Compare the chart above to the 2012 waterfall chart showing Administrative Law Judges (ALJs) approving 52% of the cases they reviewed and the 2011 waterfall chart showing ALJs approving 58%. Does anyone think the claims got weaker? What did cause this dramatic change in just two years?
19 comments:
Gee - could it be that more Judges actually apply the law and regulations? The 100% or close to it award Judges are under public scrutiny and probably those who have many cases with the same representative(s). It takes longer to complete a denial than an award in most cases - and perhaps the old "less than sedentary" shortcut doesn't work as well anymore. And perhaps more Judges are actually looking at those phoney "RFCs" submitted by attorneys which aren't supported by any or much medical evidence. Perhaps the gravy train is over for the for profit representatives.
Could be the lack of Senior Attorney fully favorable decisions at the ALJ hearing level. The chart does not specifically state ALJ Decisions, but rather classifies them as Appeals to the ALJ Hearing level. If I'm not mistaken, most ODAR Senior Attorneys are now exclusively writers/mentors and are no longer issuing favorable decisions. In their heyday, some Senior Attorneys issued as many as 30 pays a month.
agree with above.
Recent training has indicated that "less than sedentary" is not legally sufficient. This will get rid of at least a few FF for those less than 50 that don't GRID.
Senior Attorney Advisors no longer writing FF decisions.
I'm seeing a lot of cases where the claimant has actually returned to work while waiting for a hearing. As the economy improves, this will only increase.
Certainly, the senior attorneys stopping decision writing has hurt. But in theory, these cases should ultimately be paid later by the ALJs due to the strength of these particular cases. However, the ALJs have gotten much tougher. I chalk it up to the political pressure they're receiving from above. These things seem to cyclical and we're starting to notice that some of the newer and tougher ALJs are starting to "soften" a bit.
You guys have your info a bit wrong. While we senior attorneys are paying a whole lot fewer cases this FY ourselves (with a hard cap set by the agency but currently undisclosed to us), we still can and do issue OTRs.
The new NSU (national screening unit) program (replacing the VSU) gives us cases to review. The amount each SAA gets depends on location; I generally see about 6-8 per month. These NSU cases are the only cases we can possibly pay. Also, as I've written about before, we are limited to Meets/Equals and direct GRID applications--no 96-8p, no too many nonexertionals, etc.
While our home offices can and do (at least in my office) assign us cases to review pre-hearing, we are only reviewing for the purpose of referring (if we believe the case warrants it) to a random ALJ on rotation to consider doing an OTR--again, we can only pay cases given to us by the NSU.
I've actually reviewed a good number of cases where I believe an OTR decision was appropriate and the random ALJ assigned the case agreed with me (and issued an OTR). Maybe other offices aren't doing this as much, or maybe other offices have more ALJs that are scared of doing OTRs ever since WV (spoiler alert: many ALJs avoid OTRs now).
While I imagine the limit on SAA OTRs has had a not-negligible effect on these numbers, I would suspect the previous posters are correct in saying it is new judges following the regs more closely, a crackdown by the AC on 96-8p and other RFCs lacking specific functional limitations, and the high-volume high payers (If one looks at the publicly available data, he will quickly find that most ALJs on the higher end of dispositions issued were high percentage payers) being advised to slow down and issue fewer dispositions.
Good info, 10:07. Thanks for the corroboration that ALJs appear to be wary of issuing too many favorable decisions these days.
I didn't say that--I said they are wary of issuing OTRs. And that they can't fall back on the ol' "can't work 8/40" without actually listing specific functional limitations in their fully favorable decisions.
What is missing in the chart and comments is SSI. Like to see a breakdown on those cases for adults and children. Generational, let's get the whole family on, SSI is a fact of life in SSA offices...
I don't know if you'd find an R value in the 0.8 or 0.9 range, but I definitely would expect a much higher probability that in a household with one SSI recipient, there will be another SSI recipient vs. in a household with a DIB recipient there is another DIB recipient...
dismissals should be excluded from any calculation of an ALJs approval rate. a claimant's abandonment of his claim by failing to appear has absolutely nothing to do with how often an ALJ pays cases that are before him.
IE the actual average pay rate is ~ 65%
@11:57, Dismissal rates should not be excluded from calculations. Keep in mind that reps are compensated on a contingent fee basis. In the last few years, as the approval rate has plummeted, my standards for accepting representation have increased such that I turn away at least 25-30% of claimants. While I don't have exact statistics, several ALJs have commented that their dismissal rates have greatly increased. I suspect that the "no shows" of which these ALJs complain are not claimants who have returned to work but are probably those who have been turned away for representation by several reps. Responsible reps help the system by screening cases and thus discourage weak claims from continuing. The single biggest reason I reject cases is that many claimants have no access to medical care (in a state in which the governor turned down expanded Medicaid) to produce sufficient evidence.
"single biggest reason I reject cases is that many claimants have no access to medical care (in a state in which the governor turned down expanded Medicaid) to produce sufficient evidence."
How about helping out by paying for an examination (or at least requesting a CE), if the claimant has real impairments these will show up.
The Appeals Council is unnecessary-more than 80% of cases denied or dismissed. And you get better service and the chance someone will pick up the phone at your local DMV. Layer upon layer of red tape just to issue paychecks to federal workers.
Shut down this bureaucracy and put the savings into the federal courts that proves it knows how to process cases in a timely manner.
@12:23
Dismissals absolutely should be excluded. If I pay the 1st three hearings, but dismiss my next 7 because the claimant failed to show up..is my pay rate 100% or 20%?
Of course it's 100%. It's not my fault your claimant went back to work and/or abandoned his application. Why should it be held against me?
@12:30
My observation is that, with some exceptions, one-time examination results do not normally convince adjudicators at initial or recon to approve claims, especially where treating source evidence is sparse. That's true whether an agency CE or one secured by the claimant or rep is involved. That's not surprising, given there is a 12 month duration requirement for benefits.
For that reason, reps do much better to assist clients in getting into substantial treatment, which is better for the client and which provides more appropriate documentation over time.
Some exceptions to that general observation involve reports that include objective data likely to support a listing theory, like a valid IQ result.
11:57 - please check your math. 48% pay and 35% deny yields @58% pay rate not counting dismissals [48/83 = @58%. 2012 rate @62%.
not counting dismissals:
2005: 71.2% (62/87)
.
.
2008: 75.0% (63/84)
2009: 74.1% (63/85)
2010: 71.3% (62/87)
2011: 66.7% (58/87)
2012: 61.9% (52/84)
2013: 57.8% (48/83)
But, have the total number of dismissals increased? What about the number of dismissals as a percentage of total cases considered?
Representatives don't 'weed out the weak cases' as mentioned earlier. They 'cherry pick' the best cases. Big difference.. Everyone, including those with weaker cases, deserve a fair hearing.
And most that I have spoken with won't take your case till after the second denial.. of course that's after you have done all the paperwork. Whats left to do at that point to warrant the thousands of dollars that they will be paid.
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