Posts Tagged With: Disability

Red Flag Judges At Social Security Says Rep. Jackie Speier

 

When California Rep. Jackie Speier is not chasing military officers looking for sexual sadists, she is following Social Security Judges trying to “red flag” them. She proposes a system to review cases from “red flag” judges. Judges who have high approval rates send up ‘red flags’. Speier has had enough. The Democrat from San Mateo who has been on the front lines fighting to expose and correct the epidemic of sexual assault and harassment in the military has turned her attention to her own colleagues. Representative Speier introduced a bill that would require all House members and staff to take sexual harassment training every two years.

 Rep. Jackie Speier, California Democrat, one of the heads the House Oversight and Government Reform subcommittee on health care, say Social Security employees should be allowed to look at the social media profiles (such as, Facebook, Twitter, etc) of those applying for disability, reasoning that photos and other information people post can expose the applicants as able-bodied.

She also said that two Social Security judges may have approved thousands of bogus disability claims, but the agency has never gone back to review those judges’ cases to stop the ones that were fraudulent.

Speier said the agency should come up with a system to review cases from “red-flag” judges who show inclinations toward rubber-stamping applications.

In an exhaustive 11-page memo to Social Security acting Commissioner Carolyn W. Colvin, she  detailed nearly a dozen recommendations for improving a disability system that has received an explosion of applications in recent years and is in danger of going bankrupt by 2016.

It was indefensible that the Social Security Administration (SSA) hasn’t reviewed applications approved by two administrative law judges, David B. Daugherty in West Virginia and Charles Bridges in Pennsylvania, who have been accused of making bogus disability determinations.

Kia Anderson, a spokeswoman for Social Security, said the SSA takes fraud seriously and will review the lawmakers’ recommendations.

“We recognize that one case of fraud is too many and work aggressively to detect and prevent abuses. We continue to enhance our program integrity efforts by adding tools like data analytics which enables us to identify patterns of suspicious behavior in disability applications,” she said.

She made a pitch for Congress to grant more funding so the SSA can put more effort into preventing fraud.

The oversight committee has been looking into the disability issue for some time and took testimony from Judge Jasper J. Bede, an SSA Regional Chief Administrative Law Judge who told investigators that some judges appeared to be rubber-stamping applications. (Read more at http://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757)

Judge Bede singled out Judge Bridges, who decided more than 2,000 cases a year and who often went beyond looking at an applicant’s disability and considered income or other factors.

Judge Daugherty, meanwhile, approved 99.7 percent of his cases from 2005 through 2011, awarding disability benefits to 8,413 people — the equivalent of $2.5 billion in total lifetime benefits.

Major cases of disability fraud have been reported in West Virginia, Puerto Rico and, most recently, New York City, where investigators said police officers falsely claimed disability from the Sept. 11, 2001, terrorist attacks.

Some of those New York cases were exposed in part because investigators found online photos of the officers engaged in flying helicopters, going on deep-sea sport-fishing trips and riding personal watercraft.

That is one reason lawmakers want Social Security employees to scour social media before approving applications, and again when they go back for periodic checks, known as continuing disability reviews (CDR).

“To increase efficiency and reduce the number of erroneous disability determinations, SSA personnel should be allowed to review each applicant’s social media accounts prior to the decision to award benefits. Additionally, we suggest that SSA require that all CDRs incorporate a review of the beneficiary’s social media accounts,”  Ms. Speier said.

 

Social Security has repeatedly refused to let its investigators use social media, arguing that its judges aren’t trained to evaluate the information.

“Adjudicators should do what they are trained to do: Review voluminous files to determine eligibility for disability benefits. Office of Inspector General fraud investigators should do what they are trained to do: vigorously follow up on any evidence of fraud,” said Ms. Anderson.

From 2010 through 2012, Americans filed 8.6 million disability claims, but judges and Social Security’s disability review office reported only 411 suspicions of fraud. That works out to fewer than one out of every 20,000 applications.

Part of the problem is that Social Security is lax in reviewing cases of those deemed temporarily disabled to see whether they have recovered.

