Someone really needs to investigate the claims reps at the initial level. They need to be punished for every denied claimed that got approved at the ALJ. I have a feeling that initial level claims deny ppl because they don't want their files audited. They want great quality scores to get their raises. If that is the case, they will be accountable to God for the suffering they have caused to the defenseless.
From what I've been told, if an employee at the Disability Determination Services (DDS) makes a determination to grant disability benefits and the medical evidence COULD even POSSIBLY be interpreted otherwise, their supervisors come down on them like a ton of bricks. A few years ago, we were told that when North Carolina DDS approved a case, it had to be cleared by the regional authority in Birmingham. If true, the message is clear for a DDS employee--deny, deny deny, or you'll be in trouble.
I've often said that if DDS did the job right, I wouldn't be able to make a living representing claimants at hearings. And, there would be fewer jobs for ALJs. I have a healthcare background, and I can't believe the types of cases for which DDS denies benefits.
especially when certain states do not give Medicaid to single individuals. SSDI/SSI approval is the difference between life and death, and waiting 2-3 years to have money to treat a serious illness is attempted murder.
To 4:30pm: claims reps don't make medical decisions at any level. At initial and recon levels, Disability Determination Services (sometimes known as Disability Adjudicative Services) gets the medical and makes the disability decisions.
I had a family member denied initially and then approved later at the ALJ. Luckily he had health insurance from work and was able to get State Disability until he was approved.
I recall one case that I sent to DDS marked terminal illness or "TERI" with a claimant with tongue cancer, unable to speak and living in a nursing home at age 30, and the case came back denied.
By the time it got approved at the Recon level, the claimant had died, and since it was SSI only, all I could do was give proof of Medicaid entitlement.
I asked the 2nd rep at DDS what the heck is going on, with the denial in the first place? She cleared it quick with a decision but it was too late for any cash benefits.
I felt so bad because I was calling DDS and even spoke with a manager there. I think in this case it would have been good for someone to review the denial, since clearly this was an extreme case of someone just clearing their cases without doing any review at all!
This is a slippery slope. I believe DDS' role is properly to be a mostly-denying body doing a quick review, paying obvious cases and passing the rest on. You reps and 100% pro-claimant people cry foul, but what's the alternative? Your beef really boils down to you want a hearing-level quality/specific type review at the onset (immediately). It's kind of silly to expect DDS to do ODAR's job. There are three (two in prototype states) levels of initial administrative review for a reason...
What you all want (which, at its essence is just a well-reasoned decision quickly) and what this system is designed to do can be squared with DDS review before ODAR review--we just need to get average processing time down. Which we can do with more bodies, better mgmt, and better use of resources.
So true, this is a processing time issue. However with LTD, its black and white, you either can or cannot work. Social security should be the same way. If someone has tongue cancer and dying, how could social security deny such a claim. But if reviewing denials do not cause a slap on the wrist, then of course DDS will have no problem doing denials. This is something I believe the Media needs to address.
I am disabled, currently on SSI, and live in North Carolina. From my experience with DDS I believe DDS is crooked and corrupt. I have been disabled for many years and never had a problem proving it with medical documentation sent in to SSA when they requested it. That is, until until DDS got involved in reviewing my medical case records, and DDS has been trying to disregard ALL REAL medical evidence given to their so called investigators by me to the point of me now having to have a hearing in front of an ALJ of which the hearing has not been scheduled by the SSA as yet. I will bring witnesses and all my medical records to the hearing to show as proof of me having qualified disabilities as defined by the SSA. It seems these DDS state offices basically want a disabled person to be to the point of state care or vegetable status as in "state homes" and "institutions" before they, DDS, will approve a person as disabled by their crooked definition, which BTW in no way follows SSA guidelines for defining a disabled person. I guess the state run care facilities would automatically get the disabled persons disability checks $$$ paid directly to their state government run institutions. Many disabled individual who qualify as disabled can manage on their own at home with family and or friends help, I manage at home with the help of close family. I feel bad for those without family or friends to support them and witness the oppression they have to deal with from DDS, an agency who is obviously against disabled peoples rights. I see my rights as a disabled person being violated by DDS case workers. Hopefully the ALJ will follow the law on the books as written when my hearing date is scheduled. We as disabled persons have to vent where someone will listen, or no one would know what goes on with the DDS offices. The DDS office that has my case is located in Raleigh, North Carolina where they deny deny deny as stated by this poster from March 2015... "Anonymous said... From what I've been told, if an employee at the Disability Determination Services (DDS) makes a determination to grant disability benefits and the medical evidence COULD even POSSIBLY be interpreted otherwise, their supervisors come down on them like a ton of bricks. A few years ago, we were told that when North Carolina DDS approved a case, it had to be cleared by the regional authority in Birmingham. If true, the message is clear for a DDS employee--deny, deny deny, or you'll be in trouble.
