file lawsuits in the traditional tort system (i.e.,
pursue civil action). A strategy used to reduce claims
processing time is to increase the use of electronic
file sharing among agencies, expert witnesses, and
other parties.
DISCUSSION OF RESULTS AND TARGETS
Long-Term Objective: Expand availability of
health care resources to underserved, vulnerable,
and special needs populations.
26.II.A.1. Percentage of cases in which judgment
awarding compensation is rejected and an election
to pursue a civil action is filed.
While a purpose of the VICP is to fairly compensate
individuals who have been injured by vaccines, the
Act provides that petitioners may choose to reject
an award from the VICP and sue in a traditional civil
forum. It is the goal of the VICP to ensure that
this option is rarely, if ever, utilized by those
individuals with a legitimate claim for compensation
for a vaccine-related injury. This measure tracks
the number of individuals who pursue civil litigation
following a determination that they are eligible for
compensation. From FY 05 – FY 07, the VICP met its
target of 0% for the percentage of eligible claimants
who opted to reject awards. The FY 08 and FY 09 targets
are 0%.
26.II.A.2. Average claim processing time.
This measures the average length of time from the
date the claim is filed until payment is authorized
for compensable claims, and the date of filing to
judgment for dismissed claims. This goal encompasses
total claim processing time by all program participants,
including the Department of Justice, HRSA, petitioners
and the U.S. Court of Federal Claims. Since FY 05,
the VICP average time to process claims has been less
than its targets. In FY 05, the average time was
894 days, which was less than the target for FY 05
of 990 days. The average time was reduced to 834
days in FY 06, less than the target for FY 06 of 1,005
days. In FY 07, the VICP did not meet its target
of 1,213 days for this measure due to petitioner and
Court-driven delays in adjudicating claims. For this
period, the performance outcome was 1,337 days (See
section below on “Targets Substantially Exceeded or
Not Met.”) The FY 09 target is 1,653 days. The targets
for this measure are increasing because some claims
have been stayed (i.e., the Court has stopped the
adjudication process at the request of the petitioner)
for several years and when they are finally resolved,
they will significantly increase processing times.
26.II.A.3. Percentage of cases where the deadline
for the Rule 4(b) report is met once the case has
been deemed complete.
This annual measure tracks how efficient the VICP
is at filing Rule 4(b) reports for cases that have
been filed with adequate medical documentation. The
filing of these reports is the first step in the process
of adjudicating cases. A Rule 4(b) report is similar
to the government’s “answer” in a traditional civil
lawsuit. Its purpose is to explain the government’s
position as to why an award should or should not be
compensated, provides a medical analysis of petitioner’s
claims, and assert any applicable legal arguments.
Before a Rule 4 (b) report can be completed, a VICP
physician conducts a medical analysis of the case
if adequate medical documentation has been filed.
Also, the Department of Justice conducts a legal analysis
of the case to determine if it meets the requirements
of the National Childhood Vaccine Injury Act of 1986,
as amended. The medical and legal analysis are combined
and become the Rule 4(b). This supports the VICP’s
first long-term goal by helping to ensure that fair
compensation is offered to claimants, and it supports
the second long-term goal by moving cases toward disposition
on a timely basis.
Since FY 05, the VICP has exceeded its targets for
the percentage of cases where the deadline for the
Rule 4(b) report is met once the case has been deemed
complete. In FY 05, the Rule 4(b) report deadline
was met for 83.7% of the cases that are deemed complete
which exceeded the FY 05 target of 78%. In FY 06,
the Rule 4(b) report deadline was met for 82.4% of
the cases that are deemed complete which exceeded
the FY 06 target of 80%. In FY 07, the Rule 4(b)
report deadline was met for 89.3 percent of the cases
that were deemed complete which exceeded the target
of 83 percent. The FY 08 and FY 09 targets are 86%.
26.II.A.4. Decrease the average time settlements
are approved from the date of receipt of the DOJ settlement
proposal.
The purpose of this measure is to track the average
time that settlement payments are approved and to
ensure that petitioners are satisfied with the processing
of their claims, thus, preventing award rejections.
