The plan is awfully reminiscent of prior plans to deal with the backlog. Here are the elements of this plan as I see it:
- Assumption that the most important element is better management. Current management is much smarter than the people who used to manage the Office of Disability Adjudication and Review (ODAR). Of course, they were idiots. Look at the backlog! Of course, the new guys are smart. Look at that great graphic on the cover of the report. Anybody who can produce graphics like that must have a great plan.
- Vague management initiatives. The new management initiatives consist of mere concepts that have little hope of succeeding but the new managers are so much smarter than the old managers that, of course, the new initiatives will work.
- Unrealistic assumptions about future appropriations. The plan is based upon Social Security getting all the appropriations it desires. However, in the real world, as long as the GOP controls the House of Representatives, the agency's budget may see little improvement. It may be difficult to maintain current staffing levels, much less improve them.
- The assumption that it is essential that the process be controlled so that allowance rates on disability claims remain at historic lows. Keeping approval rates low is referred to as "quality." If anything, it looks like there will be new initiatives to improve "quality." "Quality" concerns will almost certainly prevent the issuance of many staff attorney decisions.
What I see here is an unappealing mixture of arrogance, wishful thinking and cowardice. Everyone knows what would help considerably even at current funding levels -- aggressive use of the senior attorney program and encouraging Administrative Law Judges to do on the record reversals in appropriate cases. Social Security management is afraid of offending the GOP by approving more claims so they don't do what they know would work.
If I sound bitter, it's because I am. I'm out there dealing with the claimants whose lives are being destroyed by the backlogs while Social Security management seems more interested in producing great graphics than in actually doing something about the problem. What's needed is the courage to admit the obvious and do what needs to be done. Instead, we get nonsense like this which only encourages Republican budgetary obstinance. Why give the agency more money when the agency itself is telling you what you want to hear -- that they can manage their way out of the problem? Don't expect Republicans to pay attention to the rosy prediction in CARES that the agency will get more money so it can hire more workers. They will ignore that and demand that Social Security solve its backlogs without additional money while making sure that it's horribly difficult to be approved for disability benefits.
If I sound bitter, it's because I am. I'm out there dealing with the claimants whose lives are being destroyed by the backlogs while Social Security management seems more interested in producing great graphics than in actually doing something about the problem. What's needed is the courage to admit the obvious and do what needs to be done. Instead, we get nonsense like this which only encourages Republican budgetary obstinance. Why give the agency more money when the agency itself is telling you what you want to hear -- that they can manage their way out of the problem? Don't expect Republicans to pay attention to the rosy prediction in CARES that the agency will get more money so it can hire more workers. They will ignore that and demand that Social Security solve its backlogs without additional money while making sure that it's horribly difficult to be approved for disability benefits.
51 comments:
"All you need in this life is Ignorance and Confidence, and then Success is sure." Mark Twain___Of course, this could be applied to the entire Obama administration!
The last time that the hearing waits approached the 18-24 month levels, there was such a public outcry that real action had to be taken. Remember those NY Times and USA Today front page articles? Will there be a similar tipping point now as the backlogs steadily grow?
"What's needed is the courage to admit the obvious and do what needs to be done."
So what exactly is it that needs to be done that is within the agency's power to actually do or attempt?
I'm not sure you're being entirely fair here. In contrast to previous plans of this nature, this one acknowledges the hard truth that more ALJs and more support staff are needed. Remember the plans in the past that thought technology alone was going to speed up the process? This plan harkens back to what Astrue told Congress: give me the funds to hire adequately and we will reduce the backlog. They did and it was. Whether the funding will materialize this time is, of course another matter. But give credit to the plan for recognizing reality better than previous plans did.
Also, I thought you'd get bent out of shape about the fact that the plan calls for AAJs to hear some cases. The ALJ union certainly is.
Hiring more ALJs is the only way to responsibly decrease the backlog. Everything else in this plan is just busy work for management. It would also be nice to have performance standards for ALJs.
