I and others in North Carolina are seeing cases where Administrative Law Judges try to order consultative medical examinations (CEs) but the state Disability Determination Services (DDS, which handles CEs in addition to making determinations on disability claims at the initial and reconsideration levels), refuses to schedule the exams, saying they don't think them necessary.
Is this happening in other states?
I don't particularly like them but sometimes a CE is necessary and ALJs don't order many of them so this seems surprising.
I don't think DDS should be second guessing ALJs on this, especially since it's often hard to understand why DDS schedules CEs themselves when they have jurisdiction over cases. It often seems to be a stalling device for disability examiners -- as in "I'm too busy to finish work on this case now so I'll delay by ordering a CE." I don't see ALJs doing that. Clean up your own house, DDS!
Huh. We had an ALJ who would literally scheduled up to 6 CEs, over the course of up to 3 supplemental hearings rather than award. He's retired, curious now if there could have been anything done to push back on the administrative side. Letters/briefs explaining why further exams were unnecessary certainly didn't work.
ReplyDeleteNo, for ALJs it’s a “I don’t feel like reading this file” device. DDS is doing the right thing. Far too many ALJs routinely order CEs and medical experts as a matter of course in a naked effort to avoid reading claimants’ medical records. SSA is essentially paying doctors to do the job that ALJs already get paid over $170,000 per year to do. The taxpayers deserve better.
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ReplyDeleteNo, DDS is not doing the right thing. Once a hearing request is filed, jurisdiction for the case is with the Hearing Office. Scheduling of a CE is a ministerial function and the only proper action is to facilitate the scheduling of a CE. It is definitely not the province of the DDS to decide on whether that testing is needed, even if the Adjudicator thinks it is unnecessary and even if they are right. It is just not their job.
Wrong. POMS instructs DDS to follow the usual protocols for requesting CEs when a request is received from an ALJ. These protocols include instructions to reject the request if the CE is unnecessary or inappropriate (e.g, because it might harm the claimant). The regional chief ALJ is then responsible for solving any disagreements. Sorry to burst your bubble, but you ALJs are not omnipotent.
DeleteWow. Ok, first I agree with 10:10, jurisdiction has changed so DDS has no basis to refuse to schedule the CE.
ReplyDeleteSecond - 9:39 your cynicism is just dripping from your post. Many ALJ's will order CE's because they don't have a clear picture of the case, because the claimant has little treatment because of financial issues, or because they know that the AC can and will remand a decision that isn't supported. Too many ALJ's routinely order CE's and ME's to avoid reading a file? What evidence do you have for this or is it just a claim you "feel" is right? And not sure that it can possible be correct that a dr is being paid to do what an ALJ can already do when ALJ's aren't allowed to give medical opinions, do evaluations or offer exertional limitations.
Conveniently for ALJs, rules concerning PII foreclose the possibility of providing you with the proof you seek. Basis is personal experience reviewing ALJs’ work, and noticing that most CEs and MEs are: requested by the same ALJs as a matter of course in all of their cases (and noting that those ALJs routinely overlook majorly important information while showing awareness in their instructions and file review notes only of what the claimant, CEs and MEs said)
DeleteMeanwhile, the case languishes, at the expense of claimant.
ReplyDeleteI was under the impression that if a clt had no medical treatment for a year or more prior to the hearing, ALJs were required to order a CE.
ReplyDeleteTrue story - I ordered a ph CE with 7 xrays - each ankle knee and hip and the back. DDDs said their max was5 x-rays so I cut it to 3. The next doctor reviewer denied also and said they were not subjecting the cl to the radiation!
ReplyDeleteWhy did you order so many x-rays? If for arthritis, they probably won't look much different than those taken a year, 2 or even 3 years later. But, they don't show pain anyway. MRIs can also poorly correlate structural damage with pain when it comes to arthritis. But, what other than arthritis would effect soany joints?
Delete“ No, for ALJs it’s a ‘I don’t feel like reading this file’device. DDS is doing the right thing. Far too many ALJs routinely order CEs and medical experts as a matter of course in a naked effort to avoid reading claimants’ medical records.”
ReplyDeleteFunny. At least in my area, DDS uses CEs for that exact same reason. It’s how claimants with no psych allegations in their disability and function reports, no MH treatment, and no psych complaints to their PCPs end up limited to “SRTLPC.”
I only order them if I think they will help the claimant. Establish an MDI of DDD or OA in a thin file without any imaging, or establish a psych diagnosis when their are psych complaints, but no diagnosis. Stuff like that. I have had DDS kick them back, but after I provide additional rationalization I've never had one outright refused. Lately I have seen them kicked back after one missed appointment though, so it seems like they aren't rescheduling them like they once did.
ReplyDeleteDDS seems to be the main problem in all of this.
ReplyDeleteGood. The CEs are completely worthless anyway. 95% of our office's medical CEs are performed by one Dr., who issues the same useless opinion each time -- "the claimant is mildly to intermittently moderately impaired." Thanks for nothing, Doc.
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