But a review of cases from 1980 through 1983 found 40 percent of those receiving disability benefits were not disabled, suggesting a tremendous level of bad payments.

Disability judges who have high approval rates send up red flags because by the time a case gets to an administrative law judge, it has already been denied by at least one previous review at the State DDS, and often by a second DDS review, the two lawmakers said. That would suggest the approval rate for those cases should be low.

Social Security is made up of two trust funds. The main one is the Old Age and Survivors Insurance Trust Fund, with the Disability Insurance Trust Fund accounting for a smaller but growing part of the agency’s work.

 

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Judges Stripped Of Judicial Independnce At SSA

SSA increases oversight of judges in disability determinations

The Social Security Administration (SSA) recently announced plans to increase its oversight of judges (ALJs) in the disability determination process.
February 25, 2014 /24-7PressRelease/ — In an effort to improve consistency in the disability determination process (SSDI), the Social Security Administration (SSA) recently announced plans to step up its oversight of the administrative law judges (ALJ) who are responsible for awarding or denying disability benefits. The Social Security Disability Insurance program provides financial benefits to people who are unable to work because of a mental or physical disability. 
The program has increased substantially in the years since the U.S. economy took a downturn in 2008, and there are now approximately 11 million people receiving disability benefits nationwide. New job descriptions for judges To expand its oversight of the eligibility determination process, the SSA is rewriting the job descriptions of approximately 1,500 judges, who in the past have been given broad discretion over the outcome of eligibility hearings. In recent years, these eligibility hearings have yielded notoriously unpredictable results.
According to a 2011 report by the Wall Street Journal, an applicant’s likelihood of being awarded disability benefits can vary dramatically depending on the judge; while a handful of judges award benefits in nine cases out of ten, others deny benefits nearly as often.  
The new job descriptions will include language stating that the judges are subject to supervision and will remove the words “complete individual independence,” the WSJ reported. It is hoped that the changes will increase accountability among the judges and allow the SSA to take corrective measures when judges award or deny benefits inappropriately.
 Disability benefit determination 
Before becoming eligible to receive SSDI benefits, an applicant must first establish that he or she meets the SSA’s requirements for being considered “disabled.” To do so, the applicant must demonstrate that each of the following is true: – The individual cannot work because of a medical condition. – The condition has lasted or is expected to last for a year or more, or is expected to result in death.
 While the process of applying for SSDI benefits may seem relatively straightforward, in practice it can be cumbersome, time consuming and often frustrating. Not only is it necessary to submit medical records and other evidence of disability, but in most cases applicants are also required to attend an eligibility hearing before an administrative law judge.
Benefits often available after initial denial
Overall, first-time disability applicants are denied benefits as much as, according to some estimates, but a majority of denied applicants who pursue an appeal are eventually awarded benefits.
 In many cases, working with an experienced Social Security Disability lawyer can significantly improve an applicant’s chances of being awarded benefits, whether it is a first-time application or an appeal.
(Article provided by The Berkley Law Firm Visit us at www.berkleylaw.net — Press release service.)
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SSA Judges In NYC Found Guilty Of Bias. 4,000 Disability Claimants Offered New Hearings

New hearings for SS claimants who received unfavorable decisions by ALJs.

A court has approved a settlement agreement in a class action lawsuit involving Social Security Disability claimants in the State of New York. The agreement will provide claimants with new hearings.

January 24, 2014 – A settlement agreement has been reached and approved by the court in a class action lawsuit involving Social Security Disability claimants in the State of New York. Among the different types of relief stipulated in the agreement, claimants are to receive fresh hearings in front of new Administrative Law Judges, or ALJs.

(The specifics of the lawsuit)

 In 2011, various Social Security Disability applicants who sought disability benefits received unfavorable or partially favorable judgements by one of five ALJs from the Queens, New York Office of Disability Adjudication and Review (SSA/ODAR).

The claimants argued that the rulings were biased.

 In April 2011, they filed a lawsuit against the Social Security Administration. The case was later filed as a class action and expanded to include approximately 4,000 total Social Security Disability claimants.