No need to hire ALJs, when your plan allows you to make your cronies in Falls Church AAJs. Why bother with the niceties of the APA?
I think there needs to be a better way to schedule hearings and utilize hearing rooms effectively. In the ODAR I frequent, they are lucky to have more than 3-4 total hearings scheduled on a Monday or Friday. And then Tuesday-Thursday there are not enough rooms for all the ALJs to hold hearings as there are less rooms than ALJs.
I realize that an ALJ needs days out of the week to do work other than hold hearings, but to the extent that scheduling issues like the above creates an even greater delay to scheduling hearings, it should be looked at.
I'm frightened beyond belief. There's a very good chance that I will be homeless with a child in a few months due to this SSDI wait...even with 30 years of solid work history and having a well documented disease on SSDI's list. In the past year and a half, we have lost everything. I don't know how we would survive the streets, and I can't stop crying for my child's future now...
I think the best plan was making the support staff paralegals, no one ever said. 3:30 PM, If warranted, you could file a Dire Need or Critical with the Agency and possibly get your case moved ahead of others. Some of the secret words are suicidal ideation...
To 4:00 PM.
So your solution is to threaten to kill yourself?
When everyone is dire need, no one is.
Two years to a hearing date and three months to issuing the decision to two months to processing the decision. Enough already.
Not a lawyer but a long time SSA employee--why can't the decision process be streamlined--at least for allowances. Follow the DDS model--judge decides someone meets the listing/is disabled on such and such a date and allow.
"Test the use of screening and data analytics tools (e.g. SmartMands)"
What in the heck is "SmartMands"?
Why is the answer always more ALJs.
Lets make some practical, real world changes. Make it so that long term disability companies cannot force people to file for SSDI and take all the back pay. There are large scale firms that make the majority of their claims from LTD contracts. The primary reason for filing is to get the back pay from SSDI to offset the money they have paid out on the claim and reduce the future costs of paying the insured. This would eliminate tens of thousands of claims that are filed only because it is mandatory from the LTD to continue to receive the benefit.
Change the standards for ODAR staff hires. Greater education and skill requirements for those who Exhibit claims and provide support to the ALJs and Attys. Produce a properly documented and complete file for everyone to work from. Even the ODARs admit that the staff they have is not qualified to handle the jobs they are hired for.
Somehow I have the feeling that CARES will just turn into another Cares Less program, but I wonder how much was spent on coming up with the acronym and associated marketing material?
At 9:30 AM- you are using common sense and that is not allowed. If obvious claims are paid without a 15 page decision, Senator Coburn and his ilk will jump up and down about a decision being unsupported. If a 60 year old career over-the-road truck driver loses his peripheral vision, we need a 15 page decision with vocational exert testimony to explain why he is getting benefits.
That's not an exaggeration.
It's gotten to the point that OTR's aren't even granted based on amended onset dates to fit a grid rule when all pertinent requirements have been conceded at earlier stages.
Bring back David Foster!
Even being homeless and documented suicide attempt does not move one ahead quickly. My client requested dire need expedited hearing in Nov. While the file did get assigned to a judge, it has not been scheduled
So let me get this straight: if the gov't wants to obligate itself and the taxpayers to potentially hundreds of thousands of dollars of benefits in a single case, you all don't see any need for the written decision to contain all the legal findings and conclusions required by law. But if the gov't wants to find someone disabled, I gather from your various comments over the year they should have more due process than the criminal defendant facing life imprisonment and the decision from the ALJ better be as tight as an opinion from a Federal Circuit Court.
Ok, I think I got it.
*"not disabled" for that second sentence, obvi.
4:07
What are you talking about? You want to bring up due process as compared to a criminal defendant? I'll take a trial by jury on the issue of disability any day!!!!!! And I'd like to file a speedy trial request for all of my clients! Can I also accompany my clients to their consultative examinations and video tape what really happens at the exam????? Can we polygraph my client when they say they can't work due to pain???
