Rick Warshinskey, the President of the National Council of Social Security Management Associations (NCSSMA), an organization of Social Security management personnel, has written a blog piece on Social Security's budget situation. Here's an excerpt detailing some of the reasons the agency desperately needs more operating funds:
The PSCs [Program Service Centers, which compute and authorize payment of Social Security benefits] have nearly 3 million cases pending, of which nearly 50% are over 90 days old. Many of the visitors coming into SSA’s [Social Security Administration's] field offices are asking about cases pending in the PSCs. This is one reason why we have already had 1.34 million more visitors this fiscal year to date, compared to the same period last year.
Meanwhile, in the Office of Disability Adjudication and Review (ODAR) the number of pending cases has gone up 36 months in succession and is now at a record 1.14 million cases. An average hearing is now taking a record setting 535 days for a decision.
SSA is also expected to increase the number of medical Continuing Disability Reviews (CDRs) by 250,000 (pushing the agency up to 1.1 million) next fiscal year and increase the number of SSI Redeterminations the agency completes by 300,000....
58 comments:
And as I have said before, even the number of 535 days to a decision, as atrocious as it is, severely understates and misleads readers as to the actual time.
It lumps in dismissals and OTR's which substantially brings down the average. If you only look at cases that have hearings, the number is likely over two years. If you eliminate dismissals and use the median time for a decision and not the average, you weed out the exceptions like OTR's or expedited cases as well as the absurdly long due to AC or DC Remands that can take over five years on the books.
In an environment where the office I mainly visit claims a schedule hearing date average of 19 months but cases are currently being scheduled in 26 months, it is best to look at any numbers out of ODAR or SSA with an enormous grain of salt.
So reps, keep doing exactly as you are doing because the agency alone is supposed to solve everything.
At 11:25
Would you recommend that "reps" stop appealing BS decisions?
Pretty sure the 535 is from day of hearing requested to day hearing scheduled, not to date of decision. 11:25, not sure what you want reps to do. I submit very strong evidence indicating a case is a sure fire grid award and request a favorable on the record decision. ODAR says no they cannot do an otr then 8 months later we have a 15 minute hearing and it is approved based on the same facts and grid rule. Aljs seem to be afraid to issue an OTR in an obvious case.
Reps have nothing to do with the backlog, and the extremely high number of unnecessary hearings. If SSA had any real interest in bringing down the hearing backlog, they would address the reason. The reason is and has always been low, low quality DDS decisions, with no meaningful oversight. DDS is a denial culture. I have never seen a DDS denial ever reviewed for quality, but an approval has to jump through hoops. Reviewers are incentivized to move cases quickly, but not correctly. Medical consultants do not read records, they rubber stamp denials. The forms are written in many cases by the disability examiners and they know that denials are faster and not reviewed by the agency before issuance. I had 7 hearing level cases in the past month where the medical expert at hearing correctly found that a claimant met listing at onset. DDS is where the OIG investigations need to be.
The federal component reviews a significant percentage of DDS determinations...both denials and allowances. If a DDS accuracy rate dips below 95% for two quarters or more they are heavily threatened and scrutinized.
12:46 Ding! Ding! Ding! We have a winner folks. That would solve a lot of the backlog, but that is never going to happen. Go check the congressional record circa early to mid 90's in regard to Sonny Callahan. See how far he got.
Maybe with some media pressure, just maybe, something can be done now. But I am not holding my breath.
The problem is that the Agency does not want to pay more people silly, it wants to pay less. Now, no one ever comes out and says that, but it is true. Especially in this political climate. Read the excellent article that was posted a few weeks ago about the real fraud in the SS process. I think it was referred to as bureaucratic denials as a way to keep claims down.
The other problem is that the Agency/some ALJs now want the decisions to read like a formal brief but don't want to expend the resources (staff and time for that staff) to do a proper brief.
Lastly (for now) another big part of the problem is that Colvin has obvious disdain for the red headed step child historically known as BHA/OHA/ODAR/OSH1T. She starves that child of resources and then beats up on it when it can't do its job because it is starving for resources. Even if congress does give SSA more money, ODAR won't see much of it.