 Attorneys for both sides worked toward a resolution throughout the various months thereafter. (Settlement approved)

A settlement agreement was officially approved by the United States District Court for the Eastern District of New York. The approval came after written comments provided to the court as well as information obtained from the settlement hearings, among other evidence, were reviewed.

The Settlement Agreement includes individual, retrospective and prospective relief for claimants, new training and mentoring for ALJs, and a new Social Security Ruling, or SSR.

(New hearings for class members)

 In more specific terms, the Settlement Agreement stipulates that all eligible claimants, those who received unfavorable or partially favorable decisions from one of the named ALJ, defendant judges during the period stipulated in the complaint, will receive new hearings. The Social Security Administration indicates plans to send out notices to each claimant by the end of next month. Eligible claimants are provided 60 days to request a new hearing once their notices are received.

(Other settlement stipulations)

 The Settlement also stipulates that an automatic review will be conducted by the SSA’s Appeals Council (A/C)for any new claimants who receive unfavorable decisions (those that commenced October 2013 and for 30 months thereafter) by any one of the five ALJs named in the recent lawsuit. If the A/C determines any unfavorable decisions are legally insufficient, the claimant will automatically receive a fresh hearing in front of a new ALJ.

Under the agreement, the SSA will also provide additional training and mentorship to all ALJs to help them improve the ways they handle and conduct Social Security Disability hearings in the future. Additionally, the settlement stipulates a new Social Security Ruling that details new procedures on how to address allegations of “unfair ALJ hearings, ALJ bias, and ALJ misconduct.”

( Article provided by The Klein Law Group, P.C., at www.thekleinlawgroup.com)

NYC Social Security Disability Attorneys.

The Klein Law Group, P.C., fights for the rights of those who have been hurt at work or are unable to qualify for disability pay.

Practicing solely in New York state, with lawyers are highly knowledgeable in the area of New York workers’ compensation law, as well as the complex workings of the federal Social Security Administration.

The Klein Law Group, P.C., can confidently take your case at any stage, from initial application through final appeal before the Workers’ Compensation Board. In the rare event that you do not receive benefits, you pay no attorney’s fees.

The Klein Law Group, P.C., offers free consultations to discuss your rights and review your case. Contact us to arrange a consultation with one of our experienced New York workers’ comp attorneys.

Our international staff speaks Polish, Spanish, Chinese (Mandarin and Cantonese) and Russian.

 

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Social Security Judges Are “Paying-Down” The Back Log.

Seal of the United States Social Security Admi...

Seal of the United States Social Security Administration. It appears on Social Security cards. (Photo credit: Wikipedia)

The below Atlanta Journal-Constitution article of 13 Sept 2012 reminds one of the police chief’s statement in the movie ‘Casablanca’. “Frankly, Rick, I am surprised to find there is gambling in this club. Are those my winnings?”

Report: Social Security lax on disability claims

WASHINGTON —Social Security is so overwhelmed by disability claims that some officials are awarding benefits without adequately reviewing applications, potentially adding to the program’s financial problems as it edges closer to the brink of insolvency, congressional investigators say in a new report.

In more than a quarter of the 300 cases reviewed by congressional staff, decisions to award benefits “failed to properly address insufficient, contradictory or incomplete evidence.” In many cases, officials approved disability benefits without citing adequate medical evidence or without explaining the medical basis for the decision, according to the report by the Republican staff of the Senate Permanent Subcommittee on Investigations.

In some cases, it appeared that administrative law judges (ALJ) struggling to reduce backlogs didn’t take the time to review all the evidence, the report said. The judges are expected to rule on at least 500 cases a year, with one judge deciding an average of 1,800 cases a year for three straight years, the report said.

“The administrative law judges are not looking at the cases because the pressure from Social Security is to get the cases out,” said Sen. Tom Coburn of Oklahoma, the top Republican on the subcommittee. “I think you could flip a coin for anybody that came before the Social Security commission for disability and get it right just as often as the (judges) do.”

Social Security has been working for years to reduce a huge backlog of disability claims.

“We share the subcommittee’s concern that a small number of judges have failed our expectations with regard to a balanced application of the law, proper documentation, proper hearings and proper judicial conduct,” said Social Security spokesman Mark Hinkle. “We have undertaken a vigorous set of quality initiatives since the time most of these cases were filed about five years ago and data indicates that we have made substantial progress.”

