From the Huntsville Item:
Getting approved for disability payments from the Social Security Administration isn't easy, but depending on where you live, it could be even harder.
In North Alabama, for example, three of the judges who hear disability claims have the lowest approval record of any administrative law judge in the state; two of them also have among the lowest approval rate of any of the 12,000 judges nationwide. ...
Judge Cynthia Weaver approves only 12% of claims, giving her the lowest claims approval rate of any judge hearing disability cases in Alabama. Among nearly 50 judges in the country with similar disposition caseloads, between 250-260 dispositions, Weaver had the lowest approval rating for claims based on data reported in recent months.
An applicant's odds are only slightly better if they go before Judge Patrick Digsby, who approves about 13.6% of the claims that come before him. Judge Mallette Richey has the third-lowest claims approval rate at 26%. ...
If applicants choose to appeal, their odds aren't good. The Appeals Council denies 82% of claims and remands another 14% back to the judge who heard the case. There is no data on the final outcome of cases sent back to judges. Only 1% of claims are approved by the Appeals Council. ...
I've heard, probably on this blog, that the typical ALJ approves about 50% of cases. This figure has always seemed high to me given that the case has already been reviewed and denied by the state DDS at least once and most often twice. If the DDS is doing their job, then these cases should be unfavorable most of the time. The 12% figure seems about where it should be, not 50%. I'm sure Charles or others would disagree with this and I'm curious why. Is there DDS process flawed in some way that it can't be counted on to meaningfully screen the cases for the ALJs such that most of them really should be denials?
ReplyDelete“We have a rural health crisis in the state of Tennessee,” Jedlowski explained. “Because we chose not to expand Medicaid, many rural hospitals have closed because they relied on those payments to stay open. Should those communities have broadband, which is also a crisis in Tennessee, then perhaps they could maybe have a telemedicine visit with a specialist in one of our major markets.”
ReplyDeleteIt is tough to win a case without evidence of treatment, and it is tougher to get treatment that might help someone avoid filing for disability as well. Note that 13 of the 16 lowest approving states cited in the article are red states, ehich is odd because 8 or 9 of the top 10 states with the highest percentage of the population on disability are also red states.
@6:41. Yes, the DDS process is extremely flawed. The doctors spend about 5 to 15 minutes per case, most do not review the medical records but only the excerpts provided by the DDS caseworkers. I've seen significant things like significant MRI findings completely missed. On reconsideration, often the doctor rubberstamps the first decision without any of their own review or analysis. LIke everything else with this system, at DDS, its all about numbers. As long as they process a lot of cases quickly and don't approve too many, SSA is happy. Also, at least o 80 percent of the CE exams are a joke. They pay $150 and expect to get a good exam. We call them "drive by" exams. Most often these doctors don't review any records either. The psychological CEs are sometimes really bad. Seen people whose records show psychosis with diagnosis of schizophrenia with no mention in CE. I've come to believe that SSA sees DDS as a screening process. They want them to only approve the most obvious cases and let their ALJs deal with the rest. I've also come to believe that the agency lices the fact that the process is long and difficult so many will become discouraged and give up. I do agree that if DDS worked like it should, the approval rate at the hearing would be low but that would be because many more would be approved at the DDS level. Might need fewer ALJs then though.
ReplyDelete@6:41 AM. Let me offer a different perspective. Not everyone appeals their case. It is reasonable to assume that people who were incorrectly denied are more likely to pursue an appeal. It is also seems reasonable that additional evidence is often provided at hearing. This could be due to the initial denial - meaning claimant knows they didn’t have enough support for the claim the first time. This could be the influence of obtaining representation - who may help the claimant obtain additional evidence. Lastly, this could be due to the passage of time - conditions may have worsened, and there are more medical records available. Given these factors, I think the presumption of near 50 allowance rates as appropriate at the hearing level is not unwarranted.
ReplyDelete6:41 DDS has to make their decisions in 90 days. They often miss most of the evidence, meaning the files increase in size exponentially at the hearing level. DDS often uses shortcuts such as "insufficient evidence", which they can use but ALJs can't. DDS review is cursory and rushed.
ReplyDeleteFirst- no way should an approval rate be this low. Statistically this should be impossible. Which means there is something else going on. Should be looked at the same way we look at people with 80% approval rates.
ReplyDeleteAlso- the rates of approval are higher with ALJ's because the claimants get reps often after two denials. Reps know what is required and get a lot more medical evidence in to support the claim, resulting in higher pay rates than the local office or DDS decisions.