There is so much that is just wrong with this system and the way it is administered, it is a shame.
@ 12:46
SSA is starting quality review some DDS unfavorables. Advocates worked with SSA for that and its starting. Rules require them to review a certain number of unfavorables. That is currently non-discretionary.
My experience with DDS is that they do a reasonable but far from perfect job of catching listing cases. When the correct RFC findings are made, ditto for medical-vocational guidelines cases. Where they need improvement is in other claims where the claimant should be found disabled at step 5. They are simply not gathering, rating and properly considering the type of information needed to do a good job at that.
"The federal component reviews a significant percentage of DDS determinations...both denials and allowances. If a DDS accuracy rate dips below 95% for two quarters or more they are heavily threatened and scrutinized. "
This is absolute bologna! Accuracy is not measured correctly. Agreeing with DDS does not make them accurate. Accepting their work without investigation is not QR. I said MEANINGUL review. That would mean actually reading the actual medical evidence, and doing a real workup rather than rubber stamping what the reviewer and the medical consultant said...Actually reading the evidence seems like way too much work unless you really want to get it right. You can't make a determination about quality of a decision without reading the evidence. How many cases can a med consultant actually do if they really read the file? Not many. Case determinative MRIs, or lab tests appear at page 150 or more of a medical exhibit and do not get seen until a rep shows the ALJ 2 years later. No one reads that far accept a rep. Come on. I have been doing this for years, obvious presumptive disability cases leave DDS as denials every single day. And if there has to be an approval, I see DDS has to deny as E3 durational even at month 11. I have worked as and with DDS examiners every day for 10 years. Vocational assessments are done with zero training. NEVER have we seen a DDS denial been ever over turned and sent back through QR. QR stops only approvals. And that is now what we are seeing at the Appeals Council. Really folks, why would the payment center by tied up with computing backpay, for 2-3 years if the DDS folks got it right? MEANINGFUL REVIEW of the DDS PLEASE.
12:46 Reps have nothing to do with the backlog? Nonsense. Reps daily bring wholly merit-less claims in front of me. They take the "my client believes he is disabled, so here we are" approach (CR11 anyone?). Maybe the Reps hope to get one of my pay-a-nose-bleed brethren. And that's our fault. But it's the Rep's fault to bring a case with no evidence, but tell me I have to hear the claimant moan and then I'll believe. With the 20% unsupported (read "hoax") cases gone, the backlog would drop.
Anonymous 12:36 said...
Pretty sure the 535 is from day of hearing requested to day hearing scheduled, not to date of decision
except the article said
"An average hearing is now taking a record setting 535 days for a decision."
Maybe they don't know what they are talking about, but the quote from the article refers to time to a decision, not time to a hearing.
8:05. Whenever SS publishes Hearing processing time stats they reference date of hearing request to date of hearing hoping folks who write articles like above misinterpret it to be to time of decision. It worked perfectly for them here. In reality add another 30+ days.
7:36 ALJ. You are obligated to give fair hearings. Rep is obligated to represent zealously. Even claimants with weak cases are entitled to a fair hearing. They believe they cannot work. They have real problems. Even if they do not rise to the heightened legal definition of "disabled" under the Act, they are still entitled to more courtesy and consideration than you give them when you credit the BS put out by the DDS "Physician" (maybe) who didn't treat them, didn't examine them, never laid eyes on them and spent all of five minutes reading the records. We both know you wouldn't trust the DDS docs or the CE docs to treat your kid's teddy bear, but you'll rely on their opinions to decide the fate of the poor claimant who hasn't been able to work as they waited for four years waiting for your learned judgement. You took an oath to uphold constitution and the act, not the nonsense put out by regional and central offices.
@7:36
I know it must be frustrating to get that many meritless claims. There are still plenty of reps who properly screen and advise their clients away from disability claims when appropriate. Naturally, those claimants don't appear in front of you. If they did you'd wish for the days when you had so few problem claims.
It can be tricky for reps because there is undeniably a big variance in understanding amongst SSA's ALJs. By that I mean understanding regarding SSA policies, the law, and the significance of certain medical and other evidence. Sadly, there are quite a few scenarios which if presented to different ALJs would result in substantially different results even with identical facts.
