Friday, May 19, 2023

SSA Revamping The Hearing Scheduling System

The Social Security Administration ("SSA") is changing the way that they schedule disability hearings.  Many moons ago, when I started practicing Social Security Disability law in 2004, a scheduler from the local hearing office would call us with available dates for our clients' hearings. Simple, right? A few years ago, SSA made the scheduling process much more complex, by having attorneys submit their "unavailability" to them 5 months in advance of the scheduling month. For instance, I would let SSA know in May which days I was unavailable for hearings in October. SSA could then fill my calendar any way that they wanted to. I have a boutique practice, so it was never an issue for my firm, but I heard this process created chaos for larger and national firms. 

Now, SSA is in the final testing stages of yet another change in scheduling protocol. The new system is called Enhanced Representative Availability Process, or ERAP, because there is nothing that SSA loves more than a good acronym! I have an upcoming training class about the new procedures on May 31st, but even the description of the program sounds convoluted and a recipe for disaster: https://www.ssa.gov/appeals/scheduling_process.html. 

Once I complete my training, I am apparently placed in a Designated Scheduling Group ("DSG"). Then there is some sort of email encryption setup and we are on our way to scheduling. Want to know a telltale sign that this likely won't work? Get a look at the email address  that we are supposed to email if we have any problems: OHO.NSD.NSS.ELU.DSG.REP@ssa.gov ? I am pretty sure this email handle was created by either C3PO or R2D2, just to ensure that we cannot get through to SSA with questions. It is downright comical. 

SSA is notorious for taking a simple process and adding steps to make it into a circus. I truly do not understand why they do not hire outside professionals with experience in making processes more efficient and lean, but the current motto at SSA seems to be "If it is already broken, why try to fix it?" We have noticed a drastic slowdown in hearing scheduling in 2023. SSA is blaming it on the backlog and lack of staff. Politicians are blaming it on SSA's continued remote working protocols, which allows some leeway in productivity. Meanwhile, fewer and fewer hearings are being scheduled in a timely manner.

If you want a rough estimate of timeframe at the hearing level, visit https://disabilityjudges.org/, this website is updated with statistics from the Freedom of Information Act ("FOIA"). If you click on California, you will see that the fastest hearing office in California is in San Bernardino and it is running 471 days behind in scheduling. The slowest hearing office is in Fresno and it is taking them approximately 744 days to schedule a hearing. Keep in mind that these statistics are just addressing the waiting periods at the hearing level. These timeframes do not include the waiting periods at the initial application and reconsideration levels.

The bottom line is that SSA seems to be falling behind in getting hearing scheduled. I doubt the new scheduling system with help improve timeframes, but I really hope SSA does something to improve hearing efficiency.

The reality is if you commit a crime, you are entitled to a speedy trial. If you are disabled, you wait and wait and continue to wait. Doesn't seem fair, does it? 

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.

Sunday, April 23, 2023

What is the Best Federal Agency To Work For?: Not the SSA

Anyone who deals with the Social Security Administration ("SSA") on a regular basis gets the sense that their employees aren't exactly "thrilled" to work at SSA. Even when the SSA employee is polite, which is not always the case, the majority of folks who are employed at SSA seem stressed and overwhelmed. When you call your local SSA field office, it often seems like the goal is to get you off the phone as quickly as humanly possible. I am based in Long Beach, California, which admittedly is a highly populated area. I always assumed that my local field offices are likely overburdened due to the size of the population that they serve, coupled with the facts that they are also understaffed and under-resourced. However, it seems that employee dissatisfaction is a pervasive problem for SSA, that isn't limited to the Southern California offices. How do I know this?

Well.....SSA ranked last for 2022 among the best large federal agencies to work for according to a survey conducted by the Partnership For Public Service .  The National Aeronautic and Space Administration ("NASA") was ranked the best large federal agency to work for. While this isn't surprising based on the devolution in customer service that I have witnessed since I first started practicing Social Security Disability law in 2004, I do hope SSA has a plan to improve morale after seeing these results. After all, unhappy workers are not productive workers. 

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.

Sunday, March 26, 2023

The Problem with Consultative Examiners

Consultative examinations are evaluations that Social Security pays for with one of their "approved" medical vendors.  Consultative examinations are only supposed to be scheduled by SSA/DDS IF evidence is “NOT available” OR the evidence is “insufficient” to determine whether a claimant has a disabling impairment. The reality is the majority of claimants are being sent to the CEs regardless of whether the file has sufficient evidence in it. SSA/DDS are essentially purchasing negative opinions in the majority of cases, as these evaluations are neither thorough or objective. Good ALJs know that CE reports are rarely legitimate and are willing to overlook a negative CE report. Biased ALJs, who view themselves as protectors of the SSA fund, rather than objective decision makers, know they can use negative CE reports to deny a claim and the Appeals Council (“AC”) will uphold the unfavorable determination.