As a matter of fact, surprisingly you may accompany your client to the CE and take notes. I am not sure about video taping, but?? Once upon a time when I was a doctor and then later when I was a lawyer, I often accompanied my clients/patients when they were sent out for a CE by the Insurance Companies. Amazingly, most doctors were friendly although surprised and I could see the wheels turning trying to remember which ortho testing they should be doing.. Meanwhile I took notes on my yellow pad. Try it, you might like it and I think it might turn out better for your claimants. What do you have to lose?
4:38
And what did you do when the examiner lied about what the patient/client did or said? Testify? Introduce your notes? As a lawyer you cannot be a witness. And of course, the claimant is never credible. You need a video.
Why bash it without giving it a chance? It's a disservice to presume bad faith on the part of the folks who are trying to do something, even if some of the ideas have been tried before. SSA has much better tools and information to monitor and manage its workloads and employees. The regulations already allow the AC to hold hearings, but the AC hasn't used this regulatory authority, mainly because it already has its hands full with the review and federal court-related workloads. I don't think the AC plans to reassign hearing cases to itself as the initial de novo fact-finder, but more likely will hold supplemental hearings in cases that already have a hearing, record, and decision and come to the AC for review. Increasing SAAs would also be helpful. More DDS oversight and information about how the various state agencies develop and adjudicate their claims would also help. It seems that if SSA could find and fix the problems at the initial and recon levels, and figure out ways to earlier identify and pay the truly disabled swimming or drowning in an ocean of claims, we could see a drop-off in unmeritorious appeals at all levels.
It has always struck me as odd that the outcry is always about the hearings backlog. Why is there never any mention of the delays at the initial and recon levels? The DDS can do no wrong. Has anyone looked into the extraordinary length of time it takes to get an initial level determination out of the DDS? If they did they would be astonished. Has anyone looked into why it takes so long to get that determination? Is it the fault of the DDS, the Field Office, or is there a flaw in the electronic process? Is it a combination of all of the above. Why does the clock start ticking for ODAR when the request for hearing is filed? If a case falls through the cracks it can take months even years to arrive at a hearings office and when it finally does it's already an aged case and likely needs additional development before a hearing can be held. In these cases ODAR is the bad guy and they just take it on the chin.
I see many decisions in 90 to 120 days from DDS. Both denials and approvals. I consider this fair timing to gather the records, review and make a decision. I have had CAL claims approved in under 72 hours. Better than any of us have ever hoped for. I get a few that get stuck, stroke or like conditions where the first 90 days will show great improvement over the initial state of the injury. DDS will hold on these claims. I did have some trouble with a Claimant that was traumatic onset quadriplegic, that stalled in DDS for more than 6 months waiting to see if there was improvement. They are by no means golden, and a far cry from perfect, but they seem to do ok.
The field office has little or nothing to do with the claim other than filing and gathering the first burst of information. They may not get all of the treating sources, medications and treatments into the initial claim due to a number of reasons, time, ill prepared Claimants, poor historians.
Remember, a denial at the ALJ level just upholds what DDS said at more than twice the cost of processing.
Recons should be eliminated. I see few claims approved at the Recon, just a rubber stamp of the initial unless something dramatic occurs to the Claimant, like death. Just lost time.
Are you kidding me? The AC has it's hands full? Where are the stats to prove that? They do not provide sufficient production or "quality" reports. They decline review or remand for 85% of cases they receive. And they take over a year to assign a case to an analyst. Get rid of the AC or reduce the staff to 25% and put the others on the line reducing the hearing backlog. I would like to hear for once justification of that bloated star chamber. And if anyone thinks the federal courts would be overwhelmed with cases, then maybe the agency would listen to people like Posner who have exposed the soft underbelly of judicial incompetence, and start training ALJs who need it. We might just get increased competence and less need for review.
It is Jan. 29 and the link still seems active. I downloaded the plan and it seems just more of the same from the 28 years I spent as an ALJ! I doubt there will ever be enough ALJ's and staff to hear both the backlog and new applications, and these idiot bureaucrats will continue to try and move the ALJ's to swing with the political tides regardless of what they are at any given time (i.e. pay down the backlog; too many pay cases so now it is deny more claims).
