From a recently released
report by Social Security's Office of Inspector General (OIG):
Our objectives were
to (a)
determine whether
the Social Security Administration
(SSA)
would
consider beneficiaries disabled using
the Initial Disability Standard,
rather than the Medical
Improvement Review Standard (MIRS), during continuing disability reviews (CDR) and
(b)
evaluate data on the MIRS exceptions
. ...
We
estimated, after all appeals,
SSA
will
pay about $269
million in
benefits
until the next CDR
due date
to about 4,000 adult
beneficiaries
who would not be disabled if SSA used the
Initial
Disability Standard
,
rather than MIRS
, during a CDR.
Additionally, although the cessation
determinations were correct, we found issues with the reason coded for cessation for some types
of
MIRS
exceptions. ...
Our review of
275
sample cases
(with a CDR continuance because of no medical improvement)
found
that if SSA used the Initial Disability Standard instead of MIRS, 12 individuals would not be
considered disabled
; 242 individuals would be disabled;
and
21 individuals had
insufficient
evidence available
to
determine
whether the individual would be
disabled. ...
I wonder who asked OIG to look at this question. Who thinks it would be possible to do away with the medical improvement standard? It would have to be someone unlike me who wasn't around in the early 1980s. I know it's not happening in any political environment I can imagine. If it did happen, from the looks of this study, it wouldn't even save much money.
I see your point of view, Charles, but surely you can see the other side.
ReplyDeleteThere are countless shoddy initial FF/PF decisions where an ALJ (perhaps one of those high payers) paid someone whose disability was...questionable.
Forcing the Agency on CDR review to have sufficient evidence to show improvement prevents the cessation of a claimant whose symptoms were not disabling at the time and haven't changed much since.
Ahh, but what about the opposite situation, you may ask? All the wrongfully denied claimants! Well, they can appeal or file new claims. The medical improvement standard will FOREVER bar a cessation on the improper FF decisions described above.
ReplyDeleteSenator William Cohen referred to SSA employees as "overzealous bureaucrats" during a Congressional hearing on high cessation rates at the time.
The outcome of those hearings eventually was the MIRS. This proposal is just the return of the pendulum.
@ 2:40
ReplyDeletecould not have said it more perfectly
no medical improvement standard on age 18 redets. not needed on adult cdr's either. the med improvment standard simply complicates what ends up being essentially the same analysis.
ReplyDeleteAge 18 redeterminations are not done with the Medical Improvement Standard now -- but by the regular adult disability standard. There is already an exception for those who obtained disability by fraud (such as the allegations made against the New York first responders) -- so the MI standard isn't used for that. There are other exceptions for when medicine has advanced in that particular area -- and a whole list of other exceptions. The MI standard is needed for ordinary folks on dib, to protect against someone with a different view from cutting off the checks. Many hearing cases are a matter of judgment, which could be decided either way. MI is needed as a matter of due process.
ReplyDeleteDear 2:40
ReplyDeleteIf the prior FF was indeed "shoddy", the Medical Improvement standard will not be a very high hurdle. Just cite a couple of medical findings different from the past; assert that they support a less restrictive rfc; and "bang" you have a defensible cessation decision.
If you can't make such an argument, then maybe the prior decision wasn't so shoddy.
9:58
ReplyDeleteI should have been more specific--the medical evidence from the prior records for these CDRs contains the same types of findings/symptoms/etc. (i.e., not seemingly disabling) that are present in the current medical evidence.
That's the problem. The symptoms/findings/etc. were not disabling then and haven't really changed (really improved--even for mild symptoms, they tend to stay stable or worsen, not improve), and thus a medical improvement finding is impossible.