Sunday, November 25, 2007

The Problem with Social Security Disability and SSI

A press release written by Senatory Byron Dorgan of North Dakota asks why it is that hundreds of thousands of U.S. citizens, as well as 2800 citizens of North Dakota, are routinely and "systematically" denied for disability only to have their cases approved at a disability appeal years later, presumably at a disability hearing that consitutes the second appeal step in the social security disability and SSI disability system.

Here's the answer. Though supporters of the current federal disability system may argue that A. some disability appeals involve medical conditions that become substantially worse between the time that an initial claim denial is issued and a disability hearing held (This, of course, does happen) and B. some cases involve claimants who have "aged into an approval by the time a hearing is held (Different medical vocational rules apply at certain ages meaning that a claimant who is denied on an application at age 53 may possibly be approved at a hearing at age 55 due to the effect of different medical vocational rules that apply at age 55), for the most the great disparity between approval rates at the disability hearing level and approval rates prior to the disability hearing level are due, at least in part, to the following series of facts:

Disability examiners, the individuals who, in theory, render disability claim decisions at the application and reconsideration levels do not actually make the decisions themselves. That is to say, they do not have unilateral authority to stamp an approval or denial on a social security disability or SSI case (aside from a minority of single decision makers). In actuality, the decision is initially made by an examiner, agreed upon (or not) by a medical or psychological consultant who is attached to the examiner's unit, and then finally signed off on, or overruled by, the examiner's unit supervisor.

This, of course, is simply the long way to state that decisional authority for the outcome of a case rests not with the examiner, but with the examiner's supervisor. Why is this fact significant? Because, as I've said before on, unit supervisors at state processing agencies are extremely concerned with the statistics of the units they supervise. Specifically, the number of returns they receive from quality control units. Returns are viewed by supervisors, as Joseph Heller (author of Catch-22) might say, as "blackeyes". No supervisor wants blackeyes, particularly when upper management has the tendency of comparing one's unit's statistics against all the others. Returns also tend to be...drumroll please...cases that were approved, not cases that were denied.

Now you see the rub. But's lets review the facts.

1. Unit supervisors, not disability examiners, have the final say-so on claims (at least before they leave their units).

2. Unit supervisors hate to receive blackeyes, otherwise known as returns.

3. Returns tend to be cases that were approved, not cases that were denied.

It doesn't take Sherlock Holmes to figure out where this all leads, does it? Human nature being what it is, it simply means that as long as A) unit supervisors are reviewed according to the number of "returns" their units receive and B) returns tend to be "cases that were approved", then the following will always tend to be true, which is C) unit supervisors will always tend to discourage the disability examiners who work in their respective units from making too many approvals. Because "too many approvals" may potentially mean more returns, and returns, which are viewed as errors, do not make supervisors look good in the eyes of their superiors.

This is my analysis of the problem with each state disability processing agency and the reason for the huge discrepancies between approval rates as rendered by disability examiners and as rendered by administrative law judges, who, contrary to disability examiners, function independently and free of coercion.

Why do you never hear about this sort of this thing in the flurry of newspaper articles that, lately, seem to abound in the press? Because it would be impossible to really understand it if you had never worked at a state disability processing agency (in some states, this agency is known as disability determination services, and in others it is known as the bureau of disability determination or the disability determination bureau). This, of course, includes disability lawyers and disability representatives, and also the claims reps who take disability applications at social security field offices, but never actually work on the medical processing of a disability claim.

Return to the Social Security Disability SSI Benefits Blog

Other Posts:
SSDI benefits and working
Degenerative disc disease and disability
Social Security Attorneys for disability claims
How long does it take to get a disability hearing?