9:40, why don't you prove that the AC is NOT overworked? Remember there are acouple different functions there. One is preparing the records for federal court review. Another is reviewing remand requests from OGC. The part you probably see most is review requests after ALJ hearings. Related to this is they are the only check we have against recalcitrant ALJs. Whether this is actually done is a separate problem, but get rid of the AC and the ALJs will run amok.
I agree with both 9:30 and 9:33. Most of our initial decisions are made within the general 4-6 month time period I tell claimants to expect. For what DDS has to do and the population they serve, that time seems not to be excessive.
I do agree that recon needs to be eliminated. I represent claimants in both recon and non-recon states. To get that initial denial and proceed right to an ALJ makes much more sense than waiting for a second rubber-stamped denial before seeing the Judge. I'm assuming the numbers justify recon's existence for SSA: the amount of "savings" of people dropping out/dying at recon level must be greater than the "costs" of keeping recon in place. Otherwise, there is no practical reason to keep recon in place, especially in only 40 out of 50 states.
Agree to eliminating Recon level. I have cases where we go to recon and others where we go straight to hearing. The small number of cases that are approved at the recon level does not justify the step. (Perhaps a compromise could be that when one applies for hearing, there would be a recon review while waiting for the hearing. If the case is approved, one less person in line. If not approved, the person is 6 months closer to the hearing date.)
lol @ 2:00 pm, the "only check we have against recalcitrant ALJs" - i.e "the only way we can force ALJs to make the decisions that SSA management wants." This exposes a fundamental truth abut the AC- they are simply the policy enforcement arm of SSA management. News flash, there is actually the Fed District court, Circuit court, and if necessary, the USSC that can all "check" ALJs. However, these bodies will actually only "check" an ALJ to the extent that their decision is actually, you know, not consistent with actual law, not the whimsy of SSA management. The AC is completely useless, it simply enforces whatever the policy de jure is given the political climate at the time, which, frankly is antithetical to the APA. Under CARES AAJS from the AC will now be encroaching into the hearing realm under (note that under the regs the AAJS can take any case they want from ODAR). While the reg states that they have to follow the regs which, presumably, are compliant with the APA, they do not actually have to follow the APA, and indeed, have no actual judicial independence. In theory at least, their superiors can tell them how to decide any given case.
Hiring more expensive and largely incompetent ALJs is the best way to completely bankrupt the system, which is exactly what the "right" wants to do. It's in their interest to create a system that is so bloated with bureaucrats that it's impossible to sustain and forces Congress to intervene. If people really care about the integrity and longevity of the SSA disability safety net, they will advocate for minimizing the hiring of money sucking ALJs by redirecting SSA budget resources toward more innovative alternatives like the senior attorney adjudicator initiative and FEDRO program.
" If obvious claims are paid without a 15 page decision, Senator Coburn and his ilk will jump up and down about a decision being unsupported. If a 60 year old career over-the-road truck driver loses his peripheral vision, we need a 15 page decision with vocational exert testimony to explain why he is getting benefits.
That's not an exaggeration. "
Completely agree with this statement. If anyone is to take responsibility for the backlog, it would have to be "Coburn and his ilk" in Congress who seem to see disability fraud around every corner. Disabled people are the target du jour - especially since hallucinations of bon-bon eating, Cadillac driving welfare mothers have faded from the political landscape. The effect of Congress's obsession with disability fraud is that a lot of unnecessary time and money is now spent writing really long decisions to state the obvious. But y'all know not to expect to hear a mea culpa from "Coburn and his ilk"!
8:20, how's the federal court system working for you so far? They can tell SSA whatever they want to do but an Alj under the "shield" of the Apa can do whatever he or she wants with no recours especially from a federal court. And you're right that the AC is the policy arm of SSA. That is precisely why we need them. Someone needs to make sure the system is working as intended not by your whims.
