Feb 5, 2015

2014 Waterfall Chart


28 comments:

Anonymous said...

Assuming AC remands result in a FF decision from an ALJ at the rate shown in the chart...the overall rate of success for an applicant for disability benefits is about 44%.

Anonymous said...

AC remands definitely are NOT 100% FF's.

Anonymous said...

It shows the Reconsideration Level is a joke and waste of everyone's time. It also shows over half of the claims for not meet the definition SSA set for its programs. That's a lot of claims that tie up resources.

Anonymous said...

How can SSA justify a "reconsideration" that results in 11 percent allowance or reversal rate and an Appeals "Council" that remands 14 percent of cases? These two "review" entities are nothing but expensive rubber stamps deterring, preventing and postponing disability claimants' recourse. Combined with an ALJ denial rate that has significantly increased despite the rise in applications by boomers, unprecedented numbers of women workers approaching retirement age and an economy that has tanked. It's an absurd shell game that congress doesn't grasp and if it did, nothing would be done. It’s no wonder Posner considers some adjudicators akin chicken to factory workers.
http://www.lawblogs.net/go/judge-posner-administrative-law-judges-are-like-chicken-factory-workers

Anonymous said...

at 8:38...I am 8:03. My calculations are not based on 100% FF after AC remand, they are based on 45% after AC remand, which is consistent with the over ALJ FF rate. Anyway, even if AC remands resulted in 100% FF decisions, the overal approval rate would only go up to 44.1%

Anonymous said...

agree with 9:53...having 55% of claims (which have as many as 5 different adjudicators reviewing them) denied indicates that too many people are attempting to game the system.

If the goal of SSA is to truly "reduce the backlog" then reforms need to be made regarding who can apply and why. Allowing all comers is a serious drain on the system and results in inadequate service/long delays for those who truly need them.

I would suggest a type of triage/screening system, similar to what is used by most emergency rooms. If you show up with a bogus claim (as evidenced by criteria TBD), you get routed one way, if your claim appears valid (again, some other criteria TBD) you get routed another way. Both claims will be heard, but resources will be concentrated on the "valid" claims.

Anonymous said...

"I would suggest a type of triage/screening system, similar to what is used by most emergency rooms. If you show up with a bogus claim (as evidenced by criteria TBD), you get routed one way, if your claim appears valid (again, some other criteria TBD) you get routed another way."

You do realize that's effectively what's already happening at the initial level.

Anonymous said...

Every time I hear someone say "game the system" I wish someone would hit them in the head with a tack hammer.

Anonymous said...

I didn't write the post you responded to, but no screening done in any of my area offices. They want to file, they get to file, barring work denials. Broken toes, pregnant strippers who can't dance...you name it, they file it.

Anonymous said...

8:03 - Sorry, that's what I get for trying to write a response on a crowded bus!

Anonymous said...

@10:32 AM, why only a tack hammer? I suggest a larger sledge or a pick ax.

Anonymous said...

9:57 has hit the nail on the head. Get rid of the frivilous junk and the frequent fliers and for that matter Supplemental Security Income, or WELFARE...

Anonymous said...

@12:06PM and while we are at it why don't we just go ahead and knock out the world peace problem while we are at it.

Its easy to use the disabled and disadvantaged as scape goats in this situation when in fact they carry none of the blame at all.

Anonymous said...

Really, teh ex-cons that can't get a job due to jail records, the smokers with their COPD, the druggies with their mental problems and lack of ability to work, the alcoholics with their mental problems and inability to work, the overweight and their diabetes and neuropathies... they carry none fo the blame at all?? Wait, what??

Anonymous said...

@12:30 PM I am not sure what kind of system you could create where you could dispose of claims at the front end like has been suggested without running the risk of filtering out claims you did not intend to. Its easy to sit here and rattle off the examples you gave but most cases, even with the facts you gave, are not that clear cut. Everyone should be entitled to a fair and equal assessment of their claim. There is no triage system I can think of that could accomplish that without running the risk of treating claimants unfairly and with the bias you clearly displayed in your examples.

Anonymous said...

@ 12:53, I wouldn't "dispose" of claims, rather some claims would be put on a slower track and others would get priority.

Anonymous said...

There are already ways to fast-track claims that seem likely to succeed. QDD, Compassionate Allowance, presumptive benefits, etc. We don't need another program. We need enough SSA staff to run the current programs well.

Anonymous said...

my suggestion is not meant as a new way to fast-track claims...it's intended to pick out the ones destined to fail and slow those down. If the system is not burdened by meritless claims, the claims with merit can be processed more quickly.

Anonymous said...

For what it's worth, I agree with whichever commenter noted that the initial (and recon) levels serve as the filters for "bogus" claims.

I work in an ODAR hearing office, and it's really, really, really rare that we see cases that aren't from at least pretty significantly limited people (even the unrepped ones that withdraw their RFHs or no show and don't respond). So yeah, I'm skeptical that there are that many out and out bogus claims that we could quickly weed out at all, but as far as wasting resourecs goes, it seems like DDS does a fine job of kicking them out because they don't seem to be present at the hearing level.

As not-claimant-centered as my views can be in this general area, I still can't believe how many people think there are so many fraudsters with very little or nothing wrong with them. Yes, there seems to be a significant number of people who apply that, had their job not dried up or if there was some other work nearby they'd be working, but even those people are overwhelmingly pretty limited, and their mental Sx and pain only get worse the longer they are out of work. And there are plenty of people who clearly won't meet/equal and don't have nearly enough of the right nonexertional limitations to hope there aren't jobs at Step 5 (i.e., folks who are too young to grid), but again, almost all those folks do have very significant and documented conditions causing significant functional limitations.