@ 10:02. Our DDS doesn't make decisions in 90 days. Its not unusual for cases to be there 6 months or longer.
ReplyDelete@6:41
ReplyDelete1. DDS does a terrible job developing the evidence, particularly when a claimant is unrepresented.
2. DDS often assumes any non-exertional limitation is irrelevant under the grids, but when it gets to a hearing with an actual VE, it's an award.
3. Recon is pretty much a rubberstamp, so obviously the rate is low. We should eliminate it. It does not add anything.
4. A 12% award rate is absurd. The passage of time alone, due to change in age categories, results in more than 12% of DDS denials supporting an award, with NO change in evidence (i.e. DDS found sedentary but alternative work sustainable, claimant turned 50, and now grid rules direct disability).
Ideally, obviously the award rate by an ALJ should be low, because DDS should have awarded an ALJ awarded case, at the initial level in most cases. But in reality, 12% is going to be lower than what the evidence supports, unless SSA gets the hearing time so low that minimal time has passed between DDS and the administrative hearing.
This is 6:41 again. The stuff we see coming out of DDS sometimes is just too bad to adequately describe. When you've seen this stuff for yourself, any defense falls flat. A psychologist there admitted to me that he and his colleagues do not have time to review medical records. He blamed the fact that he missed the fact that a claimant had 23 psychiatric hospitalizations on the fact that the DDS caseworkers miss putting things in the excerpts. News articles from Tennessee have pointed out the fact that these alleged doctors are allegedly reviewing so many cases they cannot devote more than a few minutes to each case. And, there was a lawsuit a few years ago, I think it was in Nevada, or maybe Utah, I don't remember but in depositions a couple of their alleged doctors admitted that they didn't review the records. The really sad thing is that many ALJs know this but still defer to their opinions. Due process is something you have to look hard to find in this system. Saying it is a "flawed" system is a significant understatement. And, yes, I have little doubt the agency likes it the way it is.
ReplyDeleteMany allowances, both with and without reps, are due to the lengthy time to schedule, hold and decide a ODAR case. During this long time the claimant's health is unlikely to be getting better and more often worse hence many allowances. There should be more remands on many overly delayed cases.
ReplyDeleteIf an ALJ is approving 10-20%, then she is looking for clear and convincing, not a preponderance, of the evidence. The legal standard is preponderance.
ReplyDeleteTrue. But, in order to uphold that decision, only "substantial" evidence supporting that decision is required. Which means that if a "reasonable" person could come to that conclusion, it is upheld. I think this needs to be changed to preponderance of the evidence on review. No reasonable employer is going to hire someone that can't actually perform and SUSTAIN a job. But, people in this position are denied every day. Too many ALJs apparently use a "beyond a reasonable doubt" standard in order to approve. I think THAT is what gets you a 15-25% approval rate. Unfortunately, too many disability are medically virtually improvable to a "sceptical judge." There are no medical proofs for depression, schizophrenia, and many other common to rare diagnoses. Furthermore, proving severity (particularly outside of "typical") is often impossible. The system basically allows ALJs to make any decision they want to, with little evidence required to support an approval or a denial. But, SSA put pressure on the high payers after Huntington without a similar pressure on high deniers.
DeleteRemember, we're talking about the same agency that still thinks the DOT is competent evidence.
ReplyDeleteThese low approving ALJs are doing a disservice to the constituents which they serve. I was under the impression that outlier ALJ's who's numbers are significantly statistically out of range with the national average were supposed to have their decisions reviewed? Does this only happen with higher approving ALJ's. I have represented hundreds of claimants and it seems to me that ALJ's are only concerned about approving too many cases and not concerned at all about low approval numbers. All to often ALJ's wear their biases on their sleeves and create result based decisions.
ReplyDeleteI would hope that NOSSCR, NADER, etc would be bringing these issues to the forefront. Why has this never been brought up by any of the congressional subcommittees.
All too often I appear before ALJ's who really should not be in their positions. They don't understand the medical issues, rely on flawed CE/DDS reports, are completely biased and don't properly apply the burdensome listing and grid rules that are skewed against the claimant.