Hinkle added, “We recognize the need for further improvement and are working hard toward that goal.”

At a subcommittee hearing Thursday, Chief Administrative Law Judge Debra Bice said the Social Security Administration has raised hiring standards for judges in the past several years. She said the agency doesn’t hesitate to hold judges accountable, where the law permits. But, Bice said, the law limits the agency’s authority over judges to ensure that they are impartial in deciding cases.

Disability claims typically increase in a bad economy because many people who worked despite their disabilities get laid off and apply for benefits. The recent recession was no exception, with a flood of applications straining the disability program’s already troubled finances.

Without congressional action, Social Security’s disability trust fund will run out of money in 2016, leaving the program unable to pay full benefits, according to the trustees who oversee the program. The trustees have urged Congress to shore up the disability system by reallocating money from the retirement program, just as lawmakers did in 1994. That fix, however, would further weaken the retirement system, which has its own long-term financial problems.

About 11 million people receive disability benefits from Social Security, an increase of more than 23 percent over the past five years. Benefits average a little less than $1,000 a month.

About 8.2 million people receive Supplemental Security Income, a disability program for poor people who don’t have substantial work histories. SSI benefits average a little more than $500 a month.

Coburn said he called for the investigation after he learned that a man he had hired to cut down trees in the yard of his home was also collecting Social Security disability. Coburn said he wanted to learn how widespread cheating was in the system, though the report doesn’t determine whether undeserving people are getting benefits. Instead, the report is limited to whether officials followed proper procedures.

The subcommittee’s staff asked the Social Security Administration to randomly select 100 cases apiece from counties in three states — Virginia, Alabama and Oklahoma. The cases were limited to those in which benefits were awarded.

The investigation was done by both Republican and Democratic staff members. However, subcommittee Chairman Sen. Carl Levin, D-Mich., did not sign off on the final report because he disagreed with some of its recommendations.

The report acknowledged that the findings may not be representative of the entire country. However, it said, “The same types of issues affected decisions across all three counties, suggesting they may be a factor elsewhere in the nation.”

(By STEPHEN OHLEMACHER, AP)

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How Five Steps Became Four In The Disability Determination Process.

English: Baton Rouge, LA, 9/3/05 -- Victims of...

English: Baton Rouge, LA, 9/3/05 — Victims of Hurricane Katrina wait outside the Social Security Administration building in hopes of getting assistance. New Orleans is being evacuated because of flooding caused by hurricane Katrina. Photo by: Liz Roll (Photo credit: Wikipedia)

Social Security Administration has finalized the expedited sequential evaluation process, making Step 4 optional for the ALJ.

The Social Security Administration has finalized its rules to expedite the five-step process for evaluating a disability claim by giving adjudicators the discretion to skip step 4 and proceed directly to the fifth step when the Administration has insufficient information about a claimant’s prior work history to make the findings required at step 4. However, if an adjudicator finds at step 5 that a claimant may not be able to adjust to other work existing in the national economy, the adjudicator will then return to step 4 to develop the work history and make a finding about whether the claimant can perform his or her past relevant work. According to the Administration, the purpose of these changes is to promote administrative efficiency since the time the Administration spends in obtaining the work history needed to make step 4 findings frequently delays the processing of claims and requires the Administration to divert its limited administrative resources from processing other claims.

Background

At step 4 of the sequential evaluation process, the Administration determines whether a claimant can perform his or her past relevant work given his or her residual functional capacity (RFC). The Administration will look at the past fifteen years of a claimant’s work history for relevant information. To make a proper evaluation, the Administration needs information about each of the claimant’s jobs during that period, including information about job duties, tools or machinery used, the amount of physical exertion required in terms of the amount of walking, standing, lifting, and carrying during the workday, the length of time that a claimant worked each job, and the physical and mental demands of the job. With this information the Administration compares the claimant’s RFC to the physical and mental demands of these past relevant jobs to determine if the claimant can still perform any of them. If so, the claimant is found to be not disabled. However, if the claimant is currently unable to perform any past relevant work, the adjudicator will proceed to step 5.

