From The Tennessean:
The Social Security Administration is best known for running the nation's largest retirement program. But it's also responsible for deciding whether millions of Americans qualify for disability benefits.
If you want to understand how those decisions are made, it's going to cost you: $2.3 million.
That was the administration's response to a USA TODAY NETWORK request for public information. Reporters are trying to scrutinize the performance of doctors hired in each state to review federal disability applications, including their workload and how fast they reviewed application files.
The agency's extraordinary price tag indicates that Social Security has no central database, but rather allows each state to manage doctors differently — a policy that, in at least one state, led to an unusually high denial rate and hefty doctor paychecks. ...
In October, the USA TODAY NETWORK submitted a Freedom of Information Act request seeking doctor performance data for each state.
The agency responded in April, indicating they would need 72,100 hours to get such information. That’s the equivalent of nearly 60 employees working full-time on the request for a full year – without taking vacation or holidays off. ...
I personally feel any paid "witness" or "expert" is biased, because they are paid to be. I just don't think it's possible for someone to be unbiased when their livelihood requires them to be biased. They "know" they have to deliver what their "employer" wants. The same applies to DDS, ALJs and the AC. So, this story is no surprise. My guess is that "some" figure the RFC for the age and "work backwards" to just barely deny based on the grids and the claimants age. So, if the claimant would be disabled if sedentary with "occasional use of hands," they say claimant has "frequent use of hands" so the ALJ can deny!
ReplyDeletePaid expert witnesses are used throughout litigation in the United States in criminal law, personal injury, etc. One could certainly argue that your treating physician has a paid interest too. They know you want them to say your disabled and check the most restrictive boxes possible on this form my attorney gave me or else I might not come back for my follow-up visit and go to someone else who will check the right boxes. It goes both ways.
ReplyDeleteThis is just another example of why the government should not be in the disability business. Return SSA to it's original design.
ReplyDeletethis is exactly why it is so important that ALJs continue to be appointed for life, and that their decisional independence be protected, and that they not be political hires that have not been found to be qualified.
ReplyDeleteAs a patient in a doctor's office , you are just one of hundreds of patients. Frankly, they would rather have patients that don't need forms filled out... They can make more money on less demanding patients. On the other hand, some doctors that do "assessments" for DDS make hundreds of thousands of dollars helping SSA to deny! Getting forms filled out as a patient can be like getting a handicap parking spot from aa landlord... They won't do it until you get a lawyer involved!!!
ReplyDeleteThe AMA has been trying for years to limit the amount of time doctors can devote to being "experts" in various types of litigation. The goal is to prevent doctors from relying on being an expert for the majority of their income.
ReplyDeleteThe idea being that if a doctor only made a small percentage of their income from providing expert opinions, then the doctor would be more willing to be honest because he/she has no real fear of losing that income.
Unfortunately the insurance industry, which depends on "hired gun" doctors to deny claims blocks the AMAs efforts.
8:50 in the real world that just does not fly. It is extremely hard to even get a treating doctor to fill out any paperwork on behalf of claimants nowadays much less bend the truth for them. Treating doctors are not making their livings in near entirety by providing hired gun services and usually do not hesitate to either be noncooperative or tell the patient what they don't want to hear.
ReplyDelete@10:21 Unfortunately the insurance industry, which depends on "hired gun" doctors to deny claims blocks the AMAs efforts.
ReplyDeleteIn over 20 years of litigation deposing hundreds of medical experts, it's been my experience that both sides utilize "hired gun" experts. The main difference I've found is that in medical liability cases the plaintiff typically uses experts, particularly physicians on standard of care, from outside the state, while defendants use in-state experts. This has nothing to do with insurance companies, but everything to do with physician referral patterns. I actually had one MD admit under oath that he did not testify against other physicians in his state because you don't "shit in your own back yard."
Hmmm. My doctor just don't want me dead. He has no problem filling out forms. In general though, I understand what 11:24 is saying. However, it's case-by-case, especially if one has been seeing the same doctor for many years. As for stretching the truth, not my doctor! He'd never do that, nor would I ask him to! I have yet to have a doctor be noncooperative with any disability paperwork. I allow 3 doctors to communicate and if they all agree, paperwork is done, and onward life goes. I have a tenancy to stay 2 steps ahead though because my life is plagued with administrative errors. *eye roll*
ReplyDelete@ 8:21, your premise is flawed. There is absolutely no evidence that the employer of the paid witness (SSA) demands/wants/pressures etc. any certain outcome. I have worked directly with ALJs and DDS for 10+ years. I have NEVER heard any pressure toward any witness to arrive at a certain outcome. If an ALJ wants to deny/grant benefits, they will simply craft an appropriate RFC. Ditto for DDS examiner.
ReplyDelete" If an ALJ wants to deny/grant benefits, they will simply craft an appropriate RFC. Ditto for DDS examiner."
ReplyDelete@7:05: So your argument is that the experts do not make their decisions based on improper influence, rather the decision makers make decisions based on whether they want to grant or deny benefits, and then manufacture an RFC that supports their decision.
I am not 705 but I can tell you his explanation is absolutely the secret sauce
ReplyDelete7:05 AM. Think of it this way... The doctor/VE KNOWS (believes) their continued employment requires them to allow SSA (ALJ) the "flexibility" to decide how they want to. If they are "too friendly" to the claimants, then they make it too difficult to justify a denial at federal court. Way too harsh and you destroy your credibility. So, you figure out where the line is and just "barely deny," based on age, diagnoses, etc. This is so much easier than reading the files!
ReplyDeleteI know, you think this could NEVER happen! But, it is much easier than actually reading ALL of the records . Plus, medical records aren't designed to be extrapolated into physical limitations. Some doctors take extensive notes. Others barely note the diagnosis. Doctors who make these assessments based on medical records only would be hard pressed to pick the claimant out of a "lineup," even if the person's records had plenty of clues . IE: Height, weight, various diagnoses, etc.
So Tim, What is your cure? Accept all allegations of limitations by the Claimant regardless of if there is medical support?
ReplyDeleteTim, 1241 here. You are reading way too much into what is a simple explanation. A seasoned ALJ knows what hypos result in what jobs and what hypos result in no jobs. All the ALJ has to do is give the VE a range of hypos and figure it out later. There is nothing nefarious going on. The VEs are doing anything to curry favor.
ReplyDelete9:30 PM. I expect SSA to follow its rules. "...medical signs or laboratory findings must show the existence of a medically determined impairment(s) try that COULD reasonably be expected to produce the pain or other symptoms." Could SHOULD give claimants a lot of benefit of the doubt. Instead , you see "the claimant was only partially credible... " without any justification.
ReplyDelete12:41 PM. If the ALJ knows the answer to his questions to the VE, the ALJ chooses the final RFC, and the ALJ can determine that the claimant isn't "entirely credible..." without any justification for that "opinion...". So, is this hearing process largely a charade?
ReplyDeleteUnfortunately Tim sometimes it is. It really depends on the ALJ. However, what it is not is some Agency wide conspiracy.
ReplyDelete