I've often said that if DDS did the job right, I wouldn't be able to make a living representing claimants at hearings. And, there would be fewer jobs for ALJs. I have a healthcare background, and I can't believe the types of cases for which DDS denies benefits. 10:52 AM, March 16, 2015"
One tactic they use is leaving out doctors reports from family physicians showing you still have the initial medical conditions or even additional medical conditions which still prove your disability. No matter how the medical records are sent in to DDS even to their fax number they give you, they do not include your records in their own report, they pretend like the recipient is not going to doctors and has no records proving they are still disabled. Keep your own set of records bring them to any hearing you may have and bring witnesses and tell DDS you will be recording the hearing and if your state has a one party recording law then see if you have a legal right to use it. North Carolina does have the one party law and they cannot tell anyone here they can't record themselves in conversations even at a hearing since your a party to the SSA hearing, you can even request the ALJ let you record if you have good cause to ask. After the hearing ask for a transcript to make sure that everything said matches up from what was recorded at the hearing. Its a shame the disabled even have to think of do this but when you have corrupt evil oppressive people working in North Carolina's government and government in general you have to protect your rights because no one else will, they have no regard for the disabled or our rights. These DDS employees probably claim to be church goers and think they are good people, their actions speak for what they are and these that I have to deal with in DDS in Raleigh are not good people, they have a lot of negative reaping attached to them for the dirt they do to disabled people in NC while acting under the color of law, they are just contractors even the federal government rarely represents them in federal court if they or their doctors are sued for violating a disabled persons rights.
DDS acts as if someone who has physical and or even mental health issues like anxiety issues or the like are not otherwise a literate disabled person who has sense enough to read and understand the law is being broken against them and their protected status and its well documented and can be proven in a federal court of law. DDS needs to be shut down its really a waste of taxpayer money, especially when actual disabled people have to keep refiling claims that should have been approved with medical records DDS suppresses in order to deny a legitimate claim.
http://www.dmlp.org/book/export/html/1246
https://secure.ssa.gov/poms.nsf/lnx/0439518055
Program Operations Manual System (POMS) Effective Dates: 04/01/2013 - DI 39518.055 Litigation and Related Issues - Federal Tort Claims – Disability Determination Services (DDS)
Citations: Federal Tort Claims Act 28 USC §§2671 A. Definition
1. Federal tort claim
A federal tort claim is a civil suit against the Federal government for any wrongful act not including a breach of contract.
"coaching, Brian became an ordained minister"
ReplyDeleteSeems to have some interesting adls for a 61 year old claiming disability.
Someone really needs to investigate the claims reps at the initial level. They need to be punished for every denied claimed that got approved at the ALJ. I have a feeling that initial level claims deny ppl because they don't want their files audited. They want great quality scores to get their raises. If that is the case, they will be accountable to God for the suffering they have caused to the defenseless.
ReplyDeleteThat's just ignorant
DeleteFrom what I've been told, if an employee at the Disability Determination Services (DDS) makes a determination to grant disability benefits and the medical evidence COULD even POSSIBLY be interpreted otherwise, their supervisors come down on them like a ton of bricks. A few years ago, we were told that when North Carolina DDS approved a case, it had to be cleared by the regional authority in Birmingham. If true, the message is clear for a DDS employee--deny, deny deny, or you'll be in trouble.
ReplyDeleteI've often said that if DDS did the job right, I wouldn't be able to make a living representing claimants at hearings. And, there would be fewer jobs for ALJs. I have a healthcare background, and I can't believe the types of cases for which DDS denies benefits.
@10:52 AM, March 16, 2015
ReplyDeleteWow, I just cant wrap my head around that revelation. That is beyond corrupt. Not ethical AT ALL!
I feel bad for both the disability claimants and the ALJ's. Both will suffer because of DDS unethical behavior.
especially when certain states do not give Medicaid to single individuals. SSDI/SSI approval is the difference between life and death, and waiting 2-3 years to have money to treat a serious illness is attempted murder.
ReplyDeleteTo 4:30pm: claims reps don't make medical decisions at any level. At initial and recon levels, Disability Determination Services (sometimes known as Disability Adjudicative Services) gets the medical and makes the disability decisions.
ReplyDeleteTo 3:20, why do you think DDS is denying so many claims?
ReplyDeleteI had a family member denied initially and then approved later at the ALJ. Luckily he had health insurance from work and was able to get State Disability until he was approved.
ReplyDeleteI recall one case that I sent to DDS marked terminal illness or "TERI" with a claimant with tongue cancer, unable to speak and living in a nursing home at age 30, and the case came back denied.
By the time it got approved at the Recon level, the claimant had died, and since it was SSI only, all I could do was give proof of Medicaid entitlement.
I asked the 2nd rep at DDS what the heck is going on, with the denial in the first place? She cleared it quick with a decision but it was too late for any cash benefits.
I felt so bad because I was calling DDS and even spoke with a manager there. I think in this case it would have been good for someone to review the denial, since clearly this was an extreme case of someone just clearing their cases without doing any review at all!
This is a slippery slope. I believe DDS' role is properly to be a mostly-denying body doing a quick review, paying obvious cases and passing the rest on. You reps and 100% pro-claimant people cry foul, but what's the alternative? Your beef really boils down to you want a hearing-level quality/specific type review at the onset (immediately). It's kind of silly to expect DDS to do ODAR's job. There are three (two in prototype states) levels of initial administrative review for a reason...
