Its by design. QR is the boogeyman at DDS. Every pay at DDS is reviewed and if it is thrown back, the examiner gets a negative mark. Plus they are not given resources or time to develop the case. Makes it easy to deny a case on the basis of insufficient evidence.
No one in in charge thinks OHO can do better than getting it right ~40% of the time. And at this point, there are few left who care enough to prove them wrong.
No. ALJs are allowed much more ability to make a decision in the grey areas. Also the claim is more developed. Been the same numbers roughly the last 30 years or so.
There were 235,462 ALJ hearings; about 120,085 were allowed; 91,830 denied; and 25,900 dismissed (late filing, withdrawals, etc). There were 54,236 Requests for Review to the Appeals Council; about 542 were allowed; 6,508 remanded; 45,558 denied; and 1627 dismissed. There were 21,297 federal court decisions; about 213 were reversed and remanded for payment of benefits; about 12,352 were remanded for further proceedings; about 7,880 affirmed; and 852 dismissed. What does this mean? Of the 91,830 ALJ denials, the Appeals Council reversed/remanded 7,050 and the federal courts reversed/remanded 12,565 (total of 19,515). That means about 21% of all ALJ denials are reversed/remanded. That does not seem like a very good record.
This data does not comport with what I have seen at NY DSS in the last 18 months. Maybe NY is an outlier state, but app approval rates for our firm have dropped significantly -- closer to 15 to 20%. That being said, we have had 10-15% variations in app approval rates year to year.
But my concern is that there seems to be a policy change in how NY DDS reviews claims. State Agency medical experts are denying extremely strong claims for 55+ clients with medium exertion PRW. When I get access to the detailed disability determination denial explanations at the hearing level, the DDS medical expert opinions are a complete joke. They are ignoring all evidence that support manipulative limitations, and for some reason dramatically increased the threshold for what constitutes a severe mental health impairment.
"Been the same numbers roughly the last 30 years or so." Per the FY 2008 Waterfall, there were 550,000 ALJ dispositions. ALJs allowed 62% and denied 24%. That's a lot more hearings and significantly more allowances. And there were less than 14,000 federal court decisions with a 49% reverse/remand rate. So there are a lot more federal court decisions/remands and a lot fewer ALJ decisions. I think there is a problem with quality.
2. If you are grouping in the entire initial/recon/ALJ level together, a huge portion of the 51% allowed by ALJs are following either AC or FDC remand.
One would think that the percentage of the AC and Federal Court remands would be similar. If I was a judge in District Court, I would be highly annoyed with ALJ's and AC not following regulations.
At the initial level you have a large number of claims mills that work for hospitals submitting initial applications hoping to get coverage for their patients.
There's been a notable reduction in ALJ-level dismissals from 19% in FY19 to 11% in FY22. Some of the cases that would have been dismissals are probably still pending, but a lot probably got decisions--some awards, some denials, but the increased allowance rate suggests that more were awards than denials.
@11:22 - In 2008, there were over a million cases backlogged, and the ALJs were "paying it down" by awarding a higher percentage of Favorable opinions, because they were quicker to dispose of (not just less time to write up, but would not be appealed). It serves no purpose to compare current numbers to then without that context.
Also, the number of Dismissals at the ALJ level is down because OHO wouldn't dismiss claimant's who failed to appear at a telephone or video hearing. All of those were rescheduled for an in-person hearing, and so in the last couple months the number of dismissals have gone way up because Hearing Offices are finally able to clear those cases off their books.
I’d love to hear more about this “huge portion” of favorable ALJ decisions being made on remand. Based on the numbers above, ALJs are making ~118k favorable decisions with ~18k total court/AC remands on an annual basis. Even if one were to assume that every single remand was being reversed (which, of course, is not the case), that’s only 15-16% of all favorable decisions.
I’m guessing you wouldn’t say that ALJs with a 15% award rate are awarding a huge portion of their cases.
