The National Organization of Social Security Claimants Representatives (NOSSCR) has obtained from Social Security the following report on allowance rates on disability claims at the initial and reconsideration levels. NOSSCR published this in its newsletter, which is only available to members. Click on each page to view full size.
I practice in a prototype state with no reconsideration. With only a 12% approval rate for recon, I fail to see the point of having it. It is much simpler to explain to a client that they'll get to see a Judge after the initial determination. Having a second level with an almost guaranteed second denial only adds to the waiting and misery of the clients. Am I to assume that SSA ran the numbers and the costs saved by having cased drop off after a recon denial are greater than the costs paid of approving 12% of the cases at recon?
ReplyDeleteWhile you are right recon has long since outlived its usefulness (if it ever had any) there is zero chance the agency would move to eliminate it. The only thing that is keeping OHO's pending going down is that so few hearings are being requested. The receipts in my state are at a 15 year low (with the state growing about 20% in population in that period of time) Eliminating recon would cause a spike in hearing requests and thats a non-starter in the current environment.
ReplyDeleteIf the initial determination and reconsiderations were handled by legally trained individuals perhaps more of the decisions would be correct and there would be less need for hearings. Just a thought.
ReplyDeleteI live in an area where half my cases go through reconsideration and half go straight to hearing. I tell the ones going straight to hearing that the good news is they don't have to wait another 4-6 months for recon. (And my experience that only about 5% of my cases are granted on reconsideration, despite our sending our entire medical file when we apply and at recon...)
ReplyDelete5:26,
ReplyDeleteAll the legal training in the world won’t help if people apply for benefits without sufficient medical documentation. Many initial denials are cases where there is little to no treatment history. In those cases, denial may be “correct,” even if the claimant is later found disabled based on a much larger record.
Well done 6:38
ReplyDeleteTrump (2018) Budget submitted to congress included the following reforms:
ReplyDelete• Limit retroactive SSDI benefits, which currently offer a lump-sum payment covering up to 12 months
of eligibility before the beneficiary’s application date, to only cover six months.
• Disallow concurrent receipt of SSDI and unemployment insurance benefits.
• Reinstating the reconsideration stage of appeal in the 10 states where it has been eliminated as part of
a pilot program.
• Eliminate the Workers' Compensation (WC) "reverse offset," which allows 15 states to reduce their WC
benefits for those collecting SSDI rather than the reverse.
• Reform the hiring process for Administrative Law Judges (ALJs) by creating a one-year probationary
period to ensure ALJs are performing at a satisfactory level before they convert to a lifetime
appointment.
6:38, what if the state agency had the resources to try and talk with more claimants to get a good list or where they received treatment, and then did more than sending a letter or two to providers to get the treatment? What if they had staff that called or visited providers to get medical records, and reported recalcitrant providers for HIPAA or HITECH violations? What if CEs were better quality and more claimants got them?
ReplyDeleteSome folks didn't get a lot of treatment and SSA can't help that (additional Medicaid expansion could, and some other changes to our health care system) but there are a lot of people denied for insufficient evidence because they were too sick to gather it themselves and SSA didn't do much to develop the record.
12:23,
ReplyDeleteUnder the scenario you just described, we’re no longer talking about legal training; we’re talking about billions more in funding from a Congress looking for cuts to offset the yuuuuuge tax bill that just passed.
Incidentally, what role do claimant’s reps play in your vision? It sounds like they’d be little more than potted plants in most cases.
"Reform the hiring process for Administrative Law Judges (ALJs) by creating a one-year probationary period to ensure ALJs are performing at a satisfactory level before they convert to a lifetime appointment."
ReplyDeleteThat would be an interesting scenario with a 9-month ramp up to a full docket for newly hired ALJs. It's also a little difficult for anyone unfamiliar with disability to just jump in and be proficient in the law within a year's time. Conservatively, I would estimate it takes about two years of working with the law before an individual becomes comfortable with what they are doing.