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Post by Deleted on Oct 20, 2014 8:08:06 GMT -5
That professor, Pierce, did not come off looking very professional. One, he's wrong, and two, including "diddly-s__t" in your argument is a clear giveaway of a crank, not someone trying to have a serious discussion.
Also interesting on the Dictonary of Occupational Titles : "Social Security officials say they’re working on a replacement. It might be ready in 2017."
Really? That's the first I have heard of that. Anyone else hear that rumor, or have anything more concrete? Why would SSA be doing it and not DOL? (I have been told that DOL doesn't want it, but still..)
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Post by prescient on Oct 20, 2014 8:10:32 GMT -5
I got the impression that the physical aspects of the case were very weak. I'm not sure there's anything wrong with saying at the hearing "if I decide to pay this case, it's going to be based upon a review of your mental records."
I also got the impression that the judge will be paying the case.
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Post by moopigsdad on Oct 20, 2014 8:58:59 GMT -5
That professor, Pierce, did not come off looking very professional. One, he's wrong, and two, including "diddly-s__t" in your argument is a clear giveaway of a crank, not someone trying to have a serious discussion. Also interesting on the Dictonary of Occupational Titles : "Social Security officials say they’re working on a replacement. It might be ready in 2017." Really? That's the first I have heard of that. Anyone else hear that rumor, or have anything more concrete? Why would SSA be doing it and not DOL? (I have been told that DOL doesn't want it, but still..) Yes, it is my understanding there is indeed a replacement in the works done by DOL and SSA. I am friends with someone from SSA who was working on it prior to retiring. As to when it is expected, I cannot say for sure, I was led to believe it might be out by 2016. Stay tuned for further details as time passes.
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Post by hopingforalj on Oct 20, 2014 9:28:56 GMT -5
I thought all of this might arrive someday, when they were bashing on the car wreck lawyers I thought if they get to the end of that tirade, we might all be in their sights, and bingo here we are, it is hard to listen to people like this Prof. who don't operate day to day in this environment, they do not understand so many things, they speak in generality, and mostly they speak unfounded diddly that sounds good to the press.
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Post by paddlingon on Oct 20, 2014 9:47:17 GMT -5
I respect the points made in this thread specific to the article's quotations. But this article points out something indefensible: our system of government has a process that has indigent and disabled people dying without benefits while awaiting a hearing. Some of those people had meritorious claims and may have survived if they had received benefits.
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Post by hopingforalj on Oct 20, 2014 9:53:23 GMT -5
That is def true, I have had two clients die this year waiting on hearings, you are correct.
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Post by figaro on Oct 20, 2014 10:49:41 GMT -5
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Post by Deleted on Oct 20, 2014 11:05:53 GMT -5
This is a very good point. I, too, have had claimants die while awaiting a decision. In my case, I was reviewing the file a week before hearing and decided that the claimant met a listing (cancer or dialysis?) While writing the instructions I hit on the fact that he had passed five months prior. Someone really should have gotten that guy paid a long time before it hit my desk.
With that said, there is a distinction to be made. We at ODAR make up a part of the social safety net, but not all of it. Even when approved for disability, there is a wait to be approved for Medicare benefits. So, the cash benefit that we pay out is part of the equation, but really, the big part of it is health insurance/Medicare/Medicaid.
If a claimant is indigent, and terminally ill, a decision from ODAR is not going to help any time soon. If an indigent person needs care, I would hope that Medicaid would step up to ensure that care until benefits can be adjudicated. However, in some places, like my poor State, they rejected additional Federal Medicaid funds and are kicking people off the system left and right. I get claimants stating, "They took my medical card" all the time. Hard to hold the safety net together when all some want to do is tear it apart.
I guess my point is that when I hear statements that suggest that people are dying because they did not get a prompt social security decision, I think well...that is not true. People are dying because of limited access to reasonable and necessary health care, and that is not a problem that ODAR, or any other one agency, or corps of ALJs can fix.