Looking at the numbers slightly differently so the error rate of the system can be viewed easily:
Initial Claims allowed at the Reconsideration Level: 3.9% (68988 of 1,765,032) Reconsiderations allowed at the Hearing Level: 26.1% (120,085 of 459,925) ALJ decisions allowed or remanded at the AC Level: 3.0% (7050/234,462) AC decisions allowed or remanded in Federal Court: 23.2% (12,565/54,236)
Takeaways? Reconsiderations burn lots of DDS time, and the very low rate at which Initial decisions are overturned suggests that front-line employees are doing their job well for the most part, at least per rules as written. Because of that getting rid of Reconsiderations looks facially attractive (Prototype State Redux), but that would overwhelm Hearings. The large overturn rate at Hearings reflects a set of rules which are, de facto, different from those used in Initial Claims, and better aligning them would be the chief potential efficiency gain. What is most troubling here is the high rate at which Appeals Council decisions are overturned - and that they should be remanding a much greater portion of their cases back to the Hearing level.
"The large overturn rate at Hearings reflects a set of rules which are, de facto, different from those used in Initial Claims, and better aligning them would be the chief potential efficiency gain."
Agreed. If you read a lot of initial and reconsideration DDE's you find that adjudicators at those levels are not considering some agency rules that enable or require favorable disability decisions. Examples are rules in the SSRs identifying work-preclusive limitations, some special vocational profiles, and agency policies stating the mental abilities that all jobs require. Most ALJs do consider and apply those rules. I don't see that happening at initial and recon. That sends a big raft of claims that could have been approved earlier floating up to the hearing level.
One thing disappointing about these charts... Where are the numbers for those who have gone all the way through Federal Court, then started back at the beginning? For all the BS arguments about "not proving their case," especially when you consider some decisions have no basis in reality... Those who are denied and are actually disabled, they really have no choice but to reapply. Multiple scientific studies show that what I am saying is true. Ya'll don't really think that they "just go back to work?" If they could, they likely would have already did that!
No Tim…those of us in the field take their claims over and over and over again. I have had a few over the years with so many claims filed, they were permanent exclusions and had to be done on paper.
I will say, a lot of claims we got in my area during COVID have returned to work. But that is purely anecdotal.
So, in your opinion(?)... people who reapply are serial reappliers with no merits to their case? Well, to come to that conclusion, you have to asssume DDS, the ALJ, the AC, and Federal Courts all made the "right" decisions. Well, what percentage of these "reappliers" are eventually approved? In your logic, wouldn't that require the subsequent approval to be the wrong decision if the first go-around was the right one?I had 2 ALJ decisions. It is nearly impossible to fathom that those 2 decisions ae about the same person with the exact same disabilities, work history, etc. I think the problem is the "substantial evidence" standard. ALJs are allowed to "move the bar" to, what is effectively "beyond a reasonable doubt," because Federal Courts in some circuits will protect almost any decision. The legal standard needs to be changed to the Preponderance of the evidence, even on appeal!
Not all of them. I genuinely believe some of them are disabled. Multiple filings keep going until they got a grid level age to comply with their limitations or education level. I’ve seen a ton of ALJ decisions with adverse onset dates to match reaching a particular age.
I know it’s unpopular to bring it up, but I work in a low income area where filing for disability, especially SSI, is “normal”. I’m not denying people have issues that make it difficult to work.
And I agree with you about ALJ’s moving the bar and having much more latitude to approve claims that have been previously denied multiple times.
It’s almost like playing the lottery - you just keep trying until it hits. It’s sad really.
Playing the lottery? Seriously? How about "finally getting what you were promised?" SSDI is from Disability Insurance that everyone pays into! It's a social contract. Essentially, "if you pay in to this and become disabled, we will take care of you." EVERY time a disabled person who paid into the system is denied, it is a violation of that social contract. But, people like you think it's like winning the lottery. That's insulting to people who have, essentially, lost "life's lottery." I was able to work 30 years with disabilities. My reward...having to wait 6 years for the government to honor their social contract.
24 comments:
Wow, doesn't it seem like there should be better decisions at the lower levels?
Its by design. QR is the boogeyman at DDS. Every pay at DDS is reviewed and if it is thrown back, the examiner gets a negative mark. Plus they are not given resources or time to develop the case. Makes it easy to deny a case on the basis of insufficient evidence.