I'm not sure what the answer to that is. ALJ independence is a good thing but justice also requires some degree of consistency in adjudication. When that consistency is lacking it affects the integrity of the system. One of the regrettable consequences is that a rep cannot assess the merits of a claim until the identity and particular understandings of the ALJ hearing the claim are known.
Bravo 9:48!
I think all he or she was saying was that the idea that reps have no part in the backlog is demonstrably false.
7:36
Yes, let's cut out 20 percent of claims. Hopefully you are one of the 20 percent of ALJs that lose their job.
I can only speak to my office/my experience, but the vast majority of our reps come to the hearing unprepared. Despite being retained two years prior, despite knowing about how long it will take to get to hearing, despite 3 months notice of hearing (6 months for a remand) it is rare for any of our reps to come prepared with a completed record, and if they do, it was completed yesterday. Then they want the record held open after the hearing. Then the new evidence requires a supplemental hearing. If the reps would just work their cases a reasonable amount of time out I could shave many months off that statistic.
@5:41
Can you estimate how often reps will ask for additional time to submit outstanding medical evidence?
The reality is that sick and impoverished claimants push off care, and incurring debt, until they know when their hearing will be. So, in every case there will be last minute evidence within 30 days of hearing. Sick people generate medical evidence...what a novel concept. Often this evidence is just cumulative and should not hold up a hearing. For the most part, I see the large majority of approvals decided using the same evidence that the DDS had in the first place. The payment centers would not be so behind and issuing 2-3 or more years of back pay if the cases were evaluated correctly in the beginning. Where there needs to be a face to face with the claimant and the evidence is in the initial stage. The push to keep claimants doing all this one their own, on line only and out of an office just invites error.
@9:05
This is either a disingenuous argument OR you are not part of the problem that 5:41 is talking about. I've been in front of hundreds of alj's and so far I've only met one who isn't understanding of the fact that obtaining medical records is trying to hit a moving target since records continue to accumulate. What alj's complain about (to associates like me, btw. Maybe the practice leaders aren't getting the memo) is when a claimant shows up for a hearing two years after appealing and the record contains absolutely nothing but what DDS compiled. Those are the situations generating supplemental hearings which certainly do contribute to the backlog due to lack of diligence from many volume practice rep groups.
To suggest that reps play any role in the backlog is preposterous. Without reps, the backlog would be even greater. Initially we help to weed out claims from entering the pipeline by providing advice to individuals seeking to file or who come to us regarding appeals. Secondly, we develop the record at the ODAR level for the claimants we represent. Without this, ODAR would require even more staff (for which there is no money) to develop files or would need to redistribute the workload to allow for development, further delaying claims along the way.
I think insiders like to play the lets blame the reps game because we hold ODAR accountable for how they process and ultimately decide claims.
80% of the time the reps have not completed the record and no I am not talking about simply updating records. Particularly for the reps who limit their practice to disability and who are our major players, it is typical for the record to have no action taken on it since the initial denial, a flurry of submissions the week/day prior to the scheduled hearing (or demands for us to do the development) and a request to keep the record open because for the first time they are contacting a treating source for an opinion. No amount of pleading, demanding, requesting, begging had changed this practice in the 15+ years I have been an ALJ. I get about 1 OTR request a quarter and most of them are from the LTD reps who don't necessarily have a good case, they just don't want to travel. While we certainly have inter-Agency issues that extend the backlog, a little bit of professionalism and cooperation from the reps would go a long way in my practice to cutting down the wait times for the claimants.
How did I know that Dan was going to blame fellow reps for the backlog?
9:50: I'm calling BS on your 80% claim. I think you're exaggerating to try and make a point. Or are you one of those ALJs who demand a PCP visit note from the week prior for a sore throat that has no relevance to the underlying claim? And concerning OTR requests, attorneys don't request them because ALJs don't consider them! Why waste our time with such a request when they are ignored.
When I submit an OTR it doesn't even get considered. Case in point, I have a hearing today where I submitted an OTR 7 months ago. ODAR hasn't even bothered to exhibit it.
Dan has become the Ted Cruz of disability attorneys.
