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So, How Good Are the Decisions Written by Your Administrative Law Judge

In March, 2017, the Office of the Inspector General (OIG) for the Social Security Administration (SSA) issued a report which addressed the quality of decisions issues by administrative law judges (ALJs) following Social Security hearings.

As a preliminary point, the Appeals Council (AC) routinely monitors cases in which ALJs approve benefits in order to verify the quality of the written decision. Denials which are appealed to the AC are automatically reviewed as part of the appeal process following an appeal from an ALJ hearing denial.

SSA has been tracking “decisional quality” since 2014 which is defined as whether the Appeals Council agrees with ALJ benefit approval decisions. Prior to this report, ALJ decisions were approved 85% of the time, the previously set “agreed rate average.”

The current report details that 310 ALJs do not meet with agreed rate average. Worse yet, 27 ALJs had agree rates below 65%. Corrective action has been undertaken on only a handful of these ALJs

Even more disturbing is the fact that 10 Hearing Offices had decision agree rates below the established norm. No action is being taken concerning the particular offending Hearing Offices.

These are imperfect findings as denied claims must be appealed to the Appeals Council for review to be considered. For this reason, less than 25% of all ALJ decisions are eligible for consideration.

There is a separate review mechanism for dismissal denials. These are cases which are dismissed for technical reasons for which no hearing his held. The dismissal “agree rate” is only 72% , meaning that 28% of dismissals are expected to be done improperly. This is of little surprise as dismissals are routinely used by many ALJs as a means of adjudicating claims in an expedited and often unfair manner. Given the technical nature of the denials, a very high agree rate should be established. But, this would not allow SSA to resolve its backlog of approximately one million cases as quickly.

Due to the limited information provided by reviewing less than 25% of decisions, most of which are not claim denials, OIG has recommended that national agree rates for denials should be established and monitored. SSA has agreed with the recommendation.

This agreement is surprising, but this counsel remains dubious. Nearly 20 years ago, SSA announced its initial review program which included only favorable decisions. At a national conference, this counsel asked a high ranking SSA employee why denial decisions were not routinely reviewed. No answer was forthcoming. It can only be hoped that the culture at SSA has evolved to the point of acknowledging that many of its ALJs use improper “denial formulas” in writing their decisions which would not pass muster if reviewed by the AC.

At the present date, only 44% of hearings result in a granting of disability benefits. It is time the high 56% case denial rate attracts attention and requires review of claim denial decisions.

Posted in Social Security Administration, SSA |

 

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