Driven to reduce a huge backlog of disability claims, Social Security is pushing judges to award benefits to people who may not deserve them, several current and former judges told Congress Thursday.
Larry Butler, an administrative law judge from Fort Myers, Fla., called the system "paying down the backlog."
A former Social Security judge, J.E. Sullivan, said, "The only thing that matters in the adjudication process is signing that final decision." Sullivan is now an administrative law judge for the Department of Transportation.
The House Oversight and Government Reform Committee is investigating why many judges have high approval rates for claims already rejected twice by field offices or state agencies. Two current and two former judges spoke at a subcommittee hearing. ...
None of the judges who testified spoke of being specifically ordered to award claims. Three said they had been pressured to decide cases without fully reviewing medical files.
The judges described a system in which there is very little incentive to deny claims, but lots of pressure to approve them. It requires more documentation to deny a claim than to approve one, said Sullivan, the former Social Security judge. Also, rejected claims can be appealed while approved claims are not.
24 comments:
The denial rate of each of these ALJ witnesses shows they had no difficulty denying claims. They each seemed to want more power and respect.
The problem here isn't telling the judges to do their job and judge, the problem is that the ALJ witnesses don't know how to do their job, as evidenced by their extremely low allowance rates or case production. In defense of her numbers for 2010, Sullivan wimpered something about having cases taken from her. Hard to believe that cases would be taken from someone who knew what they were doing. Harder yet to believe that this reporter treats the views of this crew as representative of the main stream judge corps.
When Sullivan was in Portland, she did 0 cases because she was assigned to the union ALJ bargaining team and they still have not produced a contract for the ALJs to ratify. She was dead weight for SSA, probably no better now.
Bottom line is that these invited judges are statistical outliers when it comes to their reversal rates and as such their testimony must be considered in this light. They clearly seem to have a slant which could not be presumed of a judge who had a reversal rate more in line with the norm. Unfortunately this is very typical of Congress regardless of which side of the aisle you sit.
My impressions on reading Butler's testimony:
Very low claim approval rate + wants to make SSA system adversarial against claimants + upset about what each approved claim costs + does not like his employer + obsessed with isolated cases of fraud + very suspicious of claimant reps
I approve cases that have been denied twice by the State Agency because the State Agency does a terrible job of considering all of the claimant's impairments, does not consider the claimant's subjective complaints, and does not consider all of the evidence that has been submitted in the year plus after they've made their decision. Is that so hard to understand? The notion that State Agency determinations are entitled to such great deference is absurd.
Anon 2:36,
It's not just the extraordinary rate at which the ALJs who offered testimony deny the claimants who appear before them. Consider the "recommendations" that they offered in their testimony. Would they tend to increase the number of denials? Mostly yes. Consider the two together...and it becomes harder to doubt that they are promoting an agenda for denying more claims.
Even the appearance of an agenda like that is troubling, in my opinion. Claimants need to at least believe that when they go in front of a particular ALJ, they will get a fair and impartial hearing. When an ALJ goes on a public record as believing a lot more claims should be denied, and has a record that could be perceived as involving some degree of judicial activism in that regard, how can a Claimant believe that he will get a fair hearing from that ALJ?
A former head of DDS gave the simplest definition of the discrepancy between the DDS and the ALJ decisions. The DDS decision is made by Doctors based on medical evidence whereas the hearing decision is made by lawyers after direct testimony from the claimant.
it's also important to keep in mind that the "reversal" rates cited by charles are flat out wrong. I'm assuming that he used the improper calculation of not removing dismissals, which have absolutely nothing to do with pay rate.
8:08 AM, June 28, 2013 here here!
This reminds me of Daryl Issa's questioning of why someone who has been denied twice is getting benefits. If anyone believes that DDS processes claims according to the regs, they either live in a much different place or don't understand the process.
Justin
Then remove DDS from the process if they're so negligent.
@Anon 8:50: At the hearing level, Doctors review the claimant records and sit in and testify in the hearing.
I meant Coburn, I think, not Issa.
@11:44 Doctors (ME's) testify in a very small number of hearing overall.
Justin
I pay cases based upon the documentation and testimony. very seldom do I pay on the alleged onset date, but I will request an amended onset date until a time when the documentation supports the finding of disability. Conditions worsen. My pay rate is higher than others, but seldom reaches back to the alleged onset date. They just weren't disabled as of that date adn DDS got it right. Time passed, condition worsened, medical documentation supported testimony, pay..
That' sounds rational and logical
The Honorable Tom Coburn, M.D. (R-Oklahoma) has no interest in listening to an ALJ who allows more than 30 percent of cases. Thus the staffing should not be a mystery.
What’s to stop a 30% Outlier ALJ? Virtually nothing.
Perhaps if the Appeals Council actually did their job and returned more than 22% of clearly deficient, reversible ALJ Outlier decisions, a modicum of change might eventually filter down to all components. But that would mean real review by a component who has a diminished work load and no accountability what so ever. I would love to see House Committee on Oversight and Government Reform review the Appeals Council. But won’t hold my breath on that one.
Be careful what you wish for, 3:34.
The outlier decisions you wish the AC would start remanding in droves might just be--in significant part--the poorly and hastily written FFs cranked out by the "good," "fair," high-paying ALJs ;)
As in an ALJ hearing, all the claimant deserves is a fair and accurate review by a knowledgeable entity. If and when the AC ever rises to that level, then the “droves” of “high paying” ALJ decisions should absolutely be subject to review. That’s a change I would welcome.
The reporter doesn't cite the key fact that came out yesterday at the hearing: the national allowance rate by the ALJs is falling and is now below 50% for the first time in something like 30 years. This was the data that the SSA witness was referring to when he said the data speaks for itself. Pretty big thing for a journalist to leave out of an article.
Doesn't SSA's upper management in the Appeals Council communicate a similar message about moving cases quickly to the reduce backlog of requests for reviews?
At the AC level, it's much quicker to deny a request for review than to grant one. So what are adjudicators rewarded for? Disposing of a lot of cases - the ideal reportedly being 20 denials a day.
Over the past few years, certain AC upper managers have developed a "data fetish" that gets a lot of time and attention, has improved the career prospects of those involved, but hasn't helped to improve the quality of case processing.
These hearings aren't designed to gather facts, they are designed to advance ideological points of view. Trotting out 4 outlier ALJs whose arguments are patently invalid ("paying down the workload" when the pay rate has been steadily declining)should make this abundantly clear. Coburn, Issa, et.al. don't want a fairer system, they want fewer people to receive disability benefits. But it's politically more expedient to gin up a narrative of "lax" ALJs then it is for them to simply say what they want.
Word on the street is VSU is dead after the next six month rotation. Let's see what happens to ALJ pay rates in the 6-12 months after that before we start running around like chickens with no heads due to ALJ average pay rates dipping below 50%.
You gloom and doom reps realize there was never a program that took so many likely (and actual--VSU and informal remands pay a lot of cases) fully favorable cases away from hearings offices (and thus ALJs) in the history of ODAR/OHA, right? And that these programs might have some significant effect on ALJ pay rates? No? Ok...
Lower pay rates is most likely the reaction to many, many more people applying without a condition that sufficiently prevents them from working.
I have observed that with the expansion of online disability claim filing that it takes little to no effort to submit an application, especially those incomplete, cookie cutter applications completed by certain representative sweatshops, I mean law offices. So of course pay rates will go down, at least among ALJ's who don't approve everyone.
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