I would also like to point out sparse medical evidence does not equal a meritless/hoax claim. Are there bad claims, or maybe claims by people who don't know SSA's particular definition of disability? Yes. That does not make them fraudsters. It is the job of the rep to advise these claimants about why their claims are bad, but I chafe at the suggestion a weak claim means the guy is a hoaxer. ALJs are in an important position, and I believe the "judge" part is more important than the "administrative" part.
I submitted three OTR requests last month. Two should be stone cold mortal locks. One got granted immediately. The other lock clearly got immediately disregarded and denied. The third case was iffy but produced a closed period offer. The fact that some aljs or ODAR's are unprofessional about OTR's doesn't mean reps should give up and stop submitting them altogether
Clearly lack of funding support is far and away the most substantial cause of the backlog. What I'm saying is that it's hypocritical for representatives to throw stones when we refuse to address our own contributing factors to the backlog: 1) taking meritless claims all the way to the hearing 2) pursuing completely pedantic case strategies focused solely on job numbers and 3) failing to update med records by the hearing date.
As for the Ted Cruz quip, I am not, and never have been, a member of the Republican Party. I won't be dissuaded by my own unpopularity with my fellow reps.
"It is difficult to get a man to understand something when his salary depends upon his not understanding it." -Upton Sinclair
C'mon Dan: in a contingency-based practice like ours, there is no incentive for reps to take meritless claims! It's hard enough these days to get the valid cases paid. And why would a rep then not make the proper disability argument or purposely fail to update medical records at a hearing? We try to purposely sabotage our own source of income (winning disability claims)? I think the problem with untimely medical records is that we're trying to hit a moving target. Order the meds too early and the ALJ will demand updates. Order them too late and we're forced to keep the record open post-hearing. Some hospitals demand their own signed requests and take months to send the records. Some Medicaid-clinics routinely lose requests or don't bother sending records due to lack of personnel. With the backlogs constantly growing at different speeds depending on the particular ODAR, it's difficult to judge when to order the meds. I'm not making excuses for lazy reps, just stating the reality of the situation. But most ALJ, notwithstanding the ALJ posting above, understand the predicament and will work with reps who are trying to do their jobs.
i suspect that the volume practices out there, those "mills" whose identities we all probably know, figured out early on that there's a law of diminishing returns when it comes to the amount of work that goes into a case and the return that can be achieved in the form of a fee. So much of what frequently determines outcomes of cases is basically out of the rep's control: the alj drawn, the tx the cl has pursued, their overall credibility, etc. My bet is that these firms realized that pursuing claims the right way and doing the significant legwork involved only increased their fees marginally and not in a conventionally cost-effective way.
-Dan
so no, my opinion isn't that anyone is out there purposely "sabotaging" their cl's cases. Never attribute to malice that which can be just as easily attributed to stupidity (or in this case laziness). That translates into devoting all efforts on case acquisition and scrimping on the types of hands-on work it takes to properly plot out a case strategy early on, identify appropriate withdrawals, and obviously obtain records in a timely fashion.
While I'll concede that some of the posts about unprepared reps and sloppy hearing office practices might have some validity, I continue to believe that the greatest impediment to significantly reducing the hearing backlog remains the inadequate work at DDS. I have never seen any evidence that DDS has implemented the "One Book" approach that SSA purportedly implemented many years ago; sorry, having a checklist and boilerplate language about treating source opinions and subjective symptoms on a form doesn't cut it.
Leaving aside the outlier ALJs who pay 90% of the claims before them, shouldn't there be some concern that ODAR typically pays 50% or more of their claims? Maybe because they review the medical record more closely AND apply the "Process Unification" rulings (binding on ALL SSA adjudicators, including DDS)??
There are more outlier ALJS denying 80 percent of claims. But this situation is due to a Congress basically ignorant of the disability process and SSA's irresponsibility in managing all branches. DDS's are as competent as ALJs. Representatives on the whole expedite the process. The Appeals council should be demolished.
But not one branch is the significant cause of the backlogs. If SSA could take the money it is wasting on bogus, not all, but bogus CDRs and foolish fraud initiatives (millions); they could reduce the backlog in 12 months.
How did this discussion become about reps and their claims?
