Feb 11, 2016

The Social Security Disability Waterfall Chart 2015


18 comments:

Anonymous said...

Given the AC seems only to "pass the buck" to Federal Court, which remands 45% of cases, the AC should just be disbanded. It sits on these cases for 2 years only to respond with a form letter/boilerplate denial of review. Since the Federal Courts are essentially doing the ineffective AC's job for them, why not just allow claimants to appeal directly to Federal Court?

Anonymous said...

Cut out the Recon and AC levels. However, unless you counteract that by hiring more ALJ's you will end up waiting 3-4 years for a hearing.

The angency might also consider tightening up the initial filing guidelines. Right now, the agency takes any and all claims, no matter the alleged condition.

Anonymous said...

I am waiting that time now.

and if you consider the time for the remand and rehearing..longer.

The goal should be: Do it right, the first time.

Anonymous said...

10:52AM stated, “Cut out the Recon and AC levels. However, unless you counteract that by hiring more ALJ's you will end up waiting 3-4 years for a hearing.”

Better yet, it is high time SSA/ODAR accept the current system is NOT working. Rather than hiring so many ALJ’s, the Agency should immediately utilize the vast knowledge and experience of many of its Attorneys, and reinstate the Senior Attorney program with all the original duties and responsibilities Senior Attorney’s had when the program first began in the mid-1990’s. Then, gradually reduce the ALJ corps and create a system whereby Senior Attorney’s become Hearing Officers at GS-13-15 salary (much less than ALJ’s are paid), hold the non-adversarial SSA disability hearings and issue decisions. Face it, the non-adversarial hearings held by SSA/ODAR do not require the time consuming hiring process and OPM involvement necessary to become an ALJ, or the greater protections the APA provides to ALJ’s. Senior Attorneys are experienced, licensed lawyers who could easily transition into the Hearing Officer position. This would require hiring many more Attorney-Advisors, and create a career ladder for them.

It would also remove the distaste of being grouped as “Decision Writer’s” along with “Paralegal Specialists” who have simply moved up through the ranks from Clerk/Case Technician, without having to demonstrate any writing skills, have any particular educational background, often require intensive training and still cannot be helped, but yet, earn the same salary as an Attorney-Advisor, and do not have to pay for CLE to maintain a law license, and because of seniority, are usually paid at a higher step and given first selection when it comes to office choice, new furniture, etc.

Anonymous said...

" Right now, the agency takes any and all claims, no matter the alleged condition."

I once took a claim from someone alleging a broken arm, which would normally be a super quick denial. The guy failed to disclose he had full blown AIDS as well.

Anonymous said...

So if I'm reading the waterfall right, about 100,000 cases got denied at the Appeals Council. Of those, about 18,000 made it to federal court, and 9,000 of those were either remanded or allowed.

A 9% unsuccessful rate doesn't seem that bad to me. Lord knows the 9th Circuit, for example, doesn't have to justify its far higher unsuccessful rate. How does this show the AC's "uselessness"?

Anonymous 42 said...

Maybe because it takes the AC a year or two to read an ALJ decision and decide whether to review it further. It is not particularly difficult or time-consuming to determine whether a decision is legally sufficient.

Anonymous said...

@ 12:05:

How do you get a job at the Appeals Council? Sounds like the kind of stress free work I've been looking for all my life.

Anonymous said...

I have not heard one substantial defense of the AC. Nobody knows what's going on there, if they did they would post here and shill for their jobs. Here's an example of how bold they have become. In the last two years they won't even acknowledge a faxed appeal for "1 -2 months until it gets logged into our system....and you had better keep your fax receipt to prove you appealed timely." No one holds them accountable. Talk about waste, fraud and abuse.

Anonymous said...