Why are CEs becoming an increasing problem for us?

Prior to March of 2017, our clients had more protection from CEs, as there was the Treating Physician (Controlling Weight) Rule: 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2) in place. The Treating Physician rule essentially said that an opinion from a treating provider was given controlling weight over a report from a CE, as long as the treating opinion is well supported by the objective and clinical evidence and is not contradicted by any other substantial medical evidence. The reasoning made sense since a treating physician had a longitudinal relationship with the claimant.

Initially, after the treating physician rule was eliminated, there wasn’t an immediate fallout. Over the last 12 months, however, CEs are being increasingly used by SSA to deny claimants.  Even at the hearing level, ALJs who wish to deny a claimant are starting to utilize CEs AFTER the hearing in order to “buy” a basis to deny the claim. Even if you object to the CE appointment, SSA simply will ignore or overrule the objection. Yes, these objections help protect a claimant for Federal court, but disabled claimants do not have the luxury to wait additional appeal stages for benefits.

Below please find some specific problems that are occurring with CEs:

1.      When should CEs be used:

CEs should only be used if:

“If your medical sources cannot or will not give us sufficient medical evidence about your impairment for us to determine whether you are disabled or blind, we may ask you to have one or more physical or mental examinations or tests. We will pay for these examinations. However, we will not pay for any medical examination arranged by you or your representative without our advance approval. If we arrange for the examination or test, we will give you reasonable notice of the date, time, and place the examination or test will be given, and the name of the person or facility who will do it. We will also give the examiner any necessary background information about your condition. 20 C.F.R. §§ 404.1517, 416.917.”

The reality: SSA/DDS is treating every claim as if there is not “sufficient” evidence in the file. I am calling DDS on the cases that are stacked with evidence and demanding to know why a CE being scheduled. I am being told that the DDS reviewing doctor doesn’t feel there is sufficient evidence in the file and that a CE is being ordered to develop the case. IF, the claimant doesn’t attend, SSA is denying for “noncompliance.”

2.      Consultative examiners are not being provided ANY of the claimants’ evidence in most cases:

CEs are guided by a resource called a “Green Book.”  CEs used to be given about 50 pages of medical records, selected by DDS analyst, so the CE would have objective findings available before examining a claimant.

The reality: SSA/DDS is no longer sending any evidence to the CE for context. Instead, the CE report is based on a minimal examination that would not be able to determine disability in most instances. The physical examinations are akin to what children used to undergo to have clearance to attend physical education class…..reflex check , toe-touch check, old-fashioned grip strength test…etc.  The mental evaluations use a mini mental status examination (“MMSE”) that really only tests if a claimant is delusional. Questions vary, but common questions are:

-          Who is the President?

-          Name Your State Capital.

-          Spell “world” backwards.

-          What is the similarity b/t an apple and an orange?

-          What would you do if you smelled a fire in a movie theater?

-          What would you do if you found an envelope with a stamp on it?

-

3.      SSA dictates that the preferred consultative examiner for an evaluation is the claimant’s own treating doctor:

This language is taken DIRECTLY from SSA’s Greenbook

From SSA’s Greenbook: Consultative Examinations: A Guide for Health Professionals

Part III - Consultative Examination Guidelines

“If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the treating source for additional information or clarification, or by arranging for a CE.

The treating source is the preferred source of purchased examinations when the treating source is qualified, equipped and willing to perform the additional examination or tests for the fee schedule payment and generally furnishes complete and timely reports. Even if only a supplemental test is required, the treating source is ordinarily the preferred source for this service. SSA's rules provide for using an independent source (other than the treating source) for a CE or diagnostic study if:

  • The treating source prefers not to perform the examination;
  • There are conflicts or inconsistencies in the file that cannot be resolved by going back to the treating source;
  • The claimant prefers another source and has a good reason for doing so; or
  • Prior experience indicates that the treating source may not be a
      productive source.”

The reality: SSA/DDS has never reached out to a claimant’s treating doctor for a CE report that I have ever seen. They always use one of their vendors. 

4.      CEs evaluations are not complying with the time mandates:

SSA actually issues the length of time each evaluation should last:

“§ 404.1519n; 416.919n. Informing the medical source of examination scheduling, report content, and signature requirements.

