"SSA weeds out applicants who are technically disqualified (chiefly because they haven’t worked long enough) and sends the rest to state disability determination services (DDS) for medical evaluation. Applicants denied at that stage may ask for a reconsideration by the same state agency, and then appeal to an administrative law judge (ALJ) at SSA. Roughly half of people who get an initial denial pursue an appeal.
Ultimately — if we follow a cohort of applicants to the end of their application and appeal process — fewer than 4 in 10 are awarded benefits. Among applicants who meet the program’s technical requirements, slightly more than half are found medically eligible for SSDI."
The denial rate doesn't look as draconian when you filter out claims that never should have been filed in the first place.
First, sometimes SSA makes incorrect technical denials. They say someone isn't insured when they are, they're wrong about how long a marriage lasted when making a claim on a deceased spouse's benefits, they think someone is over-resource for SSI when that's not true, etc. Some of these technical denials get overturned on appeal.
Second, with no online SSI application system, the best way to get a protected filing date for an SSI claim is to file a Title II claim and indicate intent to file an SSI claim. This is better than waiting on hold to schedule an SSI application appointment (where you have a 16% chance of getting a busy signal), going in without an appointment and waiting for hours at a field office, or mailing or faxing in a paper app that is likely to be lost or have the wrong filing date used. Filing the Title II claim online is better for SSA as well--because then when the SSI claim is taken a lot of the information is already in the system.
Third, not everyone knows whether they're insured. One option is to look at their earnings record, but a lot of people can't get through the identity verification for MySSA and then they'd need to go to the field office to get an earnings statement and a MySSA account...not easy to do given the distance people need to travel, the wait times at field offices, and claimants' bad health. Doing a concurrent app and letting SSA figure it out is probably faster for the claimant and the agency than going to the field office, getting a benefit verification letter, and taking a paper SSI claim from scratch.
"The denial rate doesn't look as draconian when you filter out claims that never should have been filed in the first place." SSA makes itself look bad because of their impractical requirement that SSI only applicants still file a disability online because online online online. One could ask why SSI claims cannot be filed online, and that is a good question. Unfortunately, SSA is not able to give a straight answer to that simple question.
Everyone always prefixes my name with "Two Percent". If there's a 2% chance of anything, it's gonna happen to me. In my case, I was awarded on a reconsideration, due to everything happening so fast, and a delay in records. Had the reconsideration phase not been there, I would have had to wait to see a judge, with plenty of records in hand by then. I'm not for getting rid of that phase for that reason. The DDS could wait for records for longer than the few days they did (it wasn't long...). Back in 2002, so things were different back then, but had it not been for the reconsideration, it still would have delayed my benefits for quite some time, even back then.
1:49, maybe all of your clients can get through the busy signal and hold times and remember what they were told about insured status (and presumably date first/last insured as that matters too), but even then how do you know they were given the correct information based on their earnings record and that their earnings record doesn't need correcting?
Here's an idea... ALL who would be declared disabled if their claims would make them disabled! Especially if they have witness statements. Unless their is a CREDIBLE reason not to believe them. No more BS "claimant wasn't totally credible" without a real legitamate reason for that doubt. Don't want witness statements. Fine. Let us bring in all witnesses, including doctors and all "witnesses" for SSA. Make those paid doctors for SSA testify under oath.
Re: calling the 1 800 number, in over 15 years of practice I have never gotten a busy signal. If the que is long, the system will take your name/ number and call you back. I have always been called back. As for the accuracy of the information on earnings records, again never had a problem. In fact the staff have always been professional and helpful.
1:55, there was an "agent busy rate" last fiscal year of almost 15% according to https://www.ssa.gov/budget/FY20Files/2020APR_1.pdf (and it's worse this year) so you are very lucky to never get a busy signal!
I would expect that expanding SSI online claims will yield many more technical denials that might not be caught until after a favorable ALJ decision.
There are more interfaces with other systems and more permission requirements added to the SSI system, no doubt to automate verification of income and resources.
SSI's upgraded systems, web based, is already pickier than the antiquated systems. Requires more termination and re-establishment of records; more manual actions; it is less flexible. So add to that an increased volume of SSI claims, relying on self-reporting of all income and resources; I expect SSI claims processing to slow down for awhile. And as long as there are SSI couple records and SSI couples who split up and get back together and SSI children go back and forth between two parents, and paying SSI children with parents who have no SSN, the cases requiring manual action will never go away.
This section of the report caught my eye:
ReplyDelete"SSA weeds out applicants who are technically disqualified (chiefly because they haven’t worked long enough) and sends the rest to state disability determination services (DDS) for medical evaluation. Applicants denied at that stage may ask for a reconsideration by the same state agency, and then appeal to an administrative law judge (ALJ) at SSA. Roughly half of people who get an initial denial pursue an appeal.
