In 2010, 62% of Social Security Disability claims at hearing offices were approved. That number is now about 36%. Simultaneously, Administrative Law Judges (“ALJ”s) are requesting excessive support before approving SSD claims. In short, the SSA decided or it was directed to reduce the number of claims being approved, and to justify their approvals, ALJs are required to insist of receiving superfluous medical evidence.
I represent a client who stopped working after 35 years as an accounts payable clerk when she was 60 years old due to physical and mental impairments. It should be obvious that anyone with that type of work history would continue working if able to do so. Surgical reports, EMG and MRI testing, treatment records, and opinions from the claimant’s internist, both treating and IME physical medicine and rehabilitation specialists, and psychiatrist, were all submitted to support the SSD application. Nonetheless, the ALJ insisted that the claimant provide additional treatment records before approving the SSD application.
It is unclear why cumulative medical evidence is required. It could be that the ALJ was hoping to find something in the records that could be singled out to deny the claim. It is possible that the ALJ feels pressured to provide overwhelming evidence to justify an approval to avoid her decisions from being reviewed by quality control. Regardless of the reason, what is clear is that the old status quo is gone.
Friday, February 10, 2017
Wednesday, February 1, 2017
National Adjudication Team
Among other things, HALLEX I-5-3-21 describes the purpose of, and procedures for, attorney advisors in the National Adjudication Team (“NAT”). These attorneys select cases for review to see if they can be decided favorably on-the-record without the need for a hearing. The goal was to reduce the backlog of cases the Social Security Administration is experiencing at the hearing level.
There is no downside to your disability claim being transferred to the NAT. Either a fully favorable decision will be issued, or the case will be sent back to your local hearing office. I received such an approval today for a former teacher’s assistant.
The real question is what is the advantage of the NAT over hiring other attorney advisors or administrative law judges (“ALJs”) for the local hearing offices. It would seem more efficient for a local office that is already somewhat familiar with the case to screen out cases for OTRs. Thus, it would seem to make more sense to hire more attorney advisors and ALJs for local hearing offices, unless the number of claims meeting NAT criteria are too small at most hearing offices.
There is no downside to your disability claim being transferred to the NAT. Either a fully favorable decision will be issued, or the case will be sent back to your local hearing office. I received such an approval today for a former teacher’s assistant.
The real question is what is the advantage of the NAT over hiring other attorney advisors or administrative law judges (“ALJs”) for the local hearing offices. It would seem more efficient for a local office that is already somewhat familiar with the case to screen out cases for OTRs. Thus, it would seem to make more sense to hire more attorney advisors and ALJs for local hearing offices, unless the number of claims meeting NAT criteria are too small at most hearing offices.
Wednesday, January 25, 2017
Treating Testimony
I have always believed that the best evidence that a claimant can present to an administrative law judge (“ALJ”) at a Social Security Disability (“SSD”) hearing is live testimony from a treating physician. An ALJ typically rejects a supportive opinion from a treating physician by claiming it is inconsistent with other evidence or lacks support. An ALJ is duty bound to develop the record. Therefore, at a hearing, the ALJ would have to ask a testifying treating physician to explain the basis for his or her opinion before the ALJ could reject it for lacking consistency or support.
ALJ’s frequently ask a Social Security medical expert (“ME”) to testify in order to create evidence to contradict the supporting opinions of treating physicians. It becomes extremely difficult for an ME to do that when the treating physician is present to rebut the ME.
I represent a former cable installer whose SSD benefits were approved today. The ALJ gave equal weight to the opinions of the ME and the treating physicians, which he rarely, if ever does. I had advised the ALJ that the claimant’s treating physician would be waiting by the telephone to testify at the hearing, but it was unnecessary because the ME testified favorably to the claimant. I doubt that the ME would have testified favorably, or that the ALJ would have provided the opinions of the ME and treating physician equal weight, had the latter not been standing by to testify.
ALJ’s frequently ask a Social Security medical expert (“ME”) to testify in order to create evidence to contradict the supporting opinions of treating physicians. It becomes extremely difficult for an ME to do that when the treating physician is present to rebut the ME.
