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Post by privateatty on Oct 21, 2014 15:48:45 GMT -5
I wonder what sort of medical background you think they should be looking for? An attorney who has done lots of medical related law? One who was a CNA at a nursing home? An LPN? A physical therapist? A 2 year RN? A 4 year RN? A NP or PA? An MD who has never been licensed? An MD whose license is retired? An MD who isn't board certified? Are some Board certifications better than others?? What about other kinds of practitioners (i.e. psychologists, dentists, podiatrist, etc...). I agree that the ability to review a chart before you get the job has to be helpful but the issues are questions of law. Not writing a legally sufficient decision that links evidence to determination is a failure in analysis and I don't see how medical school can fix it. I understand that there are more than a few readers who have seen decisions where the writer (and Judge) did not understand the medical. That is not a problem that can be fixed with a deeper understanding of the practice of medicine and matters related thereto. This is a legal problem. It is the same problem that a lawyer has when he or she fails to articulate their case. Back in my prior lifetime I saw it all the time in a practice of personal injury matters. Can't appreciate the relationship between spinal stenosis and trauma? Its because you didn't do the research. If you get a score high enough to be picked up, OPM has determined that you have enough of the "little gray cells" (pardon me Ms. Christie) to do the work and write a cogent decision/opinion. But you need to do the work. Any applicant who can be picked up can do any area of law within 28 federal agencies. Period.
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Post by privateatty on Oct 21, 2014 15:55:38 GMT -5
I am, frankly, stunned that the judge would discuss with the media his reactions to the testimony he just heard. It is one thing for the reporter to sit in on the hearing with the claimant's permission. It is quite another to discuss the matter with the reporter afterwards. As a state ALJ, it would never occur to me to do such a thing. Indeed. I was quite stunned as well. Shockingly, from what I have heard, it appears the three Miami ALJs coordinated with the WP reporter and interacted with him over a several week period on this article. Not sure what these judges were hoping to gain from it, but it certainly goes against everything I have been taught about how to deal with the media. I don't want to break this down chapter, line and verse. One can surely understand that the intent was to focus support on how to fix or at least repair, the system. However, I can only think of that old adage about what the road to hell is paved with.
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Post by JudgeRatty on Oct 21, 2014 16:14:23 GMT -5
Really? I'm lost in your "logic." I look at the "How Am I doing?" tool as constant reminders to get cases moving and to get the dipsositions/scheduled hearings numbers up. It seems to me to only be concerned with making sure the numbers are met (with the possible exception of the AC feedback tab). And everyone knows it is easier to make the numbers by paying cases. So, care to explain how one could possible make the leap that such a tool encourages the denial of cases? Especially such as to support your initial position that the Commissioner wants cases denied despite the evidence? Are you saying the evidence doesn't support ALJ's denying more claims? 2011 ALJs allowed 58%, 2012 ALJs allowed 52%, 2013 ALJs allowed 48%. The judges are going to pay less claims at the hearing level when there are programs in place to pay more cases on the record. The VSU, informal remand process, and now the NSU scoop many of the cases off that are payable without a hearing. So your direct statistical correlation is flawed.
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Post by funkyodar on Oct 21, 2014 16:25:59 GMT -5
Are you saying the evidence doesn't support ALJ's denying more claims? 2011 ALJs allowed 58%, 2012 ALJs allowed 52%, 2013 ALJs allowed 48%. The judges are going to pay less claims at the hearing level when there are programs in place to pay more cases on the record. The VSU, informal remand process, and now the NSU scoop many of the cases off that are payable without a hearing. So your direct statistical correlation is flawed. Sratty is on point, as usual. Further, there has indeed been a push for more policy.compliant decisions. Less of the "make it favorable.because it is easier.and faster"'mentality bleeds thru when there is more emphasis placed on getting it right and in line with policy. For the life of me though I can't see how a renewed emphasis on quality and policy compliance equates to an on high edict to deny more cases. Shouldn't the goal be to pay those that should be paid and deny those that shouldn't as opposed to just do as many as one can as fast as one can? I can say that not once in my time as a senior attorney or in any of the alj training I have recently undergone has anyone ever advised I should disregard the evidence in order to meet some forgone conclusion in line with any edict or pronouncement of the commissioner as you suggest is occurring.