Exactly
"This exposes a fundamental truth abut the AC- they are simply the policy enforcement arm of SSA management. News flash, there is actually the Fed District court, Circuit court, and if necessary, the USSC that can all "check" ALJs."
Are you saying that SSA should not enforce its rules and policies, and that federal courts are better equipped to do so? Not all claimants can qualify for indigent appeals and afford to file in federal court. There are 13 Circuits, over 90 district courts, all with local rules, a mix of politically appointed judges, and their own backlogs and shortage of judges to hear the civil and criminal cases that already exist. You really think the federal courts could work through almost 200,000 direct appeals from the hearing level in a more timely and consistent manner than SSA? This isn't happening now, even with the few appeals already in federal court, and there is wide variance from district to district and Circuit to Circuit. We'd only remove the problem to a different,unpredictable forum with no accountability to the public, since Article III judges are in fact, appointed for life and more difficult to discipline or remove than Article I ALJs (even when, as Judge Posner has confessed, they make the wrong call or regret prior decisions). This is a national program, and the public and SSA have a legitimate interest in ensuring that no matter where a claimant lives in these United States, adjudication follows the regulations and policy at all levels.
Well then revamp the AC. 15% return/remand is not statistically supportable. Right now they are accountable to no one. The commissioner doesn't sufficiently understand them. Congress does not know what they do. They are a star chamber and part of the problem. I suspect 25% of cases appealed constitute harmful if not horrendous errors. If they did their jobs, less cases would go to the courts. If they did their jobs some ALJs would wake up. Many claimants who are disabled would not have to wait 4 years + for an accurate decision.
The AC offer no proactive input into the program and dodge accountability. How do they justify sitting on cases for a year and then making a decision in days? Require them to write a rationale for not taking review. Why do they no longer have to explain their decisions? They expect everyone else to; ALJs, Representatives "no more than 2000 words", "you must grab their attention" blah, blah, blah. I believe them to be one of the most dysfunctional components of SSA. Waste of time and money. Period.
3:04 gets it
I am not against the idea of an AC. But all they should do is learn the applicable law from their circuit and make sure it is applied correctly (this would include applying SSRs and the regs, though not informal memos and other nonsense), because in the end, that will be the only law that matters. Some don't like it, but thems the facts.
As currently constructed they incorporate the worse parts of SSA. Long wait times, obsession with numbers that leads to nonsense remands that would not be remanded by the Fed Court while passing on surefire remands. Even with a 15% remand rate, half of that is nonsense remands. And "how is fed court treating me"? Well a lot better than the AC since they actually explain their decisions. I'm also not sure how pointing out that the USDC remands a bunch of cases supports the assertion that the AC is doing a good job, it actually proves the opposite.
And though the contempt for the APA and judicial independence is palpable among some posters here, I would point out that AC remands don't result in any consequence for the ALJ (indeed it counts as a "new" case in the quest for 500 decision a year for the ALJ), only the claimant. The APA actually exists, in part, to shield ALJs from the sort of political interference that some posters appear to long for. Indeed the assertion that the AC (or anyone) in SSA holds people accountable is blatantly at odds with the fact that not one person in the Huntington debacle has been held accountable. ALJ Daughtery receives his lofty pension while complicit managers in SSA still have their jobs. So yeah, bust up the AC, get those people writing cases, and lets get some real f'n work done here.
To second 3:04: Period.
I love how forcing--nay, suggesting even--that ALJs to do anything, like say follow the law or policy, is always an encroachment on judicial independence. Get a new line, we're all sick of that one. You're free to decide however you'd like as long as you do so within the bounds of your discretion and the law. Some of yall just need to brush up on what those last two things actually are, lol
Sorry, but when the Law and Dicta are so conflicting and contradictory, one must first interpret it before one can follow it. Our job is to interpret and then apply our interpretations. Get the law changed to make it easier to follow and we will.