At step 5 the adjudicator determines whether a claimant’s impairments prevents him or her from doing any other work that exists in significant numbers in the national economy, considering his or her RFC and vocational factors such as age, education, and work experience. If the Administration finds that the claimant can adjust to other work, the claimant is found to be not disabled.

Why are changes being made?

Because it can be time-consuming to gather all of the necessary information regarding the claimant’s work history during the fifteen-year period that precedes the alleged disability onset date, disability determinations are often delayed. By going directly to step 5, a determination can be expedited if it is determined that a claimant is not disabled under the criteria for step 5. At step 5 the adjudicator would consider if the claimant is disabled based on (1) The special medical-vocational profiles set forth at Reg. §404.1562; (2) the Medical-Vocational Guidelines (Appendix 2 to 20 CFR, Part 404, Subpart P), whether directly or as a framework, or (3) an inability to meet the mental demands of unskilled work. If application of the step 5 rules indicates that a claimant may be disabled or if the adjudicator has any doubt whether the claimant can perform other work existing in significant numbers in the economy, the adjudicator must return to step 4 since the Social Security Act requires the Administration to make a finding about a claimant’s ability to do past relevant work before a determination is made that a claimant is disabled at step 5. The expedited process is reflected primarily in Regs. §404.1520 and §416.920.

The Administration believes that this approach to evaluation could shorten some process times in some cases because there would be no need to collect unnecessary work history at step 4 for claims that can be appropriately denied at step 5 based solely on the claimant’s age, education, and RFC. This process has already been used for the past 12 years in ten “prototype” states. (These states are Alabama, Alaska, California (Los Angeles North and Los Angles West Branches), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York, and Pennsylvania.) This expedited process will be used in all disability evaluations except for childhood disability claims under Title XVI, since those claims do not use vocational criteria.

Comments result in some minor changes

The regulations, as proposed on September 11, 2011, are adopted with a few minor changes.

The Administration agreed with a comment that adjudicators who do not make findings at step 4 of the sequential evaluation process using the expedited process must consider the potential application of the “special medical-vocational profiles” before proceeding to step 5. Those profiles are sent forth at Reg. §404.1562, SSR 82-63, and POMS DI §25010.001. If a claimant fits one of these profiles, a finding of disability will be made. The profiles include (a) persons not working at substantial gainful activity level who have worked for 35 years or more in arduous physical labor, can no longer perform this work due to an impediment, and have no more than a marginal education; (b) individuals 55 or older who have a severe impairment, no past relevant work, and have no more than a limited education; and (c) persons who are not working at SGA level, and have a lifetime commitment (30 years or more) to a field of work that is unskilled, or is skilled or semi-skilled but with no transferable skills, can no longer perform this past work because of a severe impairment(s), are closely approaching retirement age (age 60 or older), and have no more than a limited education. Accordingly, references to Reg. §404.1562 will be included in some of the regulations being amended, and a similar reminder will be inserted into an electronic tool used at the initial stages of the administrative review process.

The full text of the Administration’s announcement was published in the July 25, 2012, issue of the Federal Register (77 Fed. Reg. 43492).

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Getting Social Security Benefits Involves The Luck of The Draw.

Social Security Disability Insurance (SSDI) case outcomes depend heavily on the luck of the draw. That means which examiner handles your case, determines whether you are approved at the initial determination level.

Nicole Maestas, an analyst at RAND Corp., Santa Monica, Calif., made that argument March 20, 2012 at a hearing on SSDI program claim decisions organized by the House Ways and Means Social Security subcommittee.

The subcommittee has been holding a series of hearings on the SSDI program, which has been plagued by large caseloads, slow case determination times, a high reversal rate at the claim appeal level, and reports of employee burnout.

Private individual and group disability insurance insurers care about the fate of SSDI because many private disability insurers coordinate the benefits they pay with SSDI benefits.

RAND has found that 59% of SSDI applications now come from applicants complaining of musculoskeletal disorders or mental impairments, Maestas said, according to a written version of her remarks posted by the committee.