According to ssa.gov, the AC has 71 AAJs and 47 Appeals Officers. That's less than 120 adjudicators for the entire country, with about 150,000 incoming appeals. 1 adjudicator to deny cases and 2 to remand or issue a decision, so all cases aren't just "one and done". What a great job it would be if all they did was read the decision and say thumbs up or thumbs down - though you'd still have a wait based on the appeals to adjudicator ratio. However, to review for substantial or preponderance of the evidence when new and material evidence is submitted, they would have to look at the actual record, including the hearing testimony, right? And attorneys can request extensions to submit arguments or additional evidence. Common sense says that adds time. As 7:28am points out, one role the AC plays, whether intentional or not, is to act as a filter and buffer between the ALJs and the federal courts. Based on the percentage going to court compared to how many are appealed to AC, even with the court remands, it seems to be an effective, albeit imperfect, buffer.

Anonymous said...

I have some guesses as to how the AC decides on what cases to grant review on. Guess number one would be drawing SSN's, on small pieces of paper, out of a fish bowl. The first 4 drawn get a reversal, the next 13 get a remand, and the next 83 get denied. Rinse and repeat. They may also take these fishbowls with SSNs, throw them down a large flight of stairs, and whichever ones land on the right step, they remand.

Anonymous said...

6:31 sounds about right.

The AC's benchmark seems to be less than 15% "grant" review rate now (13% remand and 1% allowance). AC employees are probably not encouraged to grant much more than 15% - because a high remand rate would require SSA to explain why the alj's aren't doing a better job - and not only that, remands just increase the backlog, which SSA doesn't want.

At 15%, SSA can say the aljs are doing a pretty good job, and the AC can say its services are useful & relevant, and everyone's happy.

So the AC employees are going to work to the 15% benchmark, right? Grant review in 15 out of every 100 cases. Almost every alj decision has an error, but with the volume the AC does, it's doubtful they pick the worst 15 out of every 100 cases. They likely pick cases with obvious errors that jump out easily. Nothing too nuanced. So they might as well just do what 6:31 says.

Anonymous said...

1:32 PM, the Appeals Council will be hiring soon and you're welcome to submit a resume if you think it's such a cushy job. I have a bet with myself that you wouldn't last out the probationary period.

Anonymous said...

Yep, SSA is fattening up the Appeals Council and starving the field offices - what a surprise.

Anonymous said...

All these people clamoring for the AC to be disbanded...

Look, I have plenty of qualms with the AC, but here's two all-but-certain-truths you are missing:

1) if the AC was dissolved today, all (heck, maybe not even most) of its resources would not just immediately be poured into the ODAR hearing machine. It's not like all that money/infrastructure/employees would just start hearing cases for ODAR.

2) You must be some kind of naïve or stupid to want a direct appeal to Federal Court from an ALJ decision. Guess who most definitely is NOT going to beef up their staff to handle more SS appeals--that's right, the Federal Courts. While AC review is much less than ideal, what kind of review do you imagine the Fed Courts would undertake if they had to deal with thousands of new filings each year? Probably just remands back to (in most cases) the ALJ that denied you in the first place, which is a large part of the AC's SOP that you hate.

The real problem is bad ALJ hearings, right? Why have we given up on making SSA hold its ALJs accountable and focused solely on administrative and court review, which are always less than perfect, slow, and last resorts?

Anonymous said...

Bad ALJ hearings? Am I hearing that right? Reps have the duty and burden to prove their case through Step 4. In 5 years, I have seen less than a dozen prepared Reps that were ready to prove anything.. I have Reps showing up and say that they have no idea where there claimant is. They make preposterous allegations and when I ask where that is in the record they look at me with disbelief. Why don't all Reps write briefs and truly note where in the record it supports disability or limitations? Is that really asking too much? Really?

Anonymous said...


I say cut the appeals council staff in half. You would have the same remand rate.

Use the resources to increase staff at ODAR. And increase and improve quality control of ALJs and the AC.

Anonymous said...

They are in the midst of hiring 65 new A/j's and 80 attorney advisors for the Appeals Council.