Make a statistical review of cases in which ALJs reverse prior administrative denials to look for patterns showing which types of cases are most reversal prone and carefully consider adjusting policies and practices at the initial and reconsideration levels to allow more of these cases.
This was done during the Clinton Administration and it worked. This was a part of something called Process Unification. I have my own candidates for types of cases that Social Security should look at. The most important type would be bipolar disorder. Social Security is turning down almost everyone who is bipolar at the initial and reconsideration level, but 80-90% of these claims are approved by ALJs.
I have more clients suffering from bipolar disorder than anything else. It may be 10% of my caseload. The next biggest category is chronic pain syndrome. If the claimant is going to a pain clinic and being told to take methadone or some other powerful narcotic several times a day, they might just be in severe pain. However virtually all such claims are being denied at the initial and reconsideration levels, while the vast majority are approved by ALJs. Social Security probably ought to look at its policies on mental retardation, congestive heart failure, obesity and peripheral neuropathy as well.
You could probably eliminate 10-20% of appeals to ALJs in this manner and the vast majority of these claims would have been approved by ALJs anyway. This would probably take at least a year to implement.
I have more clients suffering from bipolar disorder than anything else. It may be 10% of my caseload. The next biggest category is chronic pain syndrome. If the claimant is going to a pain clinic and being told to take methadone or some other powerful narcotic several times a day, they might just be in severe pain. However virtually all such claims are being denied at the initial and reconsideration levels, while the vast majority are approved by ALJs. Social Security probably ought to look at its policies on mental retardation, congestive heart failure, obesity and peripheral neuropathy as well.
You could probably eliminate 10-20% of appeals to ALJs in this manner and the vast majority of these claims would have been approved by ALJs anyway. This would probably take at least a year to implement.
2 comments:
I see a modest number of allowances for Bipolar Disorder but I would agree with you that the number is lower than it should be. One factor is that a significant number of people who allege Bipolar Disorder don't have medical evidence to support the condition. They do have a medically determinable mental impairment but it may be Borderline Personality Disorder, depression etc. which are harder to be allowed on. The 12.04C2 listing should also be considered when the condition has been present for several years. Treatment records or treating source opinions are typically more valuable than CEs in this case.
Pain is a very controversial issue in terms of assessing limitations in functioning on mental vs. physical. Medication side effects are also considered as possible contributers to additional limitations.
I would like to see support for your claim that 80-90% of Bipolar claims are ultimately paid. Bi-Polar is alleged in almost one third of the cases I see---often, without supporting medical evidence. If someone tells a doctor they have highs and lows, it is often diagnosed as "Bipolar Disorder."
Paying such cases on an expedited basis is a very bad idea. It might pay down the backlog---but it will increase the backlog by double once the word gets out that all you have to do to get paid quickly is get your doctor to say you are Bipolar.
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