Quickly and efficiently processing settlements is
a top priority for the VICP. The VICP is unable to
reduce the targeted average time below 10 days because
of factors inherent in the approval system, such as
the necessary legal review and opinion by the HHS
Office of General Counsel. In FY 05, the average
time increased to 18 days due to staff changes, but
was reduced to 11 days in FY 06. In FY 07, the VICP
was successful in reducing the average time to approve
settlements and to pay lump sum only awards. The
average time that settlements were approved from the
date of receipt of the DOJ settlement proposal was
9.6 days, which was less than the target of 10 days.
The FY 08 target for this measure is 10 days.
The FY 09 target increases to 12 days which is a 2-day
increase from the FY 08 of 10 days. This increase
reflects the maximum efficiency possible in view of
the inherent delays in the process. The process includes
the HHS Office of the General Counsel (OGC) reviewing
the Department of Justice (DOJ) settlement proposal
and preparing a legal opinion to the VICP. This OGC
review and opinion often requires consultation with
DOJ attorneys to clarify or amend elements in the
settlement proposal. Additionally, the OGC no longer
has an attorney exclusively working on VICP correspondence
and issues. OGC attorneys currently serve a number
of HHS clients, thus priorities and time commitments
can shift, and cause reasonable delays.
26.II.A.5. Decrease the average time that lump
sum only awards are paid from the receipt of all required
documentation to make a payment.
The purpose of this annual measure is to track the
average time that lump sum awards with the required
documentation to issue payments are made and to ensure
that petitioners are satisfied. In FY 05, the average
time rose to 11 days. This measure previously read
“Decrease the average time that lump sum only awards
are paid from the date of the DOJ clearance letter
to make a payment” to now read “Decrease the average
time that lump sum only awards are paid from the receipt
of all required documentation to make a payment.”
This change was necessary to account for a DOJ-driven
policy implemented in FY 06 to process payments only
after the petitioner had submitted proof of guardianship.
Additionally, this measure change accounts for time
required to collect tax identification number information
and other necessary payment data. The FY 06 data
is only available from May through September as the
VICP database was modified in May 2006 to capture
data for this revised measure. The average for FY
06 is 3 days for the period of May through September.
In FY 07, the average time to pay a lump sump only
award from the receipt of all required documentation
to make a payment was 3.9 days, which was less than
the target of 5 days. The FY 08 and FY 09 targets
are 5 days.
26.E. Percentage of cases in which case settlements
are completed within 15 weeks.
The purpose of this measure is to track the percentage
of cases in which settlements are processed within
15 weeks from the date of the tentative agreement
between the parties and the settlement proposal is
submitted to the petitioner for his or her concurrence.
Quickly and efficiently processing settlements is
a top priority for the VICP. In FY 04, the percentage
of cases was 80%, which is the baseline for this measure.
In FY 05, the percentage of cases rose to 95% which
surpassed the FY 05 target of 85%. In FY 06, the
percentage was 97.9%, which exceeded the target of
90%. In FY 07, the percentage of cases in which settlements
are processed within 15 weeks was 96.4 percent which
surpassed the target of 92 percent.
The targets for FY 08 and FY 09 will remain at 92%
due to the complex nature of case settlements.
TARGETS SUBSTANTIALLY EXCEEDED OR NOT MET
Measure: Average claim processing time.
FY 07 Target: 1,213 days
FY 07 Result: 1,337 days
In FY 07, the VICP did not meet its average time
to process claims target of 1,213 days. For this
period, the performance outcome was 1,337 days. The
VICP did not meet its target due to unanticipated
additional petitioner and Court-driven delays in adjudicating
claims. The calculation of the average time to process
claims starts when the claim is filed, even if they
are not accompanied by the appropriate medical records,
and ends when the court issues a judgment to dismiss
the claim or a compensated claim is paid. Many claims
are filed without a complete set of medical records
which leads to delays in processing claims. In addition,
the Court permits petitioners to stay their claims
while research to support their theories of how the
vaccine caused their injuries or the Court also permits
delays in the process while petitioners search for
experts to support their causation theories.
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