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Post by paddlingon on Oct 20, 2014 12:04:32 GMT -5
I chose my words carefully, robg. I agree with you. People are dying before getting a decision, not because they are not getting a prompt decision. The benefit is just part of the equation. It is not a problem that is exclusively ODAR's responsibility and it is not solely within ODAR's ability to resolve. But it is a process that has an indefensible problem, and a solution must be provided.
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Post by Gaidin on Oct 20, 2014 13:15:48 GMT -5
I liked the comparison between the well trained lower level decisionmakers, and the ALJ, who is merely a lawyer. At least, in most states, they are physicians. Although Mr. Pierce articulated his point rather crudely, the fact remains -- does it make sense to continue to hire SSA ALJs who do not have extensive medical knowledge? The translation of a claimant's medical/education records into an RFC is the single most important job an ALJ has. 4 weeks in Falls Church is not nearly enough medical training to permit an ALJ, who has never read medical records as part of their career, to be able to do this job duty with any type of expertise. Why can't OPM create 2 registers? One for SSA which makes medical experience a required element, and a separate register for everyone else? I take serious issue with the idea that anyone must have "extensive medical knowledge" to evaluate a case. The ALJ is not being asked to render a diagnosis, provide treatment, or otherwise render care. The ALJ is being asked to determine whether a claimant's diagnosis, medical history, and other evidence meets a legal definition. I have reviewed thousands of medical records and I certainly do a better job of it today than I did when I started but that isn't because I went to medical school. This isn't a medical question it is a legal question. We don't make judges who hear med mal or workers comp cases go to medical school why would we ask ALJs to do so. It is a legal question not a medical question if the ALJ is unsure of the accuracy of the diagnosis or the records are poor there are options to try to cure the problem but you aren't going to do H&P in the hearing room.
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Post by quesera on Oct 20, 2014 16:38:52 GMT -5
Good point, but it sure would be nice if the judges they picked were always attorneys who have a gift for working with legal-medical analysis. It's not fun to see a decision from a judge who flat out does not understand the medical evidence. Couldn't there be testing on this?
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Post by valkyrie on Oct 20, 2014 17:21:06 GMT -5
You see problems with medical/legal issues going both ways, which is just one more way that you see Dick Pierce make an ignorant ass of himself. I bet we could open up a whole new thread sharing stories of state agency medical consultants gone wild. One of my favorites was the diabetic that had an ulcer that didn't heal and eventually turned septic. The state agency found that the claimant did not have a non-severe impairment because the ulcer didn't last 12 months. Of course the reason why the ulcer didn't last was the below the knee amputation 7 months after the ulcer appeared! Nice application of the regs! These are the people in which Dick Pierce places his unwavering trust. I have also seen state agency memos in which consultants are asked to "reconsider" the claimant's RFC because they turned 55, leading to a grid pay. The state agencies are under heavy pressure regarding their pay rates, because, SURPRISE, no APA protection, let alone any sense of legal ethics. Where else did Dick Pierce screw up in his middle school essay? Apparently SSA ALJs are the only conceivable reason that the overall health of Americans has gone to hell! Is Dick Pierce's head so far up his own hinder that he somehow missed the obesity/diabetes epidemic that is responsible for such a huge chunk of our caseload? You know the military is turning down record number of applicants due to obesity? I guess the SSA ALJs are doing that too. The obsolete DOT jobs are an easy target for laughs, but generally irrelevant for what we do, since the VEs only use the DOT as a base point for their analysis, and will give current jobs in response to hypos, such as scanner operator, rather than a copy machine operator. Its really a non factor. Of course the grid is outdated, but obviously that's not the ALJs' fault. Maybe Dick Pierce should take on an easier topic for his next essay, like What I did on My Summer Vacation...
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Post by JudgeRatty on Oct 20, 2014 17:36:20 GMT -5
Good point, but it sure would be nice if the judges they picked were always attorneys who have a gift for working with legal-medical analysis. It's not fun to see a decision from a judge who flat out does not understand the medical evidence. Couldn't there be testing on this? I have a feeling that would eliminate a good portion of the applicants. Personally I would be happy if they gave extra weight to those who applied with a medical background. I am a former medic, and have an extensive medical background. A lawyer with medical training ( nurse, medic, or former SSA attorney) is a big plus. Yeah, I am hoping that translates too. My first career was as an RN, mostly ER/ICU. So I get what you are saying for sure. But that will only come into play once we get on a cert & have the SSA interview. The OPM process is generic for all ALJs, and they don't care about that. I think a plug at the SSA interview stage will no doubt be a benefit! I know it helps in many respects in the speed at which I review files now. I can zero in on what matters. There is always an advantage to having a medical background in this work. Is it necessary? No. Helpful? Absolutely!