ReplyDeleteWhat you all want (which, at its essence is just a well-reasoned decision quickly) and what this system is designed to do can be squared with DDS review before ODAR review--we just need to get average processing time down. Which we can do with more bodies, better mgmt, and better use of resources.
So true, this is a processing time issue. However with LTD, its black and white, you either can or cannot work. Social security should be the same way. If someone has tongue cancer and dying, how could social security deny such a claim. But if reviewing denials do not cause a slap on the wrist, then of course DDS will have no problem doing denials. This is something I believe the Media needs to address.
ReplyDeleteMy fear is that if they change the policy with processing times, will ALJ also start rubber stamping denials? Cant they hire a contractor to help DDS?
ReplyDeleteI am disabled, currently on SSI, and live in North Carolina. From my experience with DDS I believe DDS is crooked and corrupt. I have been disabled for many years and never had a problem proving it with medical documentation sent in to SSA when they requested it. That is, until until DDS got involved in reviewing my medical case records, and DDS has been trying to disregard ALL REAL medical evidence given to their so called investigators by me to the point of me now having to have a hearing in front of an ALJ of which the hearing has not been scheduled by the SSA as yet. I will bring witnesses and all my medical records to the hearing to show as proof of me having qualified disabilities as defined by the SSA. It seems these DDS state offices basically want a disabled person to be to the point of state care or vegetable status as in "state homes" and "institutions" before they, DDS, will approve a person as disabled by their crooked definition, which BTW in no way follows SSA guidelines for defining a disabled person. I guess the state run care facilities would automatically get the disabled persons disability checks $$$ paid directly to their state government run institutions. Many disabled individual who qualify as disabled can manage on their own at home with family and or friends help, I manage at home with the help of close family. I feel bad for those without family or friends to support them and witness the oppression they have to deal with from DDS, an agency who is obviously against disabled peoples rights. I see my rights as a disabled person being violated by DDS case workers. Hopefully the ALJ will follow the law on the books as written when my hearing date is scheduled. We as disabled persons have to vent where someone will listen, or no one would know what goes on with the DDS offices. The DDS office that has my case is located in Raleigh, North Carolina where they deny deny deny as stated by this poster from March 2015...
ReplyDelete"Anonymous said...
From what I've been told, if an employee at the Disability Determination Services (DDS) makes a determination to grant disability benefits and the medical evidence COULD even POSSIBLY be interpreted otherwise, their supervisors come down on them like a ton of bricks. A few years ago, we were told that when North Carolina DDS approved a case, it had to be cleared by the regional authority in Birmingham. If true, the message is clear for a DDS employee--deny, deny deny, or you'll be in trouble.
I've often said that if DDS did the job right, I wouldn't be able to make a living representing claimants at hearings. And, there would be fewer jobs for ALJs. I have a healthcare background, and I can't believe the types of cases for which DDS denies benefits. 10:52 AM, March 16, 2015"
One tactic they use is leaving out doctors reports from family physicians showing you still have the initial medical conditions or even additional medical conditions which still prove your disability. No matter how the medical records are sent in to DDS even to their fax number they give you, they do not include your records in their own report, they pretend like the recipient is not going to doctors and has no records proving they are still disabled. Keep your own set of records bring them to any hearing you may have and bring witnesses and tell DDS you will be recording the hearing and if your state has a one party recording law then see if you have a legal right to use it. North Carolina does have the one party law and they cannot tell anyone here they can't record themselves in conversations even at a hearing since your a party to the SSA hearing, you can even request the ALJ let you record if you have good cause to ask. After the hearing ask for a transcript to make sure that everything said matches up from what was recorded at the hearing. Its a shame the disabled even have to think of do this but when you have corrupt evil oppressive people working in North Carolina's government and government in general you have to protect your rights because no one else will, they have no regard for the disabled or our rights. These DDS employees probably claim to be church goers and think they are good people, their actions speak for what they are and these that I have to deal with in DDS in Raleigh are not good people, they have a lot of negative reaping attached to them for the dirt they do to disabled people in NC while acting under the color of law, they are just contractors even the federal government rarely represents them in federal court if they or their doctors are sued for violating a disabled persons rights.
ReplyDeleteDDS acts as if someone who has physical and or even mental health issues like anxiety issues or the like are not otherwise a literate disabled person who has sense enough to read and understand the law is being broken against them and their protected status and its well documented and can be proven in a federal court of law. DDS needs to be shut down its really a waste of taxpayer money, especially when actual disabled people have to keep refiling claims that should have been approved with medical records DDS suppresses in order to deny a legitimate claim.
http://www.dmlp.org/book/export/html/1246
https://secure.ssa.gov/poms.nsf/lnx/0439518055
Program Operations Manual System (POMS)
Effective Dates: 04/01/2013 -
DI 39518.055 Litigation and Related Issues - Federal Tort Claims – Disability Determination Services (DDS)
Citations:
Federal Tort Claims Act 28 USC §§2671
A. Definition
1. Federal tort claim
A federal tort claim is a civil suit against the Federal government for any wrongful act not including a breach of contract.