Switching gears to address 9:53, we've been over this recently. When you account for the super high percentage payer ALJs (who tended to also be super high disposition ALJs), there hasn't really been much change in ALJ (or DDS or AC, for that matter) pay rates. You can do the math yourselves--as mindblowing as it seems, those few dozen folks paying 90+% of their 800+ dispositions significantly impacted the overall ALJ pay rates and the waterfall rates, and the steady decline in pay rate since 2009 or so is largely attributable to those ALJs leaving the Agency or (in much fewer cases) straightening up and approaching the mean with regard to pay rate and dispositions. Just look at the publicly available ALJ data for the folks named in that recent Congressional report. Your whole song and dance that somehow because there were more women in the workforce beginning in the 1970s (which, in my mind would only necessarily result in a 50% increase of total disabled, not in the payrate itself...), that there are more boomers, etc. etc.--that it is beyond obviously apparent payrates should be skyrocketing--is getting tiresome, especially with recent new data (like the aforementioned data relating to high payer/high deciding ALJs) showing how mistaken your contentions are.

Manusia Bodoh said...
This comment has been removed by a blog administrator.
Anonymous said...

@5:26

My impression from 20 years as a rep is that the initial and recon levels indeed serve as a coarse filter, catching and approving a fair number of the most obviously meritorious claims. However, there are multiple categories of obviously meritorious claims they are just not set up to or trained to catch at those two levels.

A typical example: Facts are compelling that a claimant's medical impairment would cause an average of 3-4 unscheduled work absences a month. Any honest VE will tell you that person can't sustain employment. However, almost all of those cases get denied at initial and recon, because few of the CE's, adjudicators, or forms rate that category in a meaningful and clear way. However if presented well to a reasonable ALJ, those same facts can and should result in a favorable decision.

There are of course, multiple other examples like that I could provide. It would cut down considerably on the number of cases pending at the ALJ hearing level if these claims could be adjudicated correctly at the initial and reconsideration stages.

Anonymous said...

Waterfall chart does not account for folks who just drop out. So overall approval/denial rate not discernible from this chart. Obviously lots drop out, so overall approval rate is MUCH lower. Have to incorporate the numbers on the left to come up with overall rate

Anonymous said...

RE: ANON 5:26 PM, February 05, 2015

Not sure what the point was in all that, but the assertion that “there hasn't really been much change in ALJ (or DDS or AC, for that matter) pay rates” is simply wrong. Allowance rates were roughly 37 percent in 2009. It is noteworthy that the disability laws have not changed, yet allowance rates have dipped to 33 percent in 2013 and continued to decline in 2014. The result - each year over 100,000 additional claims and appeals are denied.
Comments that complaints regarding this fact are getting “tiresome”, pales in comparison to the unwarranted denials the disabled have to deal with.

Anonymous said...

11:16

did you not read my whole post? I didn't say there hasn't been a change in ALJ payrate--clearly there has been. What I said is that the change is largely due to the removal or straightening up those few dozen super high payer/decider ALJs, and that we can all do the math that proves it. There is some decline in payrate at the ALJ level that is not explained by the decline in super high payer/decider ALJs, but a very significant portion of the dip is due to the absence of their many, overwhelming FF decisions.

The whole point was to counter the assertion that this drop is entirely due to SSA forcing new ALJs (and old ones, for that matter) to be more stingey or deny more people, which, funnily, goes counter to what the ALJs themselves, or at least their union, asserts SSA pressure has resulted in (more favorables to meet productivity requirements).

Bottom line--is the ALJ corps issuing fewer FFs and PFs? Yes, but much of the dip was the result of the super high payer/decider ALJs and not some nefarious SSA plot or a crop of new ALJs who were selected because of their black hearts.

Anonymous said...

The ALJ Union is, as usual, about 3 to 4 years out of date. But, the contention is wrong that the drop in allowances is solely due to the high-paying ALJs curbing their allowances. Compare any ALJ's rate this fiscal year with a couple or three years ago -- most pay fewer cases.

Anonymous said...

Agree with the above.

But, re anon 4:19 PM, February 06, 2015 “The whole point was to counter the assertion that this drop is entirely due to SSA forcing new ALJs (and old ones, for that matter) to be more stingey or deny more people”

True, the “drop” is due to many factors including DDS, AC, SSAFO, some ALJs, 60 Minutes, NPR, demographics of wage earners, economy, more women in the workforce, more boomers, Wall Street Journal ad infinitum. However, there is no mistake in the contention that pay rates have declined. And the disabled have suffered as a result.

Anonymous said...

Let's not rewrite history. Wasn't Astrue's message to ALJs: "get rid of the backlog"? And they did, right? And nobody in ODAR, not Astrue or any of his deputies, cared or said anything about high allowance rates while ALJs were clearing the backlog, right? Only after some journalists discovered weirdly high allowance rates in some offices did ODAR start paying attention, right? And whatever management has been doing since - the message to ALJs seems to be that they better stay within the curve - which now seems to be about 40% allowance, right?

Anonymous said...

Does this chart also include appeals of non-disability decisions such as overpayments/underpayments? Is there any sense as to how many of those are appealed and what percentage are approved/denied?