The medical sources who perform consultative examinations will have a good understanding of our disability programs and their evidentiary requirements. They will be made fully aware of their responsibilities and obligations regarding confidentiality as described in § 401.105(e). We will fully inform medical sources who perform consultative examinations at the time we first contact them, and at subsequent appropriate intervals, of the following obligations:

(a) Scheduling. In scheduling full consultative examinations, sufficient time should be allowed to permit the medical source to take a case history and perform the examination, including any needed tests. The following minimum scheduling intervals ( i.e. , time set aside for the individual, not the actual duration of the consultative examination) should be used.

(1) Comprehensive general medical examination—at least 30 minutes;

(2) Comprehensive musculoskeletal or neurological examination—at least 20 minutes;

(3) Comprehensive psychiatric examination—at least 40 minutes;

(4) Psychological examination—at least 60 minutes (Additional time may be required depending on types of psychological tests administered); and

(5) All others—at least 30 minutes, or in accordance with accepted medical practices.”

 

The reality: I am having my clients time the evaluations. The majority last under 15 minutes.

5.      CEs are being scheduled even when the claimant meets a Bluebook listing:

SSA uses a 5-step sequential process to determine whether a claimant is disabled. Step 3 is, “does the claimant meet a Bluebook listing?” If the answer is “yes” the claimant should be awarded benefits. SSA is not supposed to complete a Step 4 or Step 5 assessment IF the Claimant Wins at Step 3. Step 4 is, “can the claimant perform his past work?” Step 5 is, “can the claimant perform other work in the national economy?”

 The reality: Even when there is evidence in the file that concretely shows the claimant is meeting a Bluebook listing, SSA is sending the claimant to a CE to get a residual functional capacity assessment to determine the claimant’s work abilities. The CE always comes back saying the client can do some level of work. SSA is ignoring the fact that the claimant meets the Bluebook Listing and denying the case, citing that the CE indicated the claimant could work.

What Can Be Done To Reduce The Problem With CEs

1.      Attorneys and reps need to object more to erroneously scheduled CEs in writing. It is time-consuming, so maybe NOSSCR could provide templates to the community to use so more firms are willing to object to CEs?

2.      Attorneys and reps should have their clients “time” these appointments to see if it complies with SSA’s standards.

3.      Attorney and reps should ask the ALJ to haul these CEs into the hearing for cross-examination if they know they are assigned to an ALJ who is looking to deny. If we create more work for SSA, they will be less inclined to overuse CEs.

4.      We need to let Congress know the abuses that our clients are suffering at the hands of CEs. Politicians have NO idea what happens when someone files for SSDI/SSI benefits. We need to encourage our clients to file complaints with their local Congressional Reps when they have a bogus CE evaluation, so our politicians get a sense of how corrupt the process have become. These CEs get paid anywhere from $175 to $275 to evaluate a complaint. SSA is complaining that they do not have a budget to “workup” a SSDI/SSI claim properly, BUT they are misusing government funds by scheduling CE appointments when it is inappropriate and unlawful to do so. 

Got a question that you need answered? Please check out our website at www.westcoastdisability.com. We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot me an email at megan@westcoastdisability.com or call us at (800) 459-3017 x 101.


Saturday, February 25, 2023

Social Security Disability and Long Covid

I don't normally post a lot of articles because generally I feel that the media doesn't understand Social Security Disability benefits, but here is a link to a wonderful article written by Ms. Morgan Stephens at CNN Business. Ms. Stephens writes one of the most accurate stories I have ever read about the state of Social Security Disability. While the article focuses on Long Covid, the delays and frustrations are truly applicable to all those with severe disabilities trying to obtain benefits before the Social Security Administration currently. Give it a read: https://www.cnn.com/2023/02/25/business/long-covid-workforce-issues-disability-claims/index.html

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.


Wednesday, February 22, 2023

6 Highlights From the Social Security Administration’s Operating Plan for 2023

 Acting Commissioner, Kilolo Kijakazi, Ph.D., M.S.W., released some details about the Social Security Administration’s (“SSA’s”) proposed workload and performance measures based on the budget that SSA received for 2023. SSA received an approximately $785 million dollar increase, which may sound like a lot on money (it is), but it was still $645 million less than what was requested to help rebuild the struggling SSA. Here are 6 highlights from Acting Commissioner Kijakazi’s letter to the Committee on Appropriations:

1.      SSA plans to rebuild their workforce because they have the lowest staffing levels in 25 years.

2.      SSA will have the same degree of overtime that they did for Fiscal Year 2022.

3.      SSA hopes to reduce the average wait time for initial determinations below the 206-day average wait time seen in 2022.

