It looks like SSA is allowing 75+% of all disability claims? This number would be even higher if it wasn't for state welfare agencies forcing people to file that definitely aren't disabled.
I think the chart also shows how worthless the reconsideration level is.
yes and no, you aren't factoring in the number of people who don't appeal to the next level. Just look at the initial level, 2 million people are denied and only 750k appeal that decision (roughly). I also wonder if quality reviews of favorable decisions are including in the AC level of the chart, if so then about 5% of the AC's actions are quality reviews (they do about 7k a year)
@ 10:03am I see just the opposite as would anyone else, in fact adding all 5 rates together and then dividing the 5 equally shows a 61.4% Deny Rate, so I call your statement BS.
@11:29 you cant just average the percentages - the sample sizes are totally different. @10:03 not evertone files an appeal, you looked at the wrong numbers.
To get a true rate, you would need to add the allowances together for each category.
While not perfect, to get the best idea of how many people applying in a given year get paid at some point (to get a total percentage of favorables) with the data this chart provides, you have to take the total number of favorables at all levels and figure out what percentage of total apps at the initial level (i.e. all apps filed--3,121,433) it represents, then sum.
So, 1/3 are paid at the initial level (this represents approx. 1,040,478 cases). This one third stays one third in our summation because it represents 1/3 of all apps (it's the initial level, which all apps go through, remember).
Around 1/4 of all apps are appealed to recon (which represents about 3/8 of those not paid initially), of which 12 percent are paid. Doing the math, that's another 95,623 pays. 95,623 is another 3% of all apps.
668,061 cases were heard by ALJs, of which 347,392 were paid. 347,392 is about 11% of all initial apps.
Then the AC pays 2,687 more cases (2% of the 134,335 it heard), which represents almost a percent of all apps, which, added to the few hundred paid by the Fed Cts, we can just tack on another 1 percent of all apps paid.
So, 33 + 3 + 11 + 1 = 49. About 49% of all apps filed get paid.
However, this figure does not take into account apps where some determinations/decisions occurred in different years, nor the remands from the AC and Fed Cts that will be paid after subsequent ALJ hearing (though this rate is presumably less than the average rate of 52% at the hearing level). Let's not forget this number also does not include the apps that aren't appealed to recon and that are dismissed at the ALJ level, which are not trivial in amount and may suggest the claimant's involved returned to work (I know there are lots of reasons for failure to appeal and getting a dismissal of RFH, but one of those is surely return to SGA).
So, with the admittedly limited data this chart gives, and with the caveat that the number is surely not perfect, the best guess for total percentage of apps paid at some point appears to be about 49 percent.
It would appear that the ALJ's pay the highest percentage of any component. Considering that these are the "questionable" cases, the ones that require more than a passing glance and that most of these have been denied twice, I think that shows the sincerity and effort ALJ's go to properly adjudicate these sometimes tough cases.
HOWEVER - Mr. Hall is wrong - SSA does not call this a waterfall chart and it is NOT a true waterfall chart.
Look at the heading of the report - it's a report of cases closed in that year. Adjudicative capacity at all levels can result in different numbers of final decisions.
The REAL waterfall chart tracks what happens to the applications from a year - which can often spill over into subsequent fiscal years.
Review the data from the ODAR intranet site......the actual % of disability only cases reversed at ODAR has dropped several points below 50% in 2013. While it appears that ODAR allows the most cases, it's not true - since it's a relatively small number of cases that actually reach ODAR from the start of "WATERFALL' at application date.
a statement by someone who really doesn't understand the system....
most recons are filed within 60 days of the initial decision and decided within another 60 days. If there was a high reversal rate - it would represent a serious quality issue at the initial level........
ODAR cases take 300-500 days - so things change - and the decision-making process is different at ODAR and not subject to the same quality review that the state decisions are. The ODAR AC quality review is finding that about 20% of the ALJ decisions are not supported by the evidence.....
There is a much high professional representation level at the ODAR level - and many people fall out from filing for an appeal - since professional reps decline many denied people - since they won't be paid.
@7:21 You say things change in the 300-500 days for a hearing? then why are the ALJs using the initial onset date when making their decisions? Should there be many more Partially favorable decisions with amended onset dates?
I do understand the system. I have worked in both prototype and non-prototype states. The reconsideration level needs to be done away with.
7:21, just so you know, if the claimant amends an onset date then the resulting decisions is almost always designated a fully favorable decision.
So if you are using stats that break down cases into FF, PF and UNFAV, you need to realize that a significant portion of FFs could actually be converted PFs.
12 comments:
It looks like SSA is allowing 75+% of all disability claims? This number would be even higher if it wasn't for state welfare agencies forcing people to file that definitely aren't disabled.
