The Scranton, PA Times-Tribune looks into why Social Security's Administrative Law Judges (ALJs) are approving a lower percentage of the disability claims they hear than they used to. The bottom line is that there are many theories but no one, including the Social Security Administration, knows why this has happened.
The article notes, "Officials with Social Security say the higher denial rate is partly attributable to an increase in filings due to the poor economy, which historically leads more people with marginal disabilities to seek benefits." I feel this is somewhat true as I routinely have a 25-27% dismissal rate. If 1/4 of the claimants can't even show up for their hearing, the hearing must not be very important in their lives. The other thing, the attorneys are not developing the record or writing a brief. The ODAR office is not developing the record and I get it 2 days before the hearing, so i'm not developing the record. A well developed record with a well written brief makes it hard to deny a claimant that should be awarded benefits.
ReplyDeletere 11:41am
ReplyDeleteFrom the field office perspective, I agree. We've (at least in our area) seen more marginal and far more of the frivolous type claims filed over the last 12-18 months than previously. Many of these claimants can't even tell us WHY they are disabled, only that they are (I had a woman, I kid you not, a few months ago to file a claim for her kid claiming "one eye is bigger than the other" as a disability). They aren't serious about the claims, don't have any significant MER, and have a tendency to miss scheduled CEs if there is a conflict with just about anything they consider more important (I remember one woman who missed a CE because she was standing in line at the Apple store for her shot at a new iPhone 5 - something she said was far more important to her than a stupid doctor appointment).
According to the Tribune article the local ODAR office's approval rate dropped 17% (from 64% to 47%) in just 3 years. No doubt there's more than one reason, some possibly benign and some not. However, such a large drop is newsworthy and certainly deserving of scrutiny both within and outside of the agency.
ReplyDeletesummary:
ReplyDelete1. DDS approving more marginal claims
2. senior attorneys approving more 3. marginal claims
4. more "frivolous" claims
5. ALJ's actually following the SS Act
6. increased oversight by Appeals Council and quality review leading to more care by ALJ's
7. reps/claimant's not fully developing record
even if each of those added 2% to the denial rate, it would be a noticeable change.
Huntington's disease is a death sentence and I would not wish it upon anyone. However, as with most disease processes, it develops slowly over time. Allowances must be based on the severity of the condition and degree of functional loss. A denial today could clearly be an allowance in the future. It is unfortunate that the article highlights such a case when there are many reasons why claims are denied. We at SSA work very hard to make the right call - it is not easy, but can be rewarding.
ReplyDeleteHaving seen the quality of CE reports in our area, an iPhone 5 may have been a better investment.
ReplyDeleteHere's a correlation that may or may not show causation:
ReplyDeleteIn recent years, more and more new ALJs are current SSA employees. This means they've actually learned and applied SSA law for a lengthy period of time before becoming ALJs. I don't mean to disparage our training programs, but actual experience working in SSA gives one far more knowledge/understanding of the law than any few-weeks-long training program (as good as it may be) ever could.
Do ALJs learn on the job? Sure, but they are far too busy meeting quotas to spend a great deal of time boning up on their general SSA knowledge, and many get the "I'm a judge now and thus know everything" complex and aren't even receptive to learning. Example: to the writers in the house--how many of your ALJs started putting specific functional limitations in their instructions for FF decisions based on 96-8p/96-9p/85-15 after watching the recent quarterly IVT demanding they do so? Or, for those with inadequate decision instructions, started giving instructions that even begin to meet the requirements set out in eBP and those multiple memos from Judge Bice after viewing another quarterly IVT reminding them they are supposed to do so? My point exactly.
That last part wasn't directly on point, but yeah, perhaps having a bunch of new ALJs who knew a lot about SSA law before becoming ALJs has something to do with this decrease.
@ 12:01...I agree 100%, that's what I was getting at with my bullet point 5. New ALJ's are actually knowledgable about the law and somewhat receptive to recent/increased training.
ReplyDeleteMost "old" ALJ's have no idea about any SSR's and really don't know how to apply the law. They simply size up the claimant when they walk in the room and write "FF" or "UF" in their instrution sheets, hoping a good writer will fill in the blanks. Of course, these are generalizations, but they can help explain at least some of the overal decrease in approval rate at the hearing level.
Also remember that some of the outliers are gone. Daugherty in WV was paying 800 to 1000 cases a year; even if you are generous and assume that half of those cases were legitimate pays (which is highly doubtful), that is still 400 to 500 fewer pays each year simply because of his resignation.
ReplyDeleteThe Commissioner has also limited the number of cases that can be assigned to an ALJ in a year, meaning that the highest producers (which included both higher payers and high deniers) are not able to do quite as many (I think the limit now is 800 a year -- though do not quote me on that). Fewer dispositions by high producers means fewer pays in a given year because fewer cases are being heard/disposed of overall (unless other ALJs are picking up the slack).
@ 12:01, my experience has been that newer ALJs with SSA experience tend to pay more cases than newer ALJs without SSA experience. The new non-experienced ALJs all seem to handle matters the same way, even following the same script in hearings, and appear to be fearful of repercussions of paying too many cases. At least the SSA experienced ALJs tend to have some form of independent thought in reaching decisions.
ReplyDelete@7:01 AM, at first I thought by referencing to "Huntington's disease" you were talking about Judge Daugherty later mentioned by 1:42 PM. I think all the bad press (in the Daugherty/Conn situation in Huntington it was well justified)and the push my the right to spin a tale of soaring disability recipients has made ALJs as a general rule more fearful of becoming an outlier, at least on the approval side of things. ALJs are feeling big brother watching over them now and have lost some of their independence as a result.
@2:38 PM
ReplyDeleteIt's not an easy problem. Independence for ALJs is a good thing, but some sort of method needs to be available to check those who frequently abuse their discretion.
Low approval rate outliers who frequently deny legitimate claims do a lot of damage and are particularly hard to check. The worst of them can at least be identified and curbed through litigation (like in the recent Padro v. Astrue case), if internal agency controls are not up to the task.
As you point out, on the other side all the publicity about high approval rate outliers has checked that group considerably. Fortunately most ALJs are fair and call them as they see them.
Does anyone know if ALJ's who make approvals at the hearing ever change their decision?
ReplyDelete