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Post by onepingonly on Oct 20, 2014 18:00:00 GMT -5
What percentage of cases are remanded because the ALJ did not understand the medical evidence? I have never seen or heard of one. Congress could have required doctors instead of lawyers on appeal from the initial denial, but has chosen to go with lawyers all these decades, opting for an understanding of the intricacies of due process over the medical aspects of the case. The folks at the AC and all the Art. III judges who hear appeals from ALJ decisions are lawyers, not doctors. The COSS is neither. The vast majority of the cases involve the same common ailments: DDD, HTN, DM, CAD, obesity, arthritis, COPD, CTS, MDD, ADHD. Very few cases are any kind of complicated medical mystery. I have had a couple of those, where, despite concerted efforts, the doctors were at a loss to understand and/or treat some obscure illness, a very few cases among thousands. Those cases were actually easier because the quality of the medical record was unusually excellent. All the ALJs I know are very adept at understanding the medicals.
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Post by luckylady2 on Oct 20, 2014 18:08:18 GMT -5
Although I agree that those with prior medical experience would have some advantage, I've had no problem coming up to speed on medical stuff when I need to. So I'm not sure that those of us without medical backgrounds should be discounted at all.
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Post by JudgeRatty on Oct 20, 2014 18:36:03 GMT -5
Although I agree that those with prior medical experience would have some advantage, I've had no problem coming up to speed on medical stuff when I need to. So I'm not sure that those of us without medical backgrounds should be discounted at all. I completely agree. After a period of time, any lawyer can pick it up. It's just like anything, it just takes time. It is just a matter of understanding what symptoms are consistent with what diagnoses. Once you figure that out, you can spot the inconsistencies. Yes, there are some weird rare issues, but generally as onepingonly points out, you see many of the same ailments over and over. You will be an expert in no time. I really think the medical background only helps where speed of review is involved and when you first get started. Kind of levels out over time though.
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Post by jonsprag1 on Oct 20, 2014 18:55:12 GMT -5
I suspect that many of the people on the register have prior experience reading and interpreting medical reports and listening to doctors testimony--I've been doing it for 34 years, first as a personal injury/wc attorney and then as a W/C hearing officer for the State of Maine, and a W/C hearing representative for the U.S.DOL I agree with Sratty--eventually any lawyer (or smart layperson) can pick it up so they understand what a case is all about---
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Post by JudgeRatty on Oct 20, 2014 19:07:07 GMT -5
I suspect that many of the people on the register have prior experience reading and interpreting medical reports and listening to doctors testimony--I've been doing it for 34 years, first as a personal injury/wc attorney and then as a W/C hearing officer for the State of Maine, and a W/C hearing representative for the U.S.DOL I agree with Sratty--eventually any lawyer (or smart layperson) can pick it up so they understand what a case is all about--- Exactly. Yes, we can hit the ground running, but in the marathon....and we ALL know about marathons. LOL!
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Post by cougarfan on Oct 20, 2014 19:44:37 GMT -5
Sounds like this would be a good hypothetical question for the next incarnation of the ALJ exam on refresh. Interestingly, I had a similar question asked of me during my first round of interviews several years ago.
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Post by bartleby on Oct 20, 2014 21:08:10 GMT -5
Robg, you noted, "If a claimant is indigent, and terminally ill, a decision from ODAR is not going to help any time soon." Actually, Medicaid benefits kick in as soon as the Title XVI benefits are awarded. Medicare benefits are approximately 2 years after the EOD of the Title II. This appears to award the indigent, but punish the Title II beneficiaries, who have contributed to the trust fund... This is not the only part of the Act that seems unfair to Title II recipients.
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