Winning The Case But Losing Her Home
From the
Atlanta Journal-Constitution:
Mary Ann Statler, an accountant from Acworth, had battled depression and
anxiety for years, but in the summer of 2015 her condition worsened
dramatically. ...
“I made a pretty good salary,” said the single parent of three
children. “Just as much as I tried to push myself, I couldn’t do it.”
Following her doctor’s advice, Statler applied in August 2015 for disability benefits from Social Security.
Social Security denied her claim — twice — but gave her the option to
schedule an appeal hearing before an administrative law judge. Since
then, she has been caught in a backlog of disputed disability claims
totalling more than 1 million cases nationwide. And that backlog is only
getting worse. ...
In Georgia alone, Statler is one of 28,000 people waiting an average of
nearly three years to be heard. During that delay, those waiting often
get worse or even die before a decision is made on their benefits,
experts say. ...
In the end, the judge gave full approval for her disability claim, but
it will be late next month before she sees a penny of her benefits.
That’s too late to save her house, which was sold in a bank foreclosure.
She has to be out shortly after the new year, she said. ...
If part of the solution is more personnel, I wouldn’t hold my breath.
President Trump instituted a hiring moratorium upon taking office this
year. Social Security received special permission to do some restocking, but it’s barely kept up with the pace of attrition. ...
The solution is to stop denying so many people at the DDS level. DDS is effectively using ODAR to process claims.
ReplyDeleteODAR was never designed for that.
100% true.
ReplyDeleteThere is a lot of information missing from the article. Like the date she filed, did she work after filing, what was the status of her mortgage before filing, single, married, would her SSA disability been enough to pay her mortgage anyway? Did she have medical at the lower levels indicating her level of disability?
ReplyDeleteClaims do not get denied just because DDS wants to deny them. They are denied, most commonly for a lack of medical evidence to support disability. The denial by DDS forces the Claimant to have the treatment needed to support a disability claim. It is not the job of DDS to find the proof, the burden of proof is on the Claimant. Want more cases approved at DDS level, educate people what it takes to get a claim approved. Filing and saying I am disabled with no medical records to cover the period of disability alleged wont do it.
@ 5:07
ReplyDeleteIf this is true why have DDS denials declined year over year for the last 15 years?
Has the burden of proof increased? Are there more fraudsters?
I say no. I say DDS adjudicators are given guidance that results in more denials than in the past.
How often will you open a file at the ODAR/OHO level, see a supportive consultative examiner stating that the person is disabled, and then see the DDS analyst deny the claim for "insufficient evidence" because the claimant didn't return their Work History report? Or with the medical consultant's mental RFC statement being a non-policy compliant word salad?
ReplyDeleteGranted, ODAR/OHO personnel don't usually get to see the cases that DDS grants, but their work on the denials is usually slapdash.
No doubt multiple causes contribute to the backlog. I addition to above, more low approval rate outlier ALJs means more people who really can't work but were denied will appeal or reapply. The legalized ability of more ALJs to ignore available evidence (5 day rule) adds to that number, meaning more appeals and new claims will be filed.
ReplyDeleteStill the number one reason is inadequate funding by Congress. Sam Johnson, Paul Ryan, and all your colleagues, this is what happens to your constituents when you fail to act to adequately fund agency operations. Now multiply that by thousands of people. Add in the disruption and burden to their families. Add in thousands of people who died while waiting for their claims to be decided.
I couldn't agree more. As the decision making process has become more legalistic, the claimants' chance for a speedy approval of their claims has decreased. The burden of proof has become higher and gathering more and more evidence rarely works in the claimants favor at the DDS. Claims adjudicators spend too much time i preparing the claim for the ALJ. This attitude perfecting the file and letting the judge decide has eroded the DDS's ability to make proper and timely decisions. Doing the right thing by allowing more claims at the DDS level is really the only way to solve the increasing backlog problem.
ReplyDelete@6:52 there may be an increase in the number of people that confuse chronic health condition with disability, not necessarily fraud as is the common scream here, but that the uniformed do not know the rules of the program. How many times have you told someone they have to stop working and that they will be making less than $2000 a month AND have to pay for a Medicare Part B and D premium and they say "well I make more at work than that!"
ReplyDeleteThe DDS I work with has gotten worse and worse and denies at a higher rate than ever. Worse yet are the long delays being built into the initial and reconsideration to delay receipts at ODO. We are seeing cases closed out at DDS being held 4-6 weeks before the denial letters are issued...And, then errors on the denial date in the system causing problems with appeal dates. At least half of my hearings these days are the 5 minute approval variety where the DDS RFC should have been an allowance, but the case was denied anyway. The quality of DDS evaluation, vocational analysis, and denial bias make their work product so poor that we should really just get rid of their nonsense. DDS adds 9-12 months on the front of a claim. Then another 20 months for a hearing, 3 for a decision and 2 more for $$? My clients would better off to just going straight to a judge.
ReplyDeleteI had a hearing this morning with a 67 year old man. The onset date goes back 4 years when he was 63. When he was 63 he was working three jobs. He fell off a ladder while working as a stocker at Target. His Neurosurgeon wanted to do cervical surgery. The treating Neurosurgeon placed restrictions of 20 pounds of lifting and carrying and no overhead reaching. The DDD consultants ignored and didn't even mention the restrictions. DDD found that the claimant's RFC was medium and therefore that the claimant was capable of past work. The ALJ saw through that smoke-screen and didn't ask any questions of the claimant. The ALJ took testimony from the VE. The ALJ's hypothetical used a light RFC. I am seeing more and more cases like this, i.e., over 55 individuals who the DDD finds can perform medium work. The worst of those cases was a 62 year old woman who had a neurological disease. She had never worked at the medium level in her life. Many of the DDD RFC findings are based on convenience and dishonesty.
ReplyDelete