Even after adjusting for a variety of case characteristics, such as the applicant’s age and type of health problem reported, the standard deviation for examiner case allowance rates is about 6 percentage points, Maestas said.

That means that, for 15% of the examiners, claim approval rates are 6 percentage points higher than for the average examiner.

About 5% of the examiners have approval rates that are more than 12 percentage points higher than for the average examiner.

At the initial determination level, the percentage of applicants who might have received a different result if they had started with a different examiner could be as high as 60%, Maestas said.

Because the Social Security Administration (SSA) gets and responds positively to so many SSDI appeals, the appeals process reduces the power of the “first examiner” effect, but, even after adjusting for the effects of the appeals process, it looks as if 23% of the applicants might have ended up with a different outcome if they had started with a different examiner, Maestas said.

Applicants’ need to go through appeals to reduce the initial-examiner effect is a problem because getting through the appeals process can take as long as two years, Maestas said.

Moreover, about 63% of the applicants with musculoskeletal problems win appeals for benefits, compared with 39% of the beneficiaries with mental impairments. That means beneficiaries with musculoskeletal impairments have to spend more time pursuing benefits than applicants with mental impairments do, Maestas said.

Liza Ekman, a senior policy advisor at Health & Disability Advocates, Chicago, urged Congress to increase the resources SSA has to run the SSDI program and for the SSA to try to improve the claim determination process by providing more training and guidance for the adjudicators who handle the claims.

SSA also should pay the providers who evaluate applicants more, give claimants more help with filing claims, and do more to keep applicants who are very obviously disabled from having to go through the full application process, Ekman said.

SSA has one national definition of disability, but Congress requires it to use state-based disability determination services to make the determinations.

The state services are trying to increase uniformity by sharing information about decisions on an intranet, and SSA has an Office of Quality Performance that conducts quality assurance reviews of many samples of work.

 

 

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Social Security Administration Keeps Claimants In The Dark.

(Social Security Commissioner Michael Astrue)

Social Security Administration Keeps Claimants In The Dark.

Today’s unprecedented economic crisis is bringing into sharp focus Social Security’s role as the backbone of the country’s retirement security, as well as the irresponsibility of former President George W. Bush’s policies in regard to this critical program.

Part of the Bush legacy that Astrue has continued are personnel and labor relations policies that hobble agency staff and undermine SSA’s ability to fulfill its duty to the American public. For example, Commissioner Astrue has implemented a policy prohibiting SSA employees from advising SSA claimants regarding their benefit election options. Because benefit election options, such as month of election, impact the eventual amount of benefits received, this prohibition deprives SSA claimants of advice and information that is important to their claims.

 Commissioner Astrue has also disadvantaged unrepresented claimants in disability hearings by not providing sufficient staff to explain new electronic processes to them, such as their electronic disability file, and has contributed to the disability backlog by prematurely implementing electronic processes, such as the “iclaims” program, before they have been fully developed. 

Commissioner Astrue created national hearing centers, apart from hearing offices, in circumvention of SSA’s obligations to the AALJ/IFPTE. This has resulted in one of the highest and costliest supervisory/managerial ratios in SSA. In establishing national hearing centers, where only video hearings can be conducted, Commissioner Astrue has deprived claimants of due process  by unduly encouraging them to waive in-person hearings in favor of video hearings. Commissioner Astrue has also contributed to the backlog of  disability cases by creating a work environment for SSA employees that is hostile to efficiency and effectiveness.  

 Commissioner Astrue has demonstrated a callous disregard for the Social Security Act by encouraging undue haste in making judicial decisions in disability cases and discouraging quality, thereby adversely affecting the American taxpayer because each disability case is valued at $250,000. Moreover, he has eliminated proof of age and proof of citizenship, which will likely result in an increase of fraud and beneficiary overpayments. In addition, he has reduced the processing of integrity workloads, such as redeterminations and Continuing Disability Reviews. This has resulted in billions of dollars of overpayments.

 At the core of Bush’s approach was the appointment of high-level agency officials committed to his anti-Social Security strategy.

 (AFL-CIO statement March 03, 2009)

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