Ultimately — if we follow a cohort of applicants to the end of their application and appeal process — fewer than 4 in 10 are awarded benefits. Among applicants who meet the program’s technical requirements, slightly more than half are found medically eligible for SSDI."
The denial rate doesn't look as draconian when you filter out claims that never should have been filed in the first place.
"Never should have been filed" is a bit harsh.
ReplyDeleteFirst, sometimes SSA makes incorrect technical denials. They say someone isn't insured when they are, they're wrong about how long a marriage lasted when making a claim on a deceased spouse's benefits, they think someone is over-resource for SSI when that's not true, etc. Some of these technical denials get overturned on appeal.
Second, with no online SSI application system, the best way to get a protected filing date for an SSI claim is to file a Title II claim and indicate intent to file an SSI claim. This is better than waiting on hold to schedule an SSI application appointment (where you have a 16% chance of getting a busy signal), going in without an appointment and waiting for hours at a field office, or mailing or faxing in a paper app that is likely to be lost or have the wrong filing date used. Filing the Title II claim online is better for SSA as well--because then when the SSI claim is taken a lot of the information is already in the system.
Third, not everyone knows whether they're insured. One option is to look at their earnings record, but a lot of people can't get through the identity verification for MySSA and then they'd need to go to the field office to get an earnings statement and a MySSA account...not easy to do given the distance people need to travel, the wait times at field offices, and claimants' bad health. Doing a concurrent app and letting SSA figure it out is probably faster for the claimant and the agency than going to the field office, getting a benefit verification letter, and taking a paper SSI claim from scratch.
"The denial rate doesn't look as draconian when you filter out claims that never should have been filed in the first place." SSA makes itself look bad because of their impractical requirement that SSI only applicants still file a disability online because online online online. One could ask why SSI claims cannot be filed online, and that is a good question. Unfortunately, SSA is not able to give a straight answer to that simple question.
ReplyDeleteI tell clients to call the 1 800 number. They can get insured status with a phone call. Beats going into field office.
ReplyDeleteEveryone always prefixes my name with "Two Percent". If there's a 2% chance of anything, it's gonna happen to me. In my case, I was awarded on a reconsideration, due to everything happening so fast, and a delay in records. Had the reconsideration phase not been there, I would have had to wait to see a judge, with plenty of records in hand by then. I'm not for getting rid of that phase for that reason. The DDS could wait for records for longer than the few days they did (it wasn't long...). Back in 2002, so things were different back then, but had it not been for the reconsideration, it still would have delayed my benefits for quite some time, even back then.
ReplyDeleteSome SSI claims CAN be filed online, just not all.
ReplyDelete1:49, maybe all of your clients can get through the busy signal and hold times and remember what they were told about insured status (and presumably date first/last insured as that matters too), but even then how do you know they were given the correct information based on their earnings record and that their earnings record doesn't need correcting?
ReplyDeleteSeems about right. I wonder what percentage would not raise outrage on the board. 70% 80% 100% approvals?
ReplyDeleteHere's an idea... ALL who would be declared disabled if their claims would make them disabled! Especially if they have witness statements. Unless their is a CREDIBLE reason not to believe them. No more BS "claimant wasn't totally credible" without a real legitamate reason for that doubt. Don't want witness statements. Fine. Let us bring in all witnesses, including doctors and all "witnesses" for SSA. Make those paid doctors for SSA testify under oath.
DeleteRe: calling the 1 800 number, in over 15 years of practice I have never gotten a busy signal. If the que is long, the system will take your name/ number and call you back. I have always been called back. As for the accuracy of the information on earnings records, again never had a problem. In fact the staff have always been professional and helpful.
ReplyDelete1:55, there was an "agent busy rate" last fiscal year of almost 15% according to https://www.ssa.gov/budget/FY20Files/2020APR_1.pdf (and it's worse this year) so you are very lucky to never get a busy signal!
ReplyDeleteI would expect that expanding SSI online claims will yield many more technical denials that might not be caught until after a favorable ALJ decision.
ReplyDeleteThere are more interfaces with other systems and more permission requirements added to the SSI system, no doubt to automate verification of income and resources.
SSI's upgraded systems, web based, is already pickier than the antiquated systems. Requires more termination and re-establishment of records; more manual actions; it is less flexible. So add to that an increased volume of SSI claims, relying on self-reporting of all income and resources; I expect SSI claims processing to slow down for awhile. And as long as there are SSI couple records and SSI couples who split up and get back together and SSI children go back and forth between two parents, and paying SSI children with parents who have no SSN, the cases requiring manual action will never go away.