NATIONAL VACCINE INJURY COMPENSATION PROGRAM

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.