I think the chart also shows how worthless the reconsideration level is.
yes and no, you aren't factoring in the number of people who don't appeal to the next level. Just look at the initial level, 2 million people are denied and only 750k appeal that decision (roughly). I also wonder if quality reviews of favorable decisions are including in the AC level of the chart, if so then about 5% of the AC's actions are quality reviews (they do about 7k a year)
@ 10:03am I see just the opposite as would anyone else, in fact adding all 5 rates together and then dividing the 5 equally shows a 61.4% Deny Rate, so I call your statement BS.
Initial Level: Deny 67%
Reconsiderations: Deny 88%
ALJ Hearing: Deny 32%
Appeals Council: Deny 77%
Federal Court: Deny 43%
@11:29 you cant just average the percentages - the sample sizes are totally different.
@10:03 not evertone files an appeal, you looked at the wrong numbers.
To get a true rate, you would need to add the allowances together for each category.
But the recon leve still need to be eliminated.
3,121,433 claims filed
1,476,212 ultimately approved (47.29%)
You all are doing it wrong.
While not perfect, to get the best idea of how many people applying in a given year get paid at some point (to get a total percentage of favorables) with the data this chart provides, you have to take the total number of favorables at all levels and figure out what percentage of total apps at the initial level (i.e. all apps filed--3,121,433) it represents, then sum.
So, 1/3 are paid at the initial level (this represents approx. 1,040,478 cases). This one third stays one third in our summation because it represents 1/3 of all apps (it's the initial level, which all apps go through, remember).
Around 1/4 of all apps are appealed to recon (which represents about 3/8 of those not paid initially), of which 12 percent are paid. Doing the math, that's another 95,623 pays. 95,623 is another 3% of all apps.
668,061 cases were heard by ALJs, of which 347,392 were paid. 347,392 is about 11% of all initial apps.
Then the AC pays 2,687 more cases (2% of the 134,335 it heard), which represents almost a percent of all apps, which, added to the few hundred paid by the Fed Cts, we can just tack on another 1 percent of all apps paid.
So, 33 + 3 + 11 + 1 = 49. About 49% of all apps filed get paid.
However, this figure does not take into account apps where some determinations/decisions occurred in different years, nor the remands from the AC and Fed Cts that will be paid after subsequent ALJ hearing (though this rate is presumably less than the average rate of 52% at the hearing level). Let's not forget this number also does not include the apps that aren't appealed to recon and that are dismissed at the ALJ level, which are not trivial in amount and may suggest the claimant's involved returned to work (I know there are lots of reasons for failure to appeal and getting a dismissal of RFH, but one of those is surely return to SGA).
So, with the admittedly limited data this chart gives, and with the caveat that the number is surely not perfect, the best guess for total percentage of apps paid at some point appears to be about 49 percent.
It would appear that the ALJ's pay the highest percentage of any component. Considering that these are the "questionable" cases, the ones that require more than a passing glance and that most of these have been denied twice, I think that shows the sincerity and effort ALJ's go to properly adjudicate these sometimes tough cases.
All very interesting commentary and calculations;
HOWEVER - Mr. Hall is wrong - SSA does not call this a waterfall chart and it is NOT a true waterfall chart.
Look at the heading of the report - it's a report of cases closed in that year. Adjudicative capacity at all levels can result in different numbers of final decisions.
The REAL waterfall chart tracks what happens to the applications from a year - which can often spill over into subsequent fiscal years.
Review the data from the ODAR intranet site......the actual % of disability only cases reversed at ODAR has dropped several points below 50% in 2013. While it appears that ODAR allows the most cases, it's not true - since it's a relatively small number of cases that actually reach ODAR from the start of "WATERFALL' at application date.
how worthless the "reconsideration level" is?
a statement by someone who really doesn't understand the system....
most recons are filed within 60 days of the initial decision and decided within another 60 days. If there was a high reversal rate - it would represent a serious quality issue at the initial level........
ODAR cases take 300-500 days - so things change - and the decision-making process is different at ODAR and not subject to the same quality review that the state decisions are. The ODAR AC quality review is finding that about 20% of the ALJ decisions are not supported by the evidence.....
There is a much high professional representation level at the ODAR level - and many people fall out from filing for an appeal - since professional reps decline many denied people - since they won't be paid.
A broken system? Perhaps.
@7:21 You say things change in the 300-500 days for a hearing? then why are the ALJs using the initial onset date when making their decisions? Should there be many more Partially favorable decisions with amended onset dates?
I do understand the system. I have worked in both prototype and non-prototype states. The reconsideration level needs to be done away with.
7:21, just so you know, if the claimant amends an onset date then the resulting decisions is almost always designated a fully favorable decision.
So if you are using stats that break down cases into FF, PF and UNFAV, you need to realize that a significant portion of FFs could actually be converted PFs.
I agree that recon is useless.
More detailed information (including a breakdown by states) can be found here:
http://ordp.ba.ad.ssa.gov/ODP/content/State_WaterfallCharts
HA HA HA
that's an internal SSA link - not available to the public.
be careful what you release.
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