I represent a former cable installer whose SSD benefits were approved today. The ALJ gave equal weight to the opinions of the ME and the treating physicians, which he rarely, if ever does. I had advised the ALJ that the claimant’s treating physician would be waiting by the telephone to testify at the hearing, but it was unnecessary because the ME testified favorably to the claimant. I doubt that the ME would have testified favorably, or that the ALJ would have provided the opinions of the ME and treating physician equal weight, had the latter not been standing by to testify.
Tuesday, January 17, 2017
SSD Bench Decisions
Virtually every client appearing for a hearing on a Social Security Disability (“SSD”) claim asks when they can expect to receive a decision, or will the administrative law judge (“ALJ”) say what the decision is at the hearing.
It is a rare case when an ALJ tells a claimant at a hearing, that is, from the “bench,” that SSD benefits are being approved. When that happens, the ALJ frequently issues a bench decision for the fully favorable decision. The written decision that follows in a few days is shorter than a typical fully favorable written decision.
I find it surprising that more bench decisions are not issued. ALJs consistently state that they are under significant pressure to issue more decisions. Producing a bench decision takes less time and effort than a traditional written decision. I represent a former automotive repairer with a bad back and knees who received a bench decision today. I suspect that ALJs usually do not issue bench decisions because they may want to avoid having to explain at a hearing why they are unwilling to issue a bench decision to other claimants.
It is a rare case when an ALJ tells a claimant at a hearing, that is, from the “bench,” that SSD benefits are being approved. When that happens, the ALJ frequently issues a bench decision for the fully favorable decision. The written decision that follows in a few days is shorter than a typical fully favorable written decision.
I find it surprising that more bench decisions are not issued. ALJs consistently state that they are under significant pressure to issue more decisions. Producing a bench decision takes less time and effort than a traditional written decision. I represent a former automotive repairer with a bad back and knees who received a bench decision today. I suspect that ALJs usually do not issue bench decisions because they may want to avoid having to explain at a hearing why they are unwilling to issue a bench decision to other claimants.
Pontine Stroke
According to reference.com, a pontine stroke is one that occurs in the pons, which is a portion of the brain stem. The pons, which is located between the midbrain and medulla, relays messages between the cerebral hemispheres and cerebellum. Common symptoms include double vision, dizziness, vertigo, slurred speech and imbalance.
Being disabled from a condition that is somewhat atypical may have helped one of my client’s get approved for Social Security Disability (“SSD”) benefits. The State agency usually requires claimants to attend a consultative examination (“CE”) that its contracted doctor performs. CE opinions are almost always less supportive than treating doctor opinions.
I represent a claimant who suffered from a pontine stroke. The State agency wanted to send the claimant for a CE to Industrial Medicine Associates (“IMA”), which I objected to for several reasons. On this occasion, the State agency agreed with my request that the claimant’s treating doctor perform the CE.
The treating doctor’s CE report stated that the claimant suffered from slurred speech, imbalance, spasticity and right sided weakness, including abnormal gross and fine manipulation. The CE report also provided a less than sedentary work ability. The State agency approved SSD benefits after receiving the report.
Treating doctors frequently supply opinions that claimants possess less than sedentary work abilities to the State agency, but those opinions are usually rejected in favor of the IMA opinion, or are simply rejected on the grounds that determination of disability is for the State agency to make. It may be possible that because the claimant’s problem was somewhat unusual, IMA lacked a proper doctor to do the CE, and therefore, the State agency agreed to allow the treating doctor to do the CE.
Being disabled from a condition that is somewhat atypical may have helped one of my client’s get approved for Social Security Disability (“SSD”) benefits. The State agency usually requires claimants to attend a consultative examination (“CE”) that its contracted doctor performs. CE opinions are almost always less supportive than treating doctor opinions.
I represent a claimant who suffered from a pontine stroke. The State agency wanted to send the claimant for a CE to Industrial Medicine Associates (“IMA”), which I objected to for several reasons. On this occasion, the State agency agreed with my request that the claimant’s treating doctor perform the CE.
The treating doctor’s CE report stated that the claimant suffered from slurred speech, imbalance, spasticity and right sided weakness, including abnormal gross and fine manipulation. The CE report also provided a less than sedentary work ability. The State agency approved SSD benefits after receiving the report.