4.      SSA hopes to reduce the hearing wait times to 390-days for 2023 and are hopeful to reduce it to only a 270-day average waiting period for a hearing in 2024. Keep in mind these are just the waiting period goals for the hearing levels. It doesn’t include the waiting period at the initial application or reconsideration levels.

5.      SSA is expecting that the average wait times for their (800) 772-1213 number will increase in 2023 by two minutes from a 33 to a 35 average minute wait. SSA’s goal is to answer calls in 12 minutes, so they recognize they are failing when it comes to answering the phone.

6.      SSA also expects that there will be an increase in the receipt of busy signals compared to 2022 when calling the National 800 Number. SSA expects that callers will receive a busy signal 15 percent of the time compared to 6 percent of the time in 2022. Moral of the story – only call the (800) number if it is your last resort.

You can’t have a robust system if you do not have an adequate budget to improve services. Overall, I get the impression that waiting times at stages may improve, but general service will not. Keep in mind that if you do not demand an in-person hearing, you can get a hearing scheduled in about half the average waiting time, which is why my office is not objecting to phone or video hearings.

Acting Commissioner Kijakazi’s full statement is available here at: https://www.ssa.gov/budget/assets/materials/2023/2023OP.pdf.

 Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.

Tuesday, January 17, 2023

Recent Statistics Show that Social Security Is Denying More Cases At The Initial Application Level

The Social Security Administration ("SSA") issued statistics this month showing that they are denying more claims at the initial application level compared to award ratios for the last two decades : https://www.ssa.gov/OACT/STATS/dibGraphs.html. In fact, the last time that SSA statistics showed such few initial awards was in the late 1990's. 

We are certainly noticing that SSA is allowing fewer cases at the initial application level. It is shockingly noticeable to be honest. We recently saw SSA deny two claimants at the initial application level whose hearts are pumping at under 30 percent. I am aware of two stage four cancer cases that were denied this year at the initial application level. In all cases, SSA had the evidence substantiating the severity of the diagnoses, so what could the basis for such unfair and illogical denials?

Claimants always ask me if SSA makes the programs so difficult and untimely in hopes that the claimant dies before the claimant gets the benefits. I do not think that SSA is intentionally hoping that applicants will die throughout the process, but one should not forget that disability IS an insurance program. Insurance is never an industry in which the insurer is going out of its way to help the insured. SSA is no different. 

However, the more likely reason that more claimants are being denied more regularly at the initial application level seems to come down to three factors. Being both understaffed and underbudgeted, it seems that it is far easier for Disability Determination Service ("DDS") analysts to deny, rather than approve the claim. No one asks an analyst to defend a denial, but analysts are often questioned when an allowance is being recommended.  Until Social Security, along with the Disability Determinations Services, a State entity which is contracted by Social Security to develop the cases at the lower levels, are properly staffed and funded, I do not expect we will see much of an improvement.  

Congress doesn't seem interested in providing SSA with a realistic budget to run this vital program. Thus, SSA employees are buried in work and SSA is struggling to retain employees. When SSA employees quit, supervisors pack the unmanned cases on an already overburdened employee, making it impossible for many of the field office employees to keep their heads above water.  It is an impossible situation. 

The third reason that I believe so many cases are being denied at the lower levels in recent years is that SSA/DDS are utilizing their consultative examiner ("CE") vendors in the majority of cases. These "doctors" are supposed to provide thorough physical and mental evaluations to disability applicants. Instead, what these evaluations usually entail is a 15-minute examination, akin to what I underwent as a second grader to assure my gym teacher that I was fit to square dance and hula hoop during physical education class.  Touch your toes, wiggle your fingers, walk across the room....etc. These are the evaluations that SSA/DDS are conducting to justify a denial. 

Up until 2017, SSA had a law in place referred to a "treating physician rule" in which a claimant's treating provider's opinion was entitled to the most weight under SSA law (assuming this opinion was backed by objective and clinical findings). This rule was in place because SSA logically accepted that a treating doctor would know more about her patient than an evaluator who met the claimant only once and conducted a 15-minute examination would. Since 2017, however, SSA no longer gives controlling weight to the opinion of a claimant's treating provider. Instead, current law dictates that this CE's opinion can be afforded the same, or even more, weight than that of a treating doctor in a decision. 

