From Improving the Social Security Disability Determination Process by Jack Smalligan and Chantel Boyerns for the Urban Institute:
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This report recommends improving the reconsideration step although it is vague on what an improved reconsideration step would look like.
Over the decades that I've been involved with the Social Security disability process the reconsideration stage has been remarkably stable. Apart from experiments with eliminating it, recon just hasn't changed over the years. My conclusion is that even though everyone knows recon doesn't make the system fairer, it still meets the perceived needs of Social Security policymakers by introducing an extra hurdle that reduces the number of people asking for hearings. If you're looking for any other reason for its existence or any way to improve it, you're looking in vain.
13 comments:
I practice in Michigan. The best thing SSA ever did was to eliminate the Reconsideration step. I think I can count on one hand the number of cases that were approved at Reconsideration. It is just an unnecessary procedure hurdle. They should eliminate it nationwide, and put those resources into the initial analysis.
11:16 - Over the years, SSA data is consistent that 10-15% of claims are approved at the reconsideration level. If you can "count on one hand the number of cases that were approved at reconsideration," that just means you haven't represented many claimants.
It's always interesting to hear representatives disparage the reconsideration level. On the one hand, 10-15% of claimants get benefits much sooner. That's a good thing, right? Also, the claimants get a second bite at the proverbial apple by curing any deficiencies established at the initial level and having a second DDS medical professional review their claim. On the other hand...what? Do you think the wait time would be any faster if the hearing level was flooded with an additional 10-15% more claims? No, eliminating the reconsideration wait time would only increase the hearing wait time.
So really the call to eliminate the reconsideration level only boils down to representatives wanting to sign up an additional 10-15% more clients, and the fees that go along with that. An easy bump in take-home pay, since ostensibly those are meritorious cases that would have been approved had their been a reconsideration. The claimants themselves won't benefit.
Recon catching 10% to 15% over the years has been a good thing despite the constant bellyaching it is a pointless exercise.
I wouldn't expect a good representative to see a favorable come out of recon if the representative was involved at initial because a good rep will make sure that DDS has everything they need.
The claimant helped by recon is generally unrepresented and generally a poor history who failed to report providers. Otherwise recon isn't likely to change unless there is some new evidence.
BUT remember we've been dealing with a large backlog. Recon was a last bit at the apple before embarking on a 12 to 24 month wait for someone to look at the file again. That 10% to 15% cleared at recon is a lot of people and those waits would have been even longer.
With the backlog going away, the usefulness may disappear as well
Response to 12:36,
My firm handles about 200 hearing per year and that was case years ago when Michigan still had recon. They got rid of recon because it was a waste of time. All it did was make claimants jump through another bureaucratic hurdle, and delay filling the RFH for a few months.
And before you start disparaging attorneys as just wanting fees, don't forget that the recon level delays the ultimate ALJ decision by months. So more accrued, and thus a higher fee.
No, my motivation for wanting to eliminate recon is not financial. It just makes sense to remove a useless layer bureaucracy and allocate those resources elsewhere (perhaps to trying to make more accurate decisions on the initial applications).
We see doctors on reconsideration simply copying the comments of the previous doctor, who btw probably spent no more than a 5 minutes on the file and only reviewed the examiner's excerpts of the medical records. Often on reconsideration, there is no indication that the doctor did any review or analysis of their own. I would bet in most of these cases the doctor does nothing but copy and paste the previous doctors comments and never even looks at the records. When the doctors don't do an independent review of the file, the reconsideration is a waste of time. Of course, the entire process is somewhat of a farce. A reviewing psychologist at DDS recently admitted to me that they don't have time to review the medical records and they rely on the excerpts provided by the examiners. These excerpts are typically so limited and omit so much important information that most files are not getting any sort of serious review at DDS. The big problem really is that there is no accountability for those doctors or examiners when they deny an obviously deserving claimant (which happens all the time). I recently submitted a brief on reconsideration pointing out the absurdity of the jobs cited by the examiner and how obviously made up the 1 million number for a particular job was. Yet, on reconsideration, the exact same jobs and made up numbers were cited. They don't care. As long as they are denying the majority of claims, their superiors think they are doing a great job. There is absolutely no accountability. The psychologist who admitted that they don't review the medical records also described DDS as a factory. The DDS system, at least in my state, comes no where close to providing real due process. But, since it can be cured at the hearing level (sometimes), I guess its okay, despite the fact the client has to wait a year or more to get due process.
The article inaccurately states that the federal reviewers only look at the evidence in file and if. The determination was correct based on that evidence and that they do not check to see if other evidence was available that DDS did not get.. It also falsely states that most cases come with the evidence in file and that DDS only gets a minimal amount of additional evidence. In fact most cases come with no evidence and the DDS gets almost all of the evidence. Very rarely does an attorney provide evidence that was not already in the file. We have one uncooperative source and whenever I have asked this one attorney's office for help acquiring it rhet say they cannot because of the HIPPA laws
RECON.
It seems to me the real issue is how many people drop out of the appeal system because they get discouraged. 10-15% is small but not completely trivial. The several month delay is not great, but given the very long delay for hearings, it isn't the real problem.
What I would like to see is data on how many individuals just give up because of the burdens of Recon -- and if one is cynical, one might think that this hurdle is a deliberate vehicle to reduce the number of subsequent appeals.
How can they have more Hearings process than Re considerations ???
@8:14 AM
Been living under a rock? SSA has had a longstanding backlog for hearings, and things got... well... backlogged.
@10:17
I imagine it is due to working through the backlog at the hearing level, and the fact that in 2018 when the study was done, California, Colorado, New Hampshire, New York, Louisiana, Alabama, Michigan, Missouri, and Alaska did not have a reconsideration phase meaning any initial denials went straight to the hearing level.
I will never be able to wrap my head around the cognitive dissonance that 5k-10k people per year dying while awaiting a hearing is a national travesty while 50k+ people per year being awarded benefits a year or more earlier than they otherwise would have is a waste of time.
I'd also be curious to know whether the hearing level approval rate would be closer to recon (13%) or its current level (45%) if hearings were held 90-120 days after an initial denial. My guess would be the latter, though I wouldn't be surprised if it dropped to the low 30s.
@12:26
A few reasons. 1, it's not uncommon for the death to be attributable to a lack of treatment, treatment which may have been affordable if they were on benefits. 2, it might just be our local DDS, or maybe we just do a better job than average getting awards at initial, but our recon is around 3-4%, not 13% and our hearing award rate is around 85-90%, so recon really looks like a waste of time. Sometimes that's a result of the claimant increasing in age categories or new evidence being obtained, but usually it is DDS' decision not being supported even by the record at the time of their decision. 3, sure faster hearings would lower awards based on the claimant aging into the next age category, but that's appropriate.
@11:40
#1 is my point exactly. How many of those 50-60k that are awarded benefits at recon would have died if they'd had to wait another year or so simply going from initial to a hearing? How many would have lost their car, house, etc. in addition to those who died?
If 10k is a significant number, then why isn't 5-6 times that number also significant? If 10-13% isn't a big deal, then why is 1-2%?
The faster hearings wouldn't just lower awards due to age changes. It's not at all uncommon for a diagnosis to take a year or more to be discovered, to see the results of a certain surgery manifest themselves or fail to improve an impairment, or to have claimants that file for certain conditions to develop additional conditions that exacerbate or materially change their functionality. Those cases could be lost, too.
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