Treating doctors frequently supply opinions that claimants possess less than sedentary work abilities to the State agency, but those opinions are usually rejected in favor of the IMA opinion, or are simply rejected on the grounds that determination of disability is for the State agency to make. It may be possible that because the claimant’s problem was somewhat unusual, IMA lacked a proper doctor to do the CE, and therefore, the State agency agreed to allow the treating doctor to do the CE.
Wednesday, December 21, 2016
What is an Administrative Record?
According to the Supreme Court, the administrative record includes all materials compiled by the agency, which were before the agency at the time the decision was made. That definition is well settled. Nonetheless, even though they know that they are not agencies, disability insurance companies constantly argue that the claim file they compile is an administrative record in ERISA benefit actions.
Disability insurers assert that their claim files are administrative records in order to evade discovery. For decades, disability insurers have filed motions “on the administrative record.” Courts regularly hold that no such thing exists, and treat the motions as motions for summary judgment. Insurers misname their motions because summary judgment specifically anticipates that the motion will follow the completion of discovery.
Similarly, disability insurers assert that their claim files are administrative records in order to evade their initial disclosure obligations under Rule 26(1)(1). Unum made that argument in one of my pending cases, but Judge Abrams rejected it today.
Judge Abrams explained that unlike a federal agency, which is statutorily bound to be neutral, insurance companies like Unum are not. As another Court reasoned:
“In an agency proceeding, the court reviews the decision of a board or other agency tribunal that has been authorized by Congress to make such decisions after appropriate administrative proceedings. None of the neutrality or hearing-type protections in those cases is present here.”
Disability insurers assert that their claim files are administrative records in order to evade discovery. For decades, disability insurers have filed motions “on the administrative record.” Courts regularly hold that no such thing exists, and treat the motions as motions for summary judgment. Insurers misname their motions because summary judgment specifically anticipates that the motion will follow the completion of discovery.
Similarly, disability insurers assert that their claim files are administrative records in order to evade their initial disclosure obligations under Rule 26(1)(1). Unum made that argument in one of my pending cases, but Judge Abrams rejected it today.
Judge Abrams explained that unlike a federal agency, which is statutorily bound to be neutral, insurance companies like Unum are not. As another Court reasoned:
“In an agency proceeding, the court reviews the decision of a board or other agency tribunal that has been authorized by Congress to make such decisions after appropriate administrative proceedings. None of the neutrality or hearing-type protections in those cases is present here.”
Wednesday, December 14, 2016
Pain Medicine
According to the American Board of Pain Medicine, pain medicine is concerned with the prevention of pain, and the evaluation, treatment, and rehabilitation of persons in pain. The POMS says there is no specialty board for pain or certification program. The POMS is wrong because the following specialty boards have certifications for Pain Medicine: Anesthesiology, Emergency Medicine, Family Medicine, Physical Medicine and Rehabilitation, Neurology, and Radiology.
I represent a 45 year old former nurse assistant whose application for Social Security Disability (“SSD”) benefits was approved today by an administrative law judge (“ALJ”) on-the-record (“OTR”) without a hearing. The claimant has neck and back problems that cause neck, back, leg, and hand pain, which have persisted despite treatment with the claimant’s board certified physiatrist who is certified in Pain Medicine.
When making its initial SSD decision, the State agency, is supposed to follow the POMS. Perhaps if the POMS correctly recognized that numerous medical specialty boards, including physiatry, maintain certification programs for Pain Medicine, then the State agency would have approved the claimant’s SSD application. Considering that most claimants are disabled by pain, extra weight should be given to pain specialists, regardless of whether there is an independent medical board that is part of the American Board of Medical Specialities.
I represent a 45 year old former nurse assistant whose application for Social Security Disability (“SSD”) benefits was approved today by an administrative law judge (“ALJ”) on-the-record (“OTR”) without a hearing. The claimant has neck and back problems that cause neck, back, leg, and hand pain, which have persisted despite treatment with the claimant’s board certified physiatrist who is certified in Pain Medicine.
When making its initial SSD decision, the State agency, is supposed to follow the POMS. Perhaps if the POMS correctly recognized that numerous medical specialty boards, including physiatry, maintain certification programs for Pain Medicine, then the State agency would have approved the claimant’s SSD application. Considering that most claimants are disabled by pain, extra weight should be given to pain specialists, regardless of whether there is an independent medical board that is part of the American Board of Medical Specialities.
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