What is also important to note is that SSA/DDS rarely bothers sending any of the claimant's medical records to these CEs ahead of time, in spite of the fact that DDS is supposed to provide up to 50 pages of evidence to help the CE assess the claimant's impairments.  SSA/DDS isn't looking for a legitimate opinion. Instead, SSA/DDS are simply "buying" negative opinions from their vendor to justify a denial. 

After all, these evaluations are hardly objective. Many of these consultative examiners' only stream of revenue comes from providing government evaluations. Many of these CEs do not even have outside practices, so they are completely dependent on referrals from the government to pay their bills. People normally don't bite the hand that feeds them. Just as my dogs think I am the most amazing human being to walk the earth because I provide them with three delectable meals a day, many of the CEs are as devoted to SSA/DDS, as my dogs are me, because the CEs are completely reliant on SSA/DDS for their next meal. They are afraid to indicate that a claimant is disabled, as SSA/DDS may stop using them as a vendor.  

A CE, who recently examined my client, and whom we filed a complaint against after he saw her for less than 14 minutes, told my client..."It is all political......I have to issue an opinion and you will be denied. Just appeal it. You will win when you go in front of a Judge."  After my client mentioned how quick the evaluation was, the CE also said..."I think you are confused because I don't keep a clock in here. It was longer than you think," in spite of the fact that I now have my clients  time these evaluations due to the fact that majority of them are lasting under 15 minutes.  I refer to this CE's response now as the "Las Vegas" defense due to the fact that casinos do not put clocks on the floor, so people lose track of time and continue to gamble. 

Will things get better for claimants at the initial application in 2023? I am hopeful, but doubtful at the same time. Unless SSA is given a working budget that allows them to staff the Administration properly and SSA/DDS investigates and completely overhauls the CE system that they have in place, then I believe SSA will continue to deny more and more claims at the initial application level. It is the unfortunate reality of the current SSA system. 

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.


Tuesday, December 20, 2022

Social Security’s Website Undergoes A Makeover

 The Social Security Administration (“SSA”) released a new homepage this month at ssa.gov. It was designed to try to help people locate information about disability and retirement more easily. I have filed some applications and appeals this month and the changes appear to be only cosmetic in nature. There were not any major substantive changes that would make the website easier for people to navigate. I was hoping that the refreshed website would make it more streamlined for people to use, but I honestly do not think the changes do much to make it “user friendly.” Honestly, the biggest changes that I noticed were that there was less text per page and that there was less of the color red used in the design, so it doesn’t scream “American Flag” anymore.  

Given the fact that the field offices are being bled to death right now because they are not receiving enough of a budget to staff them appropriately, this “facelift” seems to be a waste of money. SSA is in desperate need of a larger budget to run their programs appropriately.  Using the limited funds that they have to make their website look “prettier,” rather than “more functional,” when their employees are drowning in backlog, seems like a misallocation of funds. I am not going to get a tummy tuck if I cannot afford to feed and clothe my family. SSA shouldn’t be beautifying a website, when its employees are at their wits end because they cannot handle the volume of cases they are being assigned.

I received a voicemail from a SSA caseworker yesterday. He had returned my call from last week and left me a pretty hostile message telling me that I should be calling the (800) number to get details on my client’s case because he does not have time to give me status updates.  Everyone knows calling the generic (800) number would be equivalent to trying to call Bigfoot. No one is going to answer, and if someone does, he is not going to be able to answer your questions because he is a mythical (or is he?) creature who has lived in the woods his whole life and doesn’t know anything about government benefits. You only call the (800) if it is truly your last resort and you have two hours to kill.

Grumpy Cat (aka the hostile SSA caseworker) called back today on his own initiative to apologize for the message that he had left me. He sounded like he was about to cry and on the verge of a breakdown, so I wasn’t going to hammer him for the disgruntled message he left. He told me how bad things were at SSA and he had left me the message at the end of a very frustrating day and immediately regretted his message. I felt REALLY bad for the guy and acknowledged that we are aware of how dire things are for the SSA caseworkers and then he helped me with my client’s claim.

Is this new website going to make things easier for claimants. No. Is this new website going to make life easier for the SSA employees who are handling far more cases than they should be per individual. No. So what is the point?  

If you ask me, it is all about keeping up appearances. Look at the shiny new blue (not red) website that masks a dying agency.

Got a question about SSDI or SSI that you need us to answer? Please check out our website at www.westcoastdisability.com . We try to provide you with helpful information on our website that will allow you to successfully navigate the Social Security Disability process. Also, feel free to email me your questions at megan@westcoastdisability.com or call me at (800) 459-3017 x 101.