I'm 8:20 and 3:30
Dear god, I have literally, in my 15+ years inside and outside the agency, ever seen anyone say anything good about the AC until this thread. Literally. And I have friends who work on the AC.
Let me say first, I am not a judge. I am a writer. I have written a lot of denials I disagree with and a lot of pays I disagree with, but I recognize that I did not lay eyes on the claimant and respect the decision of the ALJ and wrote the case insofar that it was supported by law. I would be very interested in seeing examples of cases from the AC apologists that were so clearly inconsistent with the law, rather than their policy de jure. I have seen very few. It is usually nitpicky BS like "we don't agree so and so is severe/not severe; you cited an incorrect grid rule (though the correct grid rule dictated the same result and was not relied on anyway, i.e. there was VE testimony). Or in one case "you failed to consider the SDM opinion" (I am not even kidding with this). These are literally remands that if the specific issues were addressed, would result in the exact same decision. So why they are remanded and added to he backlog is beyond me (not really, I realize that someone somewhere had to make some arbitrary number). I can provide you with dozens of AC remands that are completely inconsistent with well established law.
If your gripe is with ALJs, it is with the method of hiring, a gripe I share, but that has nothing to do with the AC. Are judges griding out 35 year olds? No? Obviously not since no-one would ever write such a decision. With FIT its really not possible. So please tell me how ALJs are writing decisions that are so blatantly inconsistent with the law. What you are really saying is "I disagree that the C cannot work per SSR 96-8/9," which is a judgment call, and not your place unless you are the ALJ. So if you don't like the ALJs being hired, let's work to replace them, or the SSRs they rely on.
Yes APA and judicial independence shield crap ALJs from consequence. I have seen it, you have seen it, we have all seen it. Is the solution to let the bureaucrats run the whole thing as the AC apologists seem to imply? No. We should improve the hiring methodology and cast out obviously incompetent judges.
Have any of these AC apologists provided any solution to whatever phantom menace they propose is destroying the system? No, they only assert that the current AC system is somehow helping everyone; a contention refuted by the common sense of everyone. Again, real people are relying o nus for results. Lets get to the real work instead of bureaucratic one-up-manship.
Agree that the AC is and always has cost more than it's worth. Now more than ever.
Think back over the past decade: After Barnhart attempted to get rid of the AC back in 2006-2008, the AC bureaucrats made it their mission as soon as she left to ensure that it never happened again. They were obviously very successful in cozying up to Barnhart's successor, Astrue, and managed to convince him that the AC was "relevant" enough to deserve a lion's share of stimulus money to expand the size of the AC exponentially. you know - they spouted the typical SSA line: "if only we had more money, we'd be so much more successful." The result? You now have over a thousand attorneys working in the AC, and they're all trying to meet the weird ever shifting quotas for reviews per day, expected % of denials vs remands, etc. Where would they all go if the AC were eliminated?
@ 12:03
I doubt you've written as long as you say with this line, "I would be very interested in seeing examples of cases from the AC apologists that were so clearly inconsistent with the law, rather than their policy de jure. I have seen very few. It is usually nitpicky BS like "we don't agree so and so is severe/not severe; you cited an incorrect grid rule (though the correct grid rule dictated the same result and was not relied on anyway, i.e. there was VE testimony..."
Umm, pretty consistently since I started here at ODAR as an AA decision writer, the number one reason for remands in my office (and, as far as I can tell with the vague data we can see re: other offices) has been due to poor treatment of opinion evidence. And unless you consider "did not mention Tx MSS at all" or "great weight because the MSS was 'consistent with the record as a whole' is not sufficient justification/analysis" nitpicking or absurd, inconsistent application of policy minutiae, I have to disagree vigorously with you. We can all point to the ridiculous AC remand orders that leave us scratching our heads, but those are always random, rare occurrences. Ask your mgmt. to look at your entire office's list of remands in HOWMI Doing and see what the top few reasons for remand are. I guarantee you won't see much BS on that list.
