Tuesday, May 02, 2006

The least empathetic cog in the Social Security Disability evaulation system

...(long drumroll)...would be the disability examiner at the state agency responsible for handling medical determinations for the social security administration. This agency, of course, is most commonly known as DDS, or disability determination services.

I don't say this lightly, but I believe it to be the case, which, if true, is unfortunate since disability examiners are essentially the "first responders" for social security disability and ssi disability claims. That is, they are the first to see a claimant's medical records and the first to begin to form an opinion as to a claimant's eligibility (or ineligibility) for benefits.

Now, to the heart of this post. What evidence might there be to suggest that disability examiners are as I've described? Answer: allowance and denial rates. Disability examiners deny as much as 70% of initial disability claims and up to 85% of first appeals. By steep contrast, claimants who are represented at hearings are approved 62% of the time by administrative law judges.

At this point, I should entertain two followup questions which are:

1. Could a lack of empathy have anything to do with the difference in approval rates between disability examiners and disability judges?

2. If so, why might disability examiners be less empathetic in their approach to deciding claims?

Regarding the first question, yes a lack of empathy may play a role in the decisional outcomes of social security disability and ssi claims. And for this reason. Medical evidence may be objective, but the interpretation of medical evidence is not. In fact, it is very often a subjective matter. If it were not, you would not see such a wide gulf between the approval rates of examiners and judges. Aren't they both looking at the same medical records. Of course they are. Then why the difference regarding decisional outcomes? In other words, why do judges approve more cases than examiners?

Well, there are a number of factors that may play into individual cases. In some instances, an examiner will simply have erred by improperly evaluating a claimant's records or by the misapplication of a rule. And in other cases, a final decision at the initial claim or recon/review appeal stage may have much to do with the influence of an examiner's unit supervisor, unit medical consultant, or a quality control unit. However, without a doubt, a deficient amount of empathy toward the medical conditions of claimants certainly plays a strong role in the process. And for confirmation of this, you need only consider the fact that the social security administration has been sued in the past for its failure to properly acknowledge the limiting effects of pain.

As to question 2 (why might disability examiners be less empathetic in their approach to deciding claims?), I should point out the fact that disability examiners tend to be younger individuals, very often in their early to mid-twenties. And, as younger individuals, most have never experienced the types of functional restrictions and limitations (and yes, pain) that claimants who are filing for disability benefits have experienced, or are currently experiencing. How can you have any insight into such matters when your personal experience is itself so limited?

However, any lack of empathy on the part of disability examiners toward the claimants whose cases they adjudicate is probably more an issue of employment. Whose employment? The examiners. The way the social security disability system currently operates, disability examiners are only theoretical adjudicators. That is, their decisions are subject to influence, revision and alteration by their case consultants (essentially, these are assistant unit supervisors), unit supervisors, unit medical consultants (doctors who work at DDS), and by individuals in quality control. All in all, disability examiners make decisions in theory only, because in actuality any decision they arrive at may be changed on a dime.

Granted, this may be a necessary part of the system, for to some extent this has the effect of ensuring that examiners will always cross their T's and dot their I's.

However, it also has another effect that is somewhat insidious. Disability examiners learn very early on that to keep their jobs and not have their unit supervisors constantly at their throats, they must learn to make decisions on cases that are in accordance with the personal preferences of the supervisors they work under. And it is for this reason that you can potentially take one disability claim and send it to five different DDS (disability determination services) units----and get back five different decisions. Different units have different supervisors with different ideas about case decisions.

Cut to the chase: Disability examiners have not enough empathy toward disability claimants because they find it more important to be in agreement with their unit supervisors, who, typically, lean more toward denials of claims versus approvals of claims. In other words, job security is the paramount concern. And, of course, it comes at the expense of claimants.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Winning Disability Benefits
Social Security Disability Process
How social security determines you are disabled
Social Security Disability SSI Indiana


Blogger Steve said...

Excellent article!

9:07 AM  

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