Monday, October 28, 2013

socialNsecurity Appendix F

The SSA has released the production numbers and claim approval rates for all of its ALJs, in response to a Freedom of Information Act request.
There is now online searchable database that allows you to search by a particular ALJ’s name and see the number of cases decided by that ALJ in a given year, and his approval rating. That means the percentage of claims he granted or denied.
It appears that overall nationwide that a small percentage of ALJs routinely grant 6 out of 10 cases. The majority reverses or grants benefits in 7.5 to 8.0 cases. Then there are quite a few who grant 9 out of 10 cases. Their approval rate is over 85 percent. And there are a few who reverse or grant 100% of the cases they dispose of. Many times they do not hold a hearing. They simply write a short form reversal and reverse the case “on- the-record”.  
What does this mean to the average American? It appears that, for many Social Security disability claimants, it all comes down to the luck of the draw. Getting the right ALJ makes the difference between winning and losing. This encourages attorney/representatives to shop around for the right ALJ. Some hearing offices are considered more favorable than others. The claimants’ representatives in Compton, California routinely refused to appear for scheduled hearing at the Downey ODAR because they said that they could not win a case in Downey. One even threatened to file a complaint with a national civil rights organization. This resulted in cases being postponed and rescheduled, and thereby resulted in lengthening the processing times for disability cases.
Also, if more than 90% of all claimants eventually are granted benefits, why does it take over 5 years or more? If the DDS and the ALJs are wrong over 90% of the time, why do we need a 5,000 person beaurocracy to delay or deny benefits to deserving claimants? Could their salaries and the costs they incur to keep such a system in place possibly cost the taxpayers less than the price of paying the claimants their legitimate benefits?
There are only two possible decisions the DDS and the ALJ can make. Those are to reverse or affirm the case? If they reverse, the claimant will receive benefits. If they affirm, the claimant will be denied benefits temporarily and will have to appeal the denial decision. According to the Law of Averages, a trained chimpanzee will be correct 50% of the time if he flips a coin. Then why are these very learned and specially trained members of the bar wrong so much of the time? There must be a reason.
One possible reason is that delaying or denying claims will save the Government money. In five years many of the claimants will die of a symptom related to their disability or some other cause. The Government will keep all their money unless there is a dependent relative who qualifies and who files for those benefits. Also, a very large percentage of illiterate or ignorant claimants will not appeal a denial decision. Some will be so discouraged with the process that they refuse to participate in the process for obtaining benefits.
Take for example the case of General Daniel “Chappie” James, U. S. Air Force. He retired after 35 years of service in the Air Force, and he died within two weeks of retiring. He never collected one retirement check. He never collected Old Age, Disability, or Retired Social Security Benefits. The Government kept all of that money. General James is not unique. There are many Americans similarly situated. So it pays to encourage people to delay retirement, and to work longer. Also, it may be cost effective to delay or deny disability benefits for as long as possible.
 Consider a simple example. Let us assume that all denied claimants will file an appeal.
1. 100 people apply for disability benefits.
2. If 40 percent are approved at the DDS level, then 40 of these individuals will be approved and 60 will be denied.
3. If the 60 who were denied file an appeal, and a request for reconsideration, then approximately 10 of these individuals will be approved.

* At this point, 50 of the 100 have been approved.

4. If the remaining 50 who were denied on their reconsideration appeal (60-10=50) decide to file an appeal for hearing before an ALJ, we can be sure that 25 or 35 more individuals will be approved if they appeared for the hearing.  The claimant might die, go to jail, be confined to a hospital, be confined to some other institution, leave the country, or move out of the service area.

We can be sure that 25 is the number of claimants who would be approved if they appeared before the ALJ without representation. 35 is the number of individuals who would be approved if they appeared with representation (according to a national statistic, claimants represented at hearings had a 62% percent or better likelihood of being approved for disability at a hearing if they had representation, which also translated to a fifty percent increased chance of being approved at a hearing if they had representation versus going to the hearing alone).
5. Add up the numbers and you get the following: of the original 100 applicants for disability, as many as 75 individuals were approved for disability.  If you assume that everyone who went to a hearing had representation, then as many as 85 out of the original 100 applicants were approved for disability.
Now, is this example true to life? Not really. Why? Because some claimants give up along the way and do not file their appeals, some continually file new claims instead of filing appeals, some miss filing deadlines, some fail to show for their hearings, and some decide to "go it alone" at a hearing versus getting representation.
This illustrates one fact: if you get denied for disability, you stand an excellent chance of eventually being approved if you simply do not give up, i.e. you file your appeals and go to your disability hearing prepared.)


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