Saturday, April 27, 2013

DDS Actually Listened

The Social Security Administration (the “SSA”) uses state disability agencies to process medical determinations for initial Social Security Disability (“SSD”) decisions. In some states, such as New York, the state agency is known as Disability Determination Services (“DDS”). After the SSA sends the claim to the DDS, it is assigned to a disability examiner or analyst who functions similarly to an insurance claims manager. 

The disability analyst is supposed to collect and interpret the medical and vocational evidence. However, many, if not most, analysts automatically demand that claimants be examined by DDS doctors, and then decide if the claimant is disabled based upon that exam, rather than what the treating doctors say. In fact, when the disability analyst denies an application, the decision specifically states that the decision was not based upon the opinion of the treating doctor. 

In response to DDS customary CE demands, I send a letter asking, among other things, if the DDS made any attempts to contact the treating doctors for medical information. Invariably, up to today that is, my letters have been ignored, and instead, the DDS simply resends the identical CE demand. 

I represent a 56 year old former heavy equipment repairman. The DDS sent its usual CE demand, and I replied with a letter asking if the DDS had asked either of the treating doctors for medical information. Unbeknownst to me, the DDS disability analyst sent a letter to the claimant’s family doctor that asked the doctor to explain the basis for the functional limitations he had provided for the claimant. The doctor provided the explanation a few weeks ago, and the claimant received SSD benefits today. 

You would think that the SSD process would usually work as it did in this case. In other words, the DDS gathers the available medical evidence to see if a treating doctor’s disability opinion is well supported. Unfortunately, the DDS usually ignores what the treating doctors say, and will deny the application if the claimant does not attend the DDS exam. The SSA then reverses the DDS decision because the opinion of a treating doctor is supposed to be given greater weight compared to a non-treating doctor. A huge waste of tax dollars.

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