I've been with ODAR for over 25 years, most of that as a SAA, and I'm in complete agreement with 12:03. There has always been a glaring need for a "harmless error" standard at the AC, which I can pretty much guarantee would greatly reduce the number of remands (that is, if applied correctly). In many instances, it's clear that the analyst/AO simply did not read the decision very closely, or (worse) cherry-picked evidence to support a remand. With the assembly-line, factory mentality ODAR employs regarding disability adjudication, it's pretty much a foregone conclusion that any case looked at closely enough could yield an arguable ground for remand. It's the beast that's been created by the intellectual giants at SSA for God knows why, and despite excellent reasons for doing so no one seems interested in altering it for the better.
You should look closely at the CAReS plan. Part of the plan Is to have non-APA administrative appeal judges handle non-disability cases (i.e. Overpayment, eligibility issues, etc.) AND some FEDERAL COURT REMANDS. The representative community should value and support the ALJs independence from the SSA Policy of the Day (such as stated above: "quality" means more denials). This plan erodes that independence as AAJs do not have qualified judicial independence under the Administrative Procedures Act and thus (under the threat of discipline and sanction) must follow SSA "policy" even if it conflicts with the regulations.
The rep community cares about the long waits and outcomes for clients and claimants, not about the ALJs' perceived threat to independence. The vast majority of ALJs try to be conscientious and actually do the work to review the actual evidence and apply the law, but some ALJs seem to be able to do whatever they want, deny or pay (ie Huntington) without much oversight, insult and mistreat claimants and decide cases without following the rules. It takes repeated complaints of bias, unfair treatment, or abuse of discretion for action, if any, to be taken against an ALJ who is undeserving of the title and position of trust, and a long drawn-out, expensive process to discipline or remove the bad ones (or they retire before any action can be taken). The CAREs plan also includes additional ALJ hires, but in the meantime, if I can get an oral argument and have a hearing with the AC that could result in a faster decision for my clients, I'll take it. There are many agencies that use non-APA hearing officers and still administer fair justice. Congress could decide that the crisis can be solved without the APA ALJs.
The only way to decrease the backlog is to hold ALJs accountable. We don't need to hire more if we won't hold them to standards. Most ALJs do a good job but there are enough who don't. ALJs want the privileges of an employee but they do not want the accountability.
I am not an attorney or a rep. I am just another person who is a victim of this government bs. I have worked since I was 15. I received my Associate degree in nursing in 1996. I have been dealing with Juvinal Diabeties since I was 3 years old. It is poposterous that Diabetiez was taken out of the Blue Book. There is a huge difference in type 1 vs type 2. I was well managed until a minor injury from a car accident turned in to a 8 month battle with a non healing wound. Then after finishing wound care I was diagnosed as having sever bilateral peripheral neuropathy as well as contractures of my right foot and ankle, aquired deformity of the left leg and foot, osteomyelitis, hammer toe. This is in addition to depression, ADHD, anxiety, PTSD, insomnia, mood disorder, DDD, Spondolosis, schools is, kyphosis, bilateral carpal tunnel, contractures in both hands, premature bilateral cateracts which was corrected but I now have frequent minor bleeds in my left eye and my vision carries between 20/70 and 20/200, hearing loss related to hyperbarics, repeat episodes of cellulitis and ulcers on my feet. I am now using either a cane or walker and an air boot when walking. I was denied on my intial application and recon. I had my attorney request OTR because I meet multiple listings, but It was denied so now the waiting game
I am not an attorney or a rep. I am just another person who is a victim of this government bs. I have worked since I was 15. I received my Associate degree in nursing in 1996. I have been dealing with Juvinal Diabeties since I was 3 years old. It is poposterous that Diabetiez was taken out of the Blue Book. There is a huge difference in type 1 vs type 2. I was well managed until a minor injury from a car accident turned in to a 8 month battle with a non healing wound. Then after finishing wound care I was diagnosed as having sever bilateral peripheral neuropathy as well as contractures of my right foot and ankle, aquired deformity of the left leg and foot, osteomyelitis, hammer toe. This is in addition to depression, ADHD, anxiety, PTSD, insomnia, mood disorder, DDD, Spondolosis, schools is, kyphosis, bilateral carpal tunnel, contractures in both hands, premature bilateral cateracts which was corrected but I now have frequent minor bleeds in my left eye and my vision carries between 20/70 and 20/200, hearing loss related to hyperbarics, repeat episodes of cellulitis and ulcers on my feet. I am now using either a cane or walker and an air boot when walking. I was denied on my intial application and recon. I had my attorney request OTR because I meet multiple listings, but It was denied so now the waiting game
Part 2
I have posted my solution to the whole Approval process on other boards and what I said started a few debate so I decided to put it here. What is flawed starts from the intial stages when your application goes to DDS. The first thing is have RN on Nurse Practioners review the claim. This would be to simple because great nurses know meds and side effects, they understand disease process, they know how to tell the difference between subjective and objective information. This would be a much better process than having a non medical person review the file.
