Post by hilltopper on Sept 8, 2014 22:04:35 GMT -5
Well it has been a few days since any of us newbies has logged in with an update, so I thought I would take a shot at second week impressions from a NODAR. [In deference to that kinder, gentler kitty cat, TigerLaw I too like the moniker - NODAR]
Anyone who has worked with computers for the past 10+ years will be able to learn the case management systems. They are intuitive. Many of the VOD's and national conference calls with concurrent video demos, go over the things we have been shown by our mentor judges. So, insiders like Funky are probably bored. But then so are those of us NODARS who have been let loose on the keyboard with a good mentor looking over our shoulder guiding us through the screens.
Much of what we have learned during the first 2 weeks of our onsite orientation is that understanding the process, and the fact that "you are the Commissioner's designee" for implementing agency policy are probably two of the most eye-opening aspects for those of us NODARS coming from private practice.
The mentor judges, the HOCALJ, and all the other judges [from those who have been at this for anywhere from 20 years to just 10 months] are eager to help point you in the right direction and provide guidance on how to establish a workable process. Despite their own workloads, they are not just ready, willing and able to assist - they are all eager. In our office it is clear the Judges view what they do as a team effort. Yes, there are a couple who march to the beat of their own drum, and get good results. But they too are generous with their time and their talents.
And despite the recurring refrain that 'knowledge of how to read medical records' is critical, I would say an even more critical and very necessary realization is that the way evidence is developed in working with the supporting state agency, bears no resemblance whatsoever [or logic for that matter] to the way you have been used to obtaining evidence and developing the record in your private practice.
Case in point is the development of our "Standing Orders" on how we want a case to be worked up after it has been assigned to us. Some judges ask for consultative exams. Some don't. Those who do, more often than not don't see the case for hearing until 16-18 months later. So, even in their hearing prep they are looking at a CE done by a non-treating physician that saw the claimant for one hour and performed minimal tests 16 months prior to the hearing date. That combined with Attorney/Reps who bring in new medical records on the day of the hearing and it's easy to see why it takes a while to get the cases decided and written after they have been heard.
In short, my third lesson was that the disability determination process is a Leviathan and there is no money available to order medical, psychological, or even functional capacity testing. It's all on the state agency, and they will order the minimums. And if we do get them, they will be old, of questionable value and still leave questions to be answered.
In short, it has been an eye opening 2 weeks. I anticipate it will be frustrating and illogical at times. But, like the military, (or any job for that matter), if you’re up to the challenge, you can make it a good experience. I’m enjoying it. Glad to see fellow NODARS like TigerLaw, Dukehoops, and Cat are as well.
ht
Anyone who has worked with computers for the past 10+ years will be able to learn the case management systems. They are intuitive. Many of the VOD's and national conference calls with concurrent video demos, go over the things we have been shown by our mentor judges. So, insiders like Funky are probably bored. But then so are those of us NODARS who have been let loose on the keyboard with a good mentor looking over our shoulder guiding us through the screens.
Much of what we have learned during the first 2 weeks of our onsite orientation is that understanding the process, and the fact that "you are the Commissioner's designee" for implementing agency policy are probably two of the most eye-opening aspects for those of us NODARS coming from private practice.
The mentor judges, the HOCALJ, and all the other judges [from those who have been at this for anywhere from 20 years to just 10 months] are eager to help point you in the right direction and provide guidance on how to establish a workable process. Despite their own workloads, they are not just ready, willing and able to assist - they are all eager. In our office it is clear the Judges view what they do as a team effort. Yes, there are a couple who march to the beat of their own drum, and get good results. But they too are generous with their time and their talents.
And despite the recurring refrain that 'knowledge of how to read medical records' is critical, I would say an even more critical and very necessary realization is that the way evidence is developed in working with the supporting state agency, bears no resemblance whatsoever [or logic for that matter] to the way you have been used to obtaining evidence and developing the record in your private practice.
Case in point is the development of our "Standing Orders" on how we want a case to be worked up after it has been assigned to us. Some judges ask for consultative exams. Some don't. Those who do, more often than not don't see the case for hearing until 16-18 months later. So, even in their hearing prep they are looking at a CE done by a non-treating physician that saw the claimant for one hour and performed minimal tests 16 months prior to the hearing date. That combined with Attorney/Reps who bring in new medical records on the day of the hearing and it's easy to see why it takes a while to get the cases decided and written after they have been heard.
In short, my third lesson was that the disability determination process is a Leviathan and there is no money available to order medical, psychological, or even functional capacity testing. It's all on the state agency, and they will order the minimums. And if we do get them, they will be old, of questionable value and still leave questions to be answered.
In short, it has been an eye opening 2 weeks. I anticipate it will be frustrating and illogical at times. But, like the military, (or any job for that matter), if you’re up to the challenge, you can make it a good experience. I’m enjoying it. Glad to see fellow NODARS like TigerLaw, Dukehoops, and Cat are as well.
ht