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.
No comments:
Post a Comment