Jul 3, 2018

For Real Experts Only

     What's a "smartmand case"? I'm seeing that term show up on an SSA-831 that was issued more than six months after a request for hearing. If it helps, the claimant has died. I don't even see any determination indicated on the SSA-831 but the claimant's survivors say they have been told by the field office that the claim has been approved.

7 comments:

Anonymous said...

A remand from OHO back to the state agency. Cases at OHO are screened according to some sort of secret formula that tells SSA which cases are likely to be obvious fully favorables on the record (and which the DDS probably should have granted in the first place) and the ones with the highest scores get remanded.

You can read more about it in the CARES update: https://www.ssa.gov/appeals/documents/2017_Updated_CARES_Anomaly_Plan.pdf

Anonymous said...

Does this happen about the time of Halley's Comet every century or so?

Anonymous said...

Many of those cases get denied a second (or third) time at DDS. You can also think of it as "re-recon". A DDS analyst (non-attorney, non-physician) reviews the file, typically for claimants over 50 or over 55 who are likely to "grid" out, so long as they have a hangnail. I don't know what the pay rate is on these re-recons, but I see so many back in the queue at my OHO that I'm sure it's not much higher than the DDS recon reversal rate...

Anonymous said...

I recently had one of these cases paid . . . for client who was 55 plus and on dialysis. First and probably last I'll see.

Anonymous said...

One problem with the re-recon is that they have to go back to the AOD. And that can be problematic as some firms are very sloppy about the AOD, figuring it doesn't matter and they just fix it at the hearing. So the re-recon denies and no one knows the claimant could have been paid maybe a year earlier if the rep. had sent in an amended aod when he/she first reviewed the file. Sad.

Anonymous said...

11:14, the rep can't negotiate against himself and shouldn't volunteer to take months or years off the case without speaking with SSA first. Re-recon analysts should contact the rep in good faith and work things out, if the case really can be paid from a later onset.

Anonymous said...

A few issues with these. ODAR has derived a formula to cull cases pending that are more likely to be allowed and have senior attorneys processing them. The left-overs at the bottom of the 'likely to be allowed' spectrum are being informally remanded for the re-reconsideration process. The DDS or federal site who are reviewing these are not allowed to amend the onset date, so the case has to be a fully favorable allowance or they have to send it back for a full hearing The cases that are returned to ODAR, depending on the adjudicator who reviewed them, contain a rationale regarding the case facts. Some of them are actually well written and state right out that if the onset is changed to X or if we get more information about Y then the case will likely be an allowance. Some hearing offices are better about looking at this rationale and following the directives than others. Some just throw the case back into the pending status and it waits until it comes up for the hearing. I believe the allowance rate of this informal remand project has been around 7%.