It is abundently clear that too many people file a claim and assume SSA will acquire all the necessary evidence. That assumption is false. SSA will ask for evidence but if it doesn't get it, it denies. People who assume the system will dig up the doctors or shake free the hospital report are denied until they give up or get a rep who starts getting the info needed and giving it to SSA, rather than hoping it gets to SSA. That is the system. And why DDS denials are many times not fact filled and solid, but denials on process, not merit. And why approval rates get better when information relevent to the claim is provided directly. For too many people, that is when the rep is hired for the hearing. But the idea that the prepondeance of DDS denials are solid is laughable, and a bit trolling.
ReplyDeleteThe cynic in me thinks DDS and the doctors they hire "work the case backwards." Meaning, you look at the age and complaints and put it close to the approval line, but not over. I mean, you're SUPPOSED to deny... That's why you're there. Pass the real decisions to the ALJs and ONLY spprove the most obvious cases. So, you look "credible." How else do explain a change of age from the SAME claimants after turning 50 or 55 on the SAME EVIDENCE on another application suddenly be able to do "light duty" when they were rated as "sedentary" at 47? Same person, same documents, same diagnosises... More capable? I mean, why try to figure out the real capacity for work when you can get paid for getting close, but deny to make your bosses happy? I mean, who cares about person x that you'll never see?
ReplyDeleteThanks to everybody who answered my question about the DDS. I don’t doubt any of it.
ReplyDeleteThe DDS has people with actual medical credentials, but no time to review and insufficient development. The ALJ has more time and better evidence, but no medical expertise. What a weird system for reviewing disability applications.
A judge in a Kentucky office approves only 4% and the other three judges average 50% with the same mix of cases. Please don’t even try and say that is not proof positive of bias and using a different standard.
ReplyDeleteAs an aside, please know that we have about 1200 judges, not 12,000. That may indicate a sort of looseness with the facts, or it may not.
ReplyDeleteIt seems like OHO's that have a very low approving judge always have more than one of those judges. Cleveland has multiple judges under 30%, including one who grants 11%.
ReplyDeleteMy experience is that if you grant under 20-25%, you are literally looking for ways to deny. Even in cases where DDS's evaluation result in a GRID application, these judges will come up with their own RFC less favorable than DDS's as a way to deny, or exclude favorable restrictions in DDS's RFC.
ALJ Weaver is the HOCALJ in Florence, much like ALJ Tammy Georgian (who has been featured in this blog) is HOCALJ in Charleston. SSA loves HOCALJ's who pay in the teens, apparently!
ReplyDeleteI agree that it's worth examining the reasons for unusually low approval rates. I also think the commenters suggesting that SSA cracks down on high payers should pump the brakes. The hearing office in the linked article has one ALJ who pays 82% of decisions and another who pays 78%, so it cuts both ways.
ReplyDeleteYes, Huntington put a spotlight on high payers for a while, but it didn't stop the practice. The ALJ with the most dispositions in the country last year paid more than 80% of his decisions. He's been doing this for more than a decade and is still going strong. In the same office, two other ALJs paid 86% and 79% of their decisions last year.
Another hearing office has two ALJs who issued more than 380 decisions last year, and they both awarded benefits more than 90% of the time. Nobody stepped in to take away their cases and investigate why they pay so many more cases than their colleagues.
Bottom line, ALJs with extremely low pay rates should raise an eyebrow, but if there's pressure on the highest payers, as Tim says, their numbers don't show it.
Bottom line...Get denied by one ALJ, then get approved by another ALJ on the same evidence, restrictions, diagnosises, etc. Read the 2 decisions and you can't wrap your mind around that it sounds like they CAN'T be talking about the same person? Makes the whole thing look arbitrary and unfair!
DeleteI don't understand why the judges who are at each extreme, paying too many or two few aren't brought into line or fired.
ReplyDeleteCynthia Weaver and Patrick Digby will turn your case down every time, regardless of evidence. I am intimately familiar with a case that went before one of these two judges, where the claimant had opinion evidence from FOUR doctors who said this claimant could not work. Two of the doctors were consult exams that SSA themselves set up for the claimant. Didn't matter. Claim was denied. It really begs the question... why does SSA send claimants to consult exams if they then ignore the opinion of THEIR OWN doctors? Simple answer...because doing so allows them to turn down claims. I honestly didn't know Malette Richey had numbers this bad, but I can't say that I'm completely surprised. Bottom line, if you have a case with Weaver or Digby, just go ahead and consider your claim denied. In the overwhelming majority of cases, you'd be better off to withdraw from the hearing and file again, preferably while living in a more favorable area, such as middle Tennessee.
ReplyDelete