From a recent report by Social Security's Office of Inspector General (OIG):
The Office of the Commissioner of Social Security provided the Inspector General a September 25, 2008 letter from an anonymous individual claiming to be a State of Alabama Medical Consultant (SAMC) at the DDS [Disability Determination Service] in Birmingham, Alabama. ...
Based on interviews with 53 current and former AL-DDS MCs and review of instructions the DDS provided to some of them, we concluded that, at a minimum, a perception existed that AL-DDS pressured some MCs to increase their disability allowance rates. Several MCs told us the pressure to approve claims influenced their medical decisions. We acknowledge that analyzing information on disability allowance and denial rates is beneficial in identifying anomalies, which may indicate a need for further MC training. However, we believe each case should be weighed on its own merit in accordance with SSA disability determination policies.
"AL-DDS pressured some MCs to increase their disability allowance rates"
ReplyDelete"However, we believe each case should be weighed on its own merit in accordance with SSA disability determination policies"
I'm curious how the commissioner know the dds did not weigh each case on the merit before allegedly pressuring the medical consultants?
As a former adjudicator, I'm glad that DDS pressured some of their MCs to approve more cases. I saw MANY cases that should have been approved that weren't because some MCs were biased toward not approving many claimants (e.g. those who were under 50).
ReplyDeleteI even had some MCs who would complete an RFC and then ask me to let them know if it resulted in an allowance so the RFC could be modified and prevent an allowance.
There are also some extremely lazy MCs out there. There was one I worked with who ALWAYS either said that the claimant's condition was expected to resolve to non-severe within 12 months or he wanted a CE so he didn't have to read the medical evidence already collected.
Yes, each case should be weighed on its own merit, however, that only works when you have ethical and competent MCs working at DDS.
Lazy MC's have always thought they should err on the side of not allowing.
ReplyDeleteI like this sentence: "Several MCs told us the pressure to approve claims influenced their medical decisions."
This just goes to show that medical consultants can really act as paid hacks, shifting their opinions according to the signature on the paycheck.
You can always tell the really lazy DDS decisions--they offer three jobs from the 1940's as comparable employment that the claimant could perform. I have seen it over and over--we get a good laugh out of them in the FO. They usually get allowed on appeal.
ReplyDeleteThe signature que section was eye opening. Signing 30 cases an hour is not ethically possible.
ReplyDeleteWhat Anonymous #2 is saying has also been true in my experience. The MCs heavily prone to denial are often sloppy and have a poor understanding of the regulations governing the program.
ReplyDeleteIt's easier to write an outcome-driven RFC assessment than to explain judgment. That's all about avoiding returns from the regional OQP, who get more than 50% of approvals, but only review denials in miniscule numbers.
However, in this instance, it appears from the article that their management just told them to allow more cases, regardless of how or why. That's the typical management way to deal with everything - just fix the stats and it makes it all better.
Except it doesn't.