Is it the contention that more attorneys means more claims.
Seems like someone comes to an attorney because they feel like they have a disability. The attorney just helps them along. So maybe this creates more cases.
But unlikely.
I can say that in the last couple weeks I have had three individuals contact me about getting kicked off via CDR that are so egregious that I can't ethically attempt to take a fee.
I generally don't handle CDR's unless I was the original attorney that helped the claimant get approved.
9:59; 10:30: nope, nope, and nope. as to OTRs- I should say that I am only apprised of one OTR per quarter. Too little space to explain, but I have very little helpful clerical support. So....an OTR request may never be brought to my attention. If you want consideration you need to pursue via telephone. It is what it is; when I get a request on the day before the hearing, yes, I won't drop everything to consider it. Even so, the requests are VERY rare. 80% unprepared? Yes. I agree with 1:07 and attribute it to laziness and poor lawyering. Seriously, it is that bad in my area. My experience- a few very conscientious solo practitioners and legal aid, God bless them, doing the best jobs on behalf of their clients.
I ask this every time we have this discussion.
How long should it take?
@9:46
That depends. How long can you live without any money?
It should take 120 days to hold a hearing after the filing of a request for hearing.
@9:46. Believe it or not, there actually was a time when I thought that the hearings process moved too quickly! That was about 1990 when I began practice. Charles may have a different opinion because of what he may have observed back then. Many of the cases took about 9 months from the time the Claimant applied to the hearing date. Since the Claimant came to me after either the application or recon denials, by the time I was able to obtain a copy of the file (then paper only)and obtain updated medical records, there was very little time to truly "work" the case by getting the client referred to necessary specialists such as neurologists or rheumatologists before ALJs set the case for hearing.
The claims of some claimants who were grievously injured, as by accidents, and applied immediately had their cases denied because they had not yet met the 1 year requirement, despite the severity of their injuries.
One good thing about the process going for a year or slightly more is that it helped to weed-out cases that were weak. Very few claimants who can actually return to work will remain unemployed because of their dismal financial status. However, the present backlogged situation has led to over 50% of my clients losing their homes to foreclosure.
@ Dan Smith
I personally can go without income for quite a long time. LTD insurance would cover me for 2 years. I am a consistent saver over the decades paying myself first 12% of my income. It has been saved and invested. I live well within my means, have no credit card debt, no mortgage (when I did it was less than 30% of monthly income paid off 7 years early) no car payment, reasonable utilities. I can forego cable and make smarter choices with groceries and not buy a new iPhone just because they make a new one.
SSDI is a safety net. Not a total replacement of income for those that choose to not prepare for the future. I have never had more than a high poverty lower middle income my life. Why does the ant always have to pay for the grasshopper?
really? cause by your tone it sounds like you'd oppose SS as a principle (topic for another day...)
@1:08 If you own a home and car, live within your means and pay all your bills with no debt ever, you are likely not a "high poverty lower middle income" earner. Poverty line is right around $12k. Not a lot of homeowners with that income.
Your remarks are so pretentious it is not even funny. I cannot let this go without responding.
I am an ODAR SAA employed for nearly 3 decades.
I earned numerous awards and bonuses for many years for stellar performance in both quality and quantity. I was illegally forced out of my job 3 years ago through no fault of mine. I am in litigation with the Agency.
That being said, I have been without an income for 3 years. Pleas to the highest Agency officials for help in the form of some sort of paid Admin. Leave, various forms of Emergency leave provided in the CBA, and other forms of employee assistance have repeatedly been denied. However, the Agency has granted long periods of paid Admin. Leave, bonuses and promotions to employees accused of misconduct in my case and others. High level Agency officials are engaged in a massive cover up.
I also have a disability to which the Agency has refused appropriate accommodation. Because of my health issues, I am not in a position to relocate, plus I am age 56, and SSA DISABILITY is my area of expertise, as I started with ODAR right out of law school.
