Below is a Social Security report on allowance rates at the initial and reconsideration levels on disability claims in Fiscal Year (FY) 2018, which ended on September 30, 2018. Click on each page to view full size. This appeared in the most recent issue of the newsletter (not available online) of the National Organization of Social Security Claimants Representatives (NOSSCR).
I live in North Carolina. Why is it that the initial allowance rate is 29.2% in North Carolina but 42.1% in neighboring Virginia? For that matter, why is the allowance rate 51.5% in New Hampshire but only 25.3% in Mississippi? Don't tell me the demographic differences are that great. I thought this was a national program.
Well part of the discrepancy may lie in the number of claims filed, data that is missing from this. Also education varies state to state quite a bit. Also judges are human. You want an algorithm to decide these cases? You think it is bad now.
ReplyDeleteI am surprised to see so many over 40%. You would think from this blog that every single case is denied at initial. I think this also shows that recon is valuable, although it does not show us the number of cases that are never appealed, it shows that people are getting approved quickly every day.
Likely because you have different people applying the same law without the ability to do so in exactly the same way, including some doing it entirely incorrectly (both for and against claimants). It's no different than Kingsport judges awarding benefits 62% of the time while Knoxville judges are at 47%, Greenville judges being at 42%, or Middlesboro judges being at 41%. Same in the LA area where the hearing office rates range from 36% to over 50% depending on the office or New Orleans at 44% and Metairie at 29%.
ReplyDeleteThere might be more balance across the country if the individuals evaluating each case reviewed cases around the country instead of in their jurisdictions.
@ 9:27. You must work for the agency given your reading comprehension skills. The post has nothing to do with ALJ approval data. Also, of course this blog has more to do with claims that are denied at initial. The overwhelming majority of initial and recon claims are not represented by attorneys. Or put another way--attorneys only care about cases that generate "attorney's fees" and the only way to generate "attorney's fees" are to take cases on appeal where an appreciable amount of back pay, or "past due benefits" in your language, exists.
ReplyDeleteWell thank you for mansplaining it to me, I had no idea!!!
ReplyDeleteDon't know if it is still applicable, but I was an attorney-advisor in South Florida in the early '80s when the Reagan cessation purge was on. Many of those being ceased were from NY, which I knew had state wide welfare. Many of the people were put on benefits in NY at the initial and recon levels for relatively minor impairments. I specifically remember one for "low back sprain." As the state agency which reviews the claims at initial and recon is the same agency that administered welfare (and Medicaid) I had a distinct impression that there was a concerted effort in NY (and perhaps other states) to move people from the state welfare and Medicaid rolls, onto the Federal SSDI and Medicare.
ReplyDeleteI think 9:27 had no problem reading and understanding the post. He said that given how derisive this bog is at times re DDS decisions, he was surprised at how high the allowance rates were. Judging from the blog one would think initial and recon cases were almost always denied he pointed out. I do not think he works for the agency or he would already be generally aware of the allowance rates..
ReplyDeleteSSA as a whole is a tremendously defragmented agency. There's more variance than anywhere I've ever seen across regions and areas when it comes to not just policy and enforcement of policy, but even computer programs.
ReplyDeleteIt doesn't help that the leadership SSA does get is basically told "stay out of the news and you're good". It'd take a strong leader willing to crack the whip on the regional commissioners, find a healthy enterprise software solution, and advocate aggressively for a better budget to Congress.
Don't be naive. It has been this way as long as I can remember and I became an ALJ in 1981! Each DDS has its own set of prejudices! Process unification in the 1990's was supposed to help this issue both to make the DDS decisions more uniform and make ALJ's conform to the DDS criteria. It didn't! I doubt it will ever change!
ReplyDeleteThis will never change until this Agency stops focusing on subjective factors (pain, pain, pain) in disability adjudication, rather than functional limitations as assessed by medical sources. Why don't we pay treating physicians to complete uniform functional assessment forms? Focusing on the subjective allows the ALJs to pursue various other vague subjective criteria, such as character, worthiness, laziness and downright likability.
ReplyDeleteI am not an expert on the Australian system, but started reading more about it here: https://www.humanservices.gov.au/individuals/services/centrelink/disability-support-pension/eligibility/how-we-assess-your-disability-or-condition. At first blush, it appears they focus on function rather than symptoms.
the data here needs to be unraveled......
ReplyDeletethese data are for all claims.....SSDI and SSI combined.
without exception the SSI allowance rate in each state is lower than the SSDI allowance rate.
NH has very few SSI claims......Mississippi has a very large number compared to their SSDI claims.
2:19 PM. Here's the problem with your premise: (from a study on shoulder pain)
ReplyDeleteRESULTS:
Mean pain intensity was 7.4±2.52. There has been a high degree of incapacity (mean of 57.2%). Image findings have shown abnormalities in 59.3% of reports. There has been no correlation between image findings and pain intensity, as well as there has also been no correlation between image findings and incapacity. There has been high correlation between pain intensity and incapacity (Rho=0.67; p<0.001). Pain intensity and incapacity were not different between participants with and without some type of abnormality at image exams.
CONCLUSION:
Patients with shoulder complaints may have limitations to perform daily activities and pain, even with negative image findings.
Pain often IS the functional limitation. The more the pain, the greater the limitation. If you don't think pain is limiting, then obviously you've never had any (joint, esp.)
@2:19
ReplyDeleteJust briefly perusing the Australian disability standards, aside from being much, much more difficult to obtain based on their standards (unable to work 15 hours per week for the next two years rather than 40 hours per week for at least 12 months), it appears that the functional analysis you reference is performed by a governmental doctor rather than a treating source. SSA already does this with CEs, and reps often argue that a CE's opinion shouldn't give any weight because it was a one-time examining source without any longitudinal perspective.
Perhaps the cure (as you suggest) might be to ask treating sources to provide independent functional assessments, but most either won't complete the form or will simply have their patient assist them in completing the form or just complete the forms for the doc to later sign. Most PCPs and even specialists are not well-versed in functional assessments, which I see time and time again in treatment notes where providers indicate it's beyond the scope of their practice, they won't do them, etc.
@ Tim
I read the study you quoted, and interestingly, the only data relied upon was the subjective DASH and pain rating and whatever the x-rays or ultrasounds showed for the participants. No other testing or objective measurement was performed. The real issue is that under the regulations, those 28% or so that had no impairment in their shoulder to account for their pain likely don't have an impairment that the pain can be attributed to. The regulations are pretty clear on what is required to establish disability.
Undoubtedly the biggest shortcoming in the whole process is that no one else can experience exactly what you experience to fully understand what you're dealing with. A judge's job would undoubtedly be miserable if they could, even for those that only have approval rates in the teens, though it would likely increase the accuracy.
There are numerous potentially disabling conditions that are entirely or almost entirely subjective in nature, including fibromyalgia, chronic fatigue syndrome, migraine headaches, mental illness, etc. In those cases, the other factors under the regs and SSRs (ADLs, pain complaints, treatment, etc.) are very important. But 2:19 raises an issue that the agency tried to address by eliminating the word "credibility" from that analysis in that some judges used the term to judge a person's character in making a decision rather than the evidence as a whole. That's not at all what was intended at any point in time, even before the rescission of 96-7p, but there were/are judges that refused to award benefits to a felon, someone that tested positive for drugs once, or someone they just didn't like.
I would also point out that credibility was often used to support those judges with 80%-plus favorable rates as well. See Krasfur's congressional testimony for evidence of that.