Jul 25, 2014

A Mess At The Appeals Council

     An e-mail I received recently from another attorney who represents Social Security disability claimants:
I ran my periodic ERE [Electronic Records Express, which is one of the several names used for Social Security's online system for those who represent claimants] "status reports" this morning and noticed that the Appeals Council had denied one of my cases. Problem was, the denial date was listed as 6/4/2014 - and neither I nor my client had ever received anything in the mail regarding the denial. I promptly called up to Falls Church [which is where the Appeals Council is located] to see what the hell was going on, and the very nice representative told me that I was his fourth call of the day regarding this exact issue. He said that the case was indeed denied, but that for some inexplicable reason no one bothered to mail out the decision. The representative said he has personally fielded dozens and dozens of calls over the past few weeks about this. He said that he would make sure that a new denial - with the appropriate date - would be mailed out in the next few days.


Anonymous said...

There seems to be no accountability in that division. I have at least two cases where I have faxed (with confirmation), mailed and ERE'd the request for review but somehow the appeal is not lodged and it is a mess to fix after the 60 days elapsed.

There are instances where the claim was denied before even sending out the 25 day letter (Wouldn't these analysts/adjudicators check to see if there is 25 day letter sent out given that there was no brief and the claimant was represented?)

Of course, there is no one to speak with regarding these problems directly. In my opinion the "public affairs" branch or whatever it is that you must call has very little authority on matters.

Anonymous said...

This should be no surprise. When SSA decides to ignore problems, problems increase. See extensive comments below under Jul 20, 2014 Post, Problems at the Appeals Council

Note - From OIG report March 2014 regarding SSA and Appeals Council. OIG found:

•Appeals Council managers and staff were uncertain how productivity goals are established.

•SSA and AC reduced the number of performance goals shared with the public.

•Some of AC established “quality control initiatives” were limited in duration or review and results were undocumented.

•The quality review lacked a monitoring system to identify trends and collectively they did not cover all parts of the AC workload.

OIG Recommendations
(1) Improve published performance goals, (2) establish adjudicator productivity goals, (3) enhance communication of internal goals, (4) formalize successful quality reviews, and (5) explore additional methods for conducting quality reviews of all relevant workloads.

The Agency agreed with all recommendations.

Conclusion? The Agency, the Appeals Council continues as an unaccountable Star Chamber responsible to no one and implementing nothing.

Anonymous said...

Not just the AC. I'm dealing with an overpayment & cessation issue with an SSI client of mine. She lost benefits when the agency learned of her interest in family heir property. I submitted a request for recon, asserting that the valuation was in error for not taking into account the dimunition of value of the co-ownership. Then, we got the property reassessed to show a value below the $2,000 limit. That allowed the worker to put her back into pay status prospectively, but when I told the worker that I still intended my request for recon to act as an appeal of the original overpayment notice, he insisted that I was wrong and could not do this. He apparently had never read my letter of appeal or the reason I had put down on the request form. If a waiver request is denied, then I would have no opportunity to appeal the fact of the overpayment if the agency doesn't take action on it. Whatever they do, I should be entitled to a written decision, and no one plans to give me or the client one of these. Plus, they're moving ahead to collect the overpayment while my appeal is pending. I can't do anything to stop it until I get a written decision.

I'm often tempted to go straight to federal court on matters like this (and it's not the first one where I've been stuck in administrative exhaustion of remedies limbo), since you can't exhaust administrative remedies when the administrative body won't do its work.

Anonymous said...

Overpay is one of the agency’s lowest priories. I had a case several years ago, Schizophrenic with $80,000 overpay. When we went for a face to face at the FO, I argued the math was impossible. He defended it until I asked to see his current query and just review the chronology. Opps, he said, as he noted someone had moved a comma 3 years prior. What was allegedly $80,000 was actually $800 and then, he agreed without further mathematical calculation, zero.

Anonymous said...

"A mess"
"Appeals Council"

But you repeat yourself.


Anonymous said...

This AC mess is why appealing an ALJ denial is almost not worth. Just sometimes have to call it a day and file a new app.

At least you are guaranteed to get a new hearing somewhere in the future.