Now, I did everything right financially just like you. Paid off debt, including mortgage, saved, saved, saved, etc. Nevertheless, I am now forced to apply for such other Federal employee benefits as DISABILITY Retirement and OWCP. DISABILITY Retirement requires one to apply for SSA DISABILITY. So, your 'holier than thou' assertions about what a financially responsible life you have lived, and intimation that if everyone could only be like you, then SSA DISABILITY benefits would not be needed by many, make me cringe. I have done everything right, yet look at my situation and what corrupt Agency officials are responsible. Please get off your high horse.
1:08 PM. Perhaps you're under the impression that the majority of the disabled work for thirty years and then suddenly become disabled! While this may be true for some, others have struggled for years before applying! My first symptoms of ankylosing spondylitis started when I was in high school. I was fired from a job in 1994 for "lack of agility." This was AFTER the passing of Americans with Disabilites Act. I incurred huge debts for medical expenses (reacurring iritis, etc.) while working without insurance (made too much for medicaid-$15,000 a year). I developed arthritis in my shoulders, then my hands, knees, feet... ). I haven't worked in two years and was able to "work" at a reduced capacity for only a total of eleven months in the 27 months before that! Could not qualify for LTD insurance... I'm not sure where I was supposed to be able to buy a house during the last 30 years! Still waiting for a hearing (asked in writing for OTR!)...
@1:08: "LTD insurance would cover me for 2 years."
That really depends on the carrier you are using and the actual terms of the policy.
So, which carrier are you using and what are the policy terms for disability?
Is it an ERISA employer provided plan or a private insurance contract?
@4:55 Karma. Never know when it will get you.
Before 1956 this wasn't a problem.
@ 9:42AM
Karma. Never know when it will get you...
PLEASE HOLD THAT THOUGHT BECAUSE THE FAT LADY HAS NOT YET BEGUN TO SING...
WORD IS SHE IS KNOWN TO BITE GUILTY CULPRITS, CONSPIRATORS AND COHORTS IN THE ARSE WHEN THEY LEAST SUSPECT.
Appears she already has!
Really, how so?
There is no evidence yet, and the cover up is as massive as ever.
This blog post isn't talking about hearing backlogs but about PC backlogs on post entitlement cases. Hearing effectuations are the one thing the PCs do relatively quickly.
In the field we spend tons of time telling people their action is still pending in PC, we have no idea how much longer it will be, no they can't call the PC themselves. Really, the only thing they can do about a really old action is contact their Congressional representative for intervention.
For example, when a payment returned after a person who has died is owed to the widow(er) we have to tell the survivor that this is not a priority action for PC and it could take 6 months. This causes people financial hardship. Maybe if the PC was open to the public, they'd be faster. Instead the field offices have to take all the grief but have no control over the PC.
@6:06pm - The PSCs cannot be any faster because we're too busy cleaning up your mess. TEs that have no clue that public disability benefits exist and can cause offset while WEP'd? Applications being taken and allowed for spouses who are already entitled to higher retirement benefits on their own record? Not bothering to link attorneys or place appointment forms (1696s) in file but then fax them a month later because "oops"? Yeah, we get tired of spending more time fixing field office bungled claims than doing work that are primarily assigned to the PSC like earnings round-up, redeterminations, etc. We cannot even get enough people to apply for the basic workhorse position right now because the public applying cannot pass a simple test.
I dare anyone in PC to deal with the public and the workload of the CRs in the FO and DO. They wouldn't last a week!
The problems sited above are due to the extreme number of claims and actions CRs must do. Many offices are now so understaffed the CRs are also do SR duties to include birth certificate verifications for new Number Holders.
I have no sympathy for PC, ODAR and other offices that do not deal directly with the public daily.
Um, ODAR hearing offices deal directly with the public daily, and the most desperate portion of society at that.
Here we go again, Operations people acting like they have it so badly.
Is the CR job or TE job tougher than the rank and file SCT job at ODAR or rank and file job at the PCs? Surely. A competent CR or TE has to know the ins and outs of not only disability, but retirement, aux benefits, and the million other things FO/DO folks deal with on a regular basis.
But that's why CR is a 8-9-11 career ladder and TE is a 12 and SCTs are 6-7-8. Quit whining, CRs get paid about $20k more than the comparable SCT, and I guarantee your work isn't $20k harder.
Try getting a real job if you don't like ODAR, you will find the civilian pay is even less and your health insurance is even more.
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