Second have all the states have the exact same process. The states should all add in or remove recon stage. If the first stage was done using medically knowledgable staff I think statistically intial approvals would improve Then remove CE exams for anyone who has a current medical provider that follows them and MNOWS the patient better than someone who does a 5 to 20 minute exam. These CE exams are bias they are for the most point subjective. In my experience the doctors are either fresh out of school or retired. And this is a really good income for minimum work. It is also a huge governmental waste of the SSA assets. If you need doctors for claimants who don't have established mrexicsl care. The SSA should have their own physician office staffed by set doctors. This would also streamline the efile.
The next chance is replace the antiquated Blue Book of what meets a disability with the AMA definitions and criteria The honest truth bone of the doctors I have seen in this process has a clue on excayly what the SSA DDS needs from then. The information the SSA looks for is way to specific. I will use neuropathy as an example. There are enough test that can be done through a general exam to identify that a patient has the disease by basic physical assessment. There is no need for an expensive EMG.
So this deals with a big part of the intial claim denials so if you get rid of these INITAL stages that can gender the process. The examiner should not make any decisions on a claiming with a new medical impairment until the 13 th month of the condition so there is a clear picture of the condition lasting over a year. The exception would be keeping presumptive disability.
The other thought that I tossed arround is for clamints with ongoing medical care that the doctor initiates the application process. The feed back is what if the doctor doesn't beleive in disability. The answer is that it is a stipulation that every doctor or clinic who receives state or federal funding agress to the process and presents the medical information to initiate the claim.
The last thought I pondered is just getting rid of DDS and have a judge and a medical doctor review and decided the case after a certain time frame. It would be beneficial is tbere was a revision of the virtual screening unit if this practice was used. The evidence is interested the computer analyzes the results and judge and the doctor approve or deny a claim.
Last part
When I worked as a RN in NC dealing with patients receiving PCS the state came up with a brilliant plan to save Medicaid money. They hired CCME to go out and screen intial case for home care patients, all clients changing companies and yearly reviews. The other change was any increase in hours due to significant changes of condition. Then just like SSID an administrative judge and a CCME nurse spoke with me via phone. Typically the judges and the CCME nurse manager would give the client all of their service hours back. It may be spread over 7 days vs 5 days or they may have reduced a clients hours by 1 to at most 2 hrs a week because grocery shoppingg and few other task were removed from the PCS propgram. The last time I looked at how the new CCME program was doing on cost savings the results showed that it was costing the state more money because instead of just having the home care nurse completed the assessment and the doctor sign off on it. They now had to pay for CCME contracts fee and for the ALJ review. The state of NC started this to cut down on fraud. This sounds familiarly because it the same scrutiny that the SSA shows towards applicants now we are guilty of trying to cheat the system. In the year time frame that I did this. I never had a ALJ or the nurse supervisor deny anyone. They just adjusted the service hours and days. The one benifit to this ALJ system was it took maybe 2 weeks to get a teleconference
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