From the Philadelphia Inquirer:
In an effort to reduce its massive backlog of disability determination appeals, the Social Security Administration plans to reinstate an additional step in the appeals process for Pennsylvania and nine other states.
Social Security officials say the extra step — called reconsideration — would create a more uniform system across the country and help the administration reach its goal of resolving disability appeals within 270 days. Critics have said it could have the opposite effect, possibly lengthening the appeals process.
“While some people might get a decision sooner under reconsideration, for others this step is effectively a rubber stamp of the initial decision,” Rep. Sam Johnson (R., Texas), who serves as chairman of the House Ways and Means Committee’s Social Security subcommittee, said during a Capitol Hill hearing Wednesday. “It simply further delays their hearing with an administrative law judge.” ...
14 comments:
I've not seen the statistics in at least five years but approvals used to be higher before hearing in recon states, presumably updating the medical records was the key.
I practice in a prototype state but border a non-prototype state where we also have a lot of clients. Our non-prototype state clients take an extra 3-6 months to go through the entire process given their almost-certain rubber stamp denial at recon. All this will do is cause more delays for the "lucky" claimants who happen to live in a prototype state.
10:00,
Unless you view your clients as numbers on a spreadsheet, it’s hard to reconcile your view that recon is a rubber stamp denial with the data showing that 12-14% of claims have been approved at the recon level.
I’d look at other variables, like how much medical evidence you add to the record between the initial and recon stages, versus how much gets dumped on ALJs and the Appeals Council at the eleventh hour.
2:22 I don't view my clients as numbers on a spreadsheet - that's why I'm saying recon is a waste and bad for my clients. For the few that are approved, many more statistically are denied and are forced to wait the extra 3-6 months before they eventually get their ALJ approvals. If it was purely a spreadsheet calculation for me, I'd be all for recon. It gets me a few extra early approvals while adding another 3-6 months accrued benefits on the hearing wins. But that 3-6 month extra wait is an eternity for many of my clients, many of whom face eviction and struggle to survive. They shouldn't have to wait any longer than necessary.
3:24 is spot on. As someone with a large initial claims practice in a prototype state (Ala) and who has an office in TN (non-protoype) state I see it everyday. The folks in TN get hosed on processing time. Also, I check the stats every year. TN's recon pay rate was eight (8) % for FY '17 where as the national rate was 12%.
If recons really were rubber stamps they would not take a 100 days to do
SSA has learned from our Congress. When faced with a problem, such as not enough ALJs, and too many cases going to hearings that should be approved - and would be approved if the adjudicators were given more time to get records, and did a better job of reading those records, and had a clue as to what those records mean - they "have chosen to "kick the can down the road" and employee a recon system that has never worked well to approve cases but will add months of delay. A voluntary or optional reconsideration that a claimant - or their attorney - could choose in those cases when the initial adjudicator clearly did a bad job, could save a lot of time and grief. This will do neither.
Recon or not they should be the same in every state to be equal in appearance no matter where you live.
The applicants approved at recon though don't get paid 3-6 months sooner, they get paid about a year sooner unless they live someplace with short waits.
Those struggling to survive who can provide more complete records and avoid a longer wait benefit from the program.
9:35: are you seriously saying that if only those at recon would "provide more complete records" they wouldn't be denied and have to wait for a hearing? You must have no experience dealing with DDS or cases at the reconsideration level. It doesn't matter how many updated records I provide or treating physician disabling residual functional evaluations I submit, I'm only going to win about 10% of my claims at the recon level. And the ones I do see that go through at recon are usually because the claimant turned 55, not because of updated records.
Let's say that I win 8/10 cases I sign up. 3 of those will be at the initial app level, 1 at recon, and 4 at the hearing. The 4 clients who have to wait another 3-6 months because of a recon denial is not offset by the 1 client who is paid earlier because recon exists.
And, the approvals at Recon, more frequently than at any other level including initial, tend to be for later onset dates.
This raises difficult issues with regards to appeal and risk losing what you just won, or accepting a substantially later date with, obviously less money for the claimant (and not incidentally for the rep) as well as a greater delay in receiving Medicare.
If the later onset dates made sense in the vast majority of cases, that would be one thing. But an onset date based on the date of the CE is a joke.
1:57. Did I seriously say if those at recon would provide more records at recon they wouldn't be denied? No I did not say that and if that is your attention to detail, please send your clients my way.
Anyone earning their money knows DDS does not always have all the relevant records at initial. Sometimes because the client doesn't remember a doctor or a hospital. Sometimes DDS just says "screw it" and issues decisions rather than waiting around for providers slow to provide records.
You honestly haven't had a client who thinks they are disabled because of their back and doesn't bother to list their psychiatric treatment or their ophthalmologist records. Recently got a client approved at recon by having them get their FMLA paperwork and leave records showing she had saved up her leave and began missing work a great deal about six months prior to taking FMLA and then never received medical clearance to return from FMLA.
Yes. Recon can be very beneficial.
I practiced in NY, a prototype state with no recons. When recons disappeared, it changed the nature of ALJ hearings. Prior practice indicated that ALJ appellants really meant it. They have been denied twice, and they still pursued the goal. The recon eliminated a lot of very weak or junk appeals which therefore never went to the ALJ level. In NY, ALJs became accustomed to hearing a higher percentage of cases with poor support or merit, and ALJ approval rates went down. Frankly, I believe the ALJs also developed a higher degree of contempt for the citizens who came before them, although we know that is not possible in some individual cases. I am all for the return of the recon to ALL parts of the nation. I believe some claimants will receive faster relief with an approval at the DDS recon. Further, the clients who walk into the attorneys' office for an ALJ appeal are better motivated, and they tend to, in my experience, have better merit to their claim. I believe, over time, that there will be an improvement in ALJ approval rates in protype states where the recon had been eliminated. Too bad I retired last fall to see my theory tested out empirically in my own caseload.
Even with reconsiderations being instituted the backlog will "seemingly" skyrocket as there has been an agency wide focus on issuing decisions where the claimant is getting paid for much of this year. Eventually, the more laborious files have to be issued and they take much more time for writers and judges to do. Because of it the backlog of claims will go up again.
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