No one in in charge thinks OHO can do better than getting it right ~40% of the time. And at this point, there are few left who care enough to prove them wrong.
So the vast majority of allowed claims are at the initial decision. Somewhere in the neighborhood of 70 to 75 % or so.
No. ALJs are allowed much more ability to make a decision in the grey areas. Also the claim is more developed. Been the same numbers roughly the last 30 years or so.
There were 235,462 ALJ hearings; about 120,085 were allowed; 91,830 denied; and 25,900 dismissed (late filing, withdrawals, etc).
There were 54,236 Requests for Review to the Appeals Council; about 542 were allowed; 6,508 remanded; 45,558 denied; and 1627 dismissed.
There were 21,297 federal court decisions; about 213 were reversed and remanded for payment of benefits; about 12,352 were remanded for further proceedings; about 7,880 affirmed; and 852 dismissed.
What does this mean? Of the 91,830 ALJ denials, the Appeals Council reversed/remanded 7,050 and the federal courts reversed/remanded 12,565 (total of 19,515). That means about 21% of all ALJ denials are reversed/remanded. That does not seem like a very good record.
This data does not comport with what I have seen at NY DSS in the last 18 months. Maybe NY is an outlier state, but app approval rates for our firm have dropped significantly -- closer to 15 to 20%. That being said, we have had 10-15% variations in app approval rates year to year.
But my concern is that there seems to be a policy change in how NY DDS reviews claims. State Agency medical experts are denying extremely strong claims for 55+ clients with medium exertion PRW. When I get access to the detailed disability determination denial explanations at the hearing level, the DDS medical expert opinions are a complete joke. They are ignoring all evidence that support manipulative limitations, and for some reason dramatically increased the threshold for what constitutes a severe mental health impairment.
"Been the same numbers roughly the last 30 years or so."
Per the FY 2008 Waterfall, there were 550,000 ALJ dispositions. ALJs allowed 62% and denied 24%. That's a lot more hearings and significantly more allowances.
And there were less than 14,000 federal court decisions with a 49% reverse/remand rate. So there are a lot more federal court decisions/remands and a lot fewer ALJ decisions. I think there is a problem with quality.
@10:41
1. The initial decision is a 38% award rate.
2. If you are grouping in the entire initial/recon/ALJ level together, a huge portion of the 51% allowed by ALJs are following either AC or FDC remand.
My point was most claims allowed by far are at the initial claims level.
Not the highest percentage, just sheer numbers.
One would think that the percentage of the AC and Federal Court remands would be similar. If I was a judge in District Court, I would be highly annoyed with ALJ's and AC not following regulations.
Interesting. I have never seen this report and I worked in a Hearing office for 25+ years. They never share any info with the rest of the “team”.
At the initial level you have a large number of claims mills that work for hospitals submitting initial applications hoping to get coverage for their patients.
8:08, it's in SSA's budget docs every year.
There's been a notable reduction in ALJ-level dismissals from 19% in FY19 to 11% in FY22. Some of the cases that would have been dismissals are probably still pending, but a lot probably got decisions--some awards, some denials, but the increased allowance rate suggests that more were awards than denials.
11:22 cherry picked one of the worst economic times in the last few decades to "prove" a point. LMAO
@11:22 - In 2008, there were over a million cases backlogged, and the ALJs were "paying it down" by awarding a higher percentage of Favorable opinions, because they were quicker to dispose of (not just less time to write up, but would not be appealed). It serves no purpose to compare current numbers to then without that context.
Also, the number of Dismissals at the ALJ level is down because OHO wouldn't dismiss claimant's who failed to appear at a telephone or video hearing. All of those were rescheduled for an in-person hearing, and so in the last couple months the number of dismissals have gone way up because Hearing Offices are finally able to clear those cases off their books.
I’d love to hear more about this “huge portion” of favorable ALJ decisions being made on remand. Based on the numbers above, ALJs are making ~118k favorable decisions with ~18k total court/AC remands on an annual basis. Even if one were to assume that every single remand was being reversed (which, of course, is not the case), that’s only 15-16% of all favorable decisions.
I’m guessing you wouldn’t say that ALJs with a 15% award rate are awarding a huge portion of their cases.
Looking at the numbers slightly differently so the error rate of the system can be viewed easily:
Initial Claims allowed at the Reconsideration Level: 3.9% (68988 of 1,765,032)
Reconsiderations allowed at the Hearing Level: 26.1% (120,085 of 459,925)
ALJ decisions allowed or remanded at the AC Level: 3.0% (7050/234,462)
AC decisions allowed or remanded in Federal Court: 23.2% (12,565/54,236)
Takeaways? Reconsiderations burn lots of DDS time, and the very low rate at which Initial decisions are overturned suggests that front-line employees are doing their job well for the most part, at least per rules as written. Because of that getting rid of Reconsiderations looks facially attractive (Prototype State Redux), but that would overwhelm Hearings. The large overturn rate at Hearings reflects a set of rules which are, de facto, different from those used in Initial Claims, and better aligning them would be the chief potential efficiency gain. What is most troubling here is the high rate at which Appeals Council decisions are overturned - and that they should be remanding a much greater portion of their cases back to the Hearing level.
@10:20
"The large overturn rate at Hearings reflects a set of rules which are, de facto, different from those used in Initial Claims, and better aligning them would be the chief potential efficiency gain."
Agreed. If you read a lot of initial and reconsideration DDE's you find that adjudicators at those levels are not considering some agency rules that enable or require favorable disability decisions. Examples are rules in the SSRs identifying work-preclusive limitations, some special vocational profiles, and agency policies stating the mental abilities that all jobs require. Most ALJs do consider and apply those rules. I don't see that happening at initial and recon. That sends a big raft of claims that could have been approved earlier floating up to the hearing level.
One thing disappointing about these charts... Where are the numbers for those who have gone all the way through Federal Court, then started back at the beginning? For all the BS arguments about "not proving their case," especially when you consider some decisions have no basis in reality... Those who are denied and are actually disabled, they really have no choice but to reapply. Multiple scientific studies show that what I am saying is true. Ya'll don't really think that they "just go back to work?" If they could, they likely would have already did that!
No Tim…those of us in the field take their claims over and over and over again. I have had a few over the years with so many claims filed, they were permanent exclusions and had to be done on paper.
I will say, a lot of claims we got in my area during COVID have returned to work. But that is purely anecdotal.
So, in your opinion(?)... people who reapply are serial reappliers with no merits to their case? Well, to come to that conclusion, you have to asssume DDS, the ALJ, the AC, and Federal Courts all made the "right" decisions. Well, what percentage of these "reappliers" are eventually approved? In your logic, wouldn't that require the subsequent approval to be the wrong decision if the first go-around was the right one?I had 2 ALJ decisions. It is nearly impossible to fathom that those 2 decisions ae about the same person with the exact same disabilities, work history, etc.
I think the problem is the "substantial evidence" standard. ALJs are allowed to "move the bar" to, what is effectively "beyond a reasonable doubt," because Federal Courts in some circuits will protect almost any decision. The legal standard needs to be changed to the Preponderance of the evidence, even on appeal!
Not all of them. I genuinely believe some of them are disabled. Multiple filings keep going until they got a grid level age to comply with their limitations or education level. I’ve seen a ton of ALJ decisions with adverse onset dates to match reaching a particular age.
I know it’s unpopular to bring it up, but I work in a low income area where filing for disability, especially SSI, is “normal”. I’m not denying people have issues that make it difficult to work.
And I agree with you about ALJ’s moving the bar and having much more latitude to approve claims that have been previously denied multiple times.
It’s almost like playing the lottery - you just keep trying until it hits. It’s sad really.
Playing the lottery? Seriously? How about "finally getting what you were promised?" SSDI is from Disability Insurance that everyone pays into! It's a social contract. Essentially, "if you pay in to this and become disabled, we will take care of you." EVERY time a disabled person who paid into the system is denied, it is a violation of that social contract. But, people like you think it's like winning the lottery. That's insulting to people who have, essentially, lost "life's lottery." I was able to work 30 years with disabilities. My reward...having to wait 6 years for the government to honor their social contract.
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