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Post by hopefalj on Oct 21, 2014 16:28:52 GMT -5
Really? I'm lost in your "logic." I look at the "How Am I doing?" tool as constant reminders to get cases moving and to get the dipsositions/scheduled hearings numbers up. It seems to me to only be concerned with making sure the numbers are met (with the possible exception of the AC feedback tab). And everyone knows it is easier to make the numbers by paying cases. So, care to explain how one could possible make the leap that such a tool encourages the denial of cases? Especially such as to support your initial position that the Commissioner wants cases denied despite the evidence? Are you saying the evidence doesn't support ALJ's denying more claims? 2011 ALJs allowed 58%, 2012 ALJs allowed 52%, 2013 ALJs allowed 48%. So we're making a magical, mystical leap that the lower approval rate is indicative of the agency issuing edicts to pay fewer claims and using How MI Doing to implement said edicts? Mmmkay... I mean, part of the reason the approval rates could be trending that way could be because the agency has reigned in the judges that were rubber stamping favorable decisions in the thousands without ever reviewing the evidence. And this problem wasn't limited to West Virginia or the other notorious cases, either. At the same time, I can also understand the frustration that reps feel when they land a judge that they know isn't going to pay a case no matter what evidence is presented.
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Post by JudgeRatty on Oct 21, 2014 17:18:20 GMT -5
Ok, now that I have more time...this is to respond to ssalawman's comments: The ALJ decision pay rate has been declining for MANY reasons. First, the lower level has been paying more cases up front at the initial and recon levels so there are fewer "pay" cases coming to hearing. As I mentioned earlier, the VSU, NSU, and the informal remand process took many of the "easier" pay cases and paid them OTR (that's on the record for you outsiders...no hearing held). So all this scooping up of the pay cases makes the pool of cases getting to hearing level a bit skewed. Also, throw in the economy and you have more people applying for disability and hence more cases that are not supported by medical evidence etc. So just looking at stark statistics alone without knowing the inner workings of SSA leaves you with a false sense of what is happening. There are always other factors to consider. Just like anything, there are always other sides of the story. I do not know what your background is ssalawman, but I sense a deep disappointment for the SSA system and can't imagine you are an ALJ applicant. Maybe you are an ALJ and you are not happy in your job. If that is the case, please, retire/quit/change careers now. I would love to be an ALJ and I will do a good job and do it happily. Have a good one peeps!
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Post by hal3000 on Oct 21, 2014 19:49:46 GMT -5
I am very surprised and disappointed about the way the issue of whether a Social Security ALJ should have prior medical knowledge is going in this thread. Judges of all kinds hear extremely complex and sophisticated matters every day, and have no prior knowledge or experience in the area, at all. That's what witnesses are for. Our job is to listen to all the evidence, including evidence from experts, and apply the law to the specific necessary facts. We do not need any prior knowledge or experience in a substantive area in order to do that effectively. What does a civil court judge do in a very complicated medical malpractice case? What does a judge do in a complicated products liability case? Or a securities litigation matter where there are complicated international financial issues involved? Or a criminal court judge in a case involving DNA evidence? The judges have no prior experience in these areas. They have no expertise in these areas. What they do have expertise in is listening to all of the facts, evaluating the evidence, and applying the correct rule of law to the specific facts. If the particular issue is very complicated, that's what expert witnesses are for. If you don't understand the medicine, call a medical expert as a witness. But to argue that we can't do our jobs because we don't have medical experience, or vocational experience for that matter, is to completely miss the point of what we do, and how we are supposed to do it, and not just us, but all judges, everywhere, at least in the USA.
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Post by travis on Oct 21, 2014 19:56:58 GMT -5
Why is the union focusing on an unenforced "quota" when the Agency plans to decimate the field office staffing and centralize pulling and writing? This is a bigger issue that will negatively impact all ALJs. Who wants all their decisions written out of the office? We will lose quality control. We will spend more time editing crappy decisions and have less time to review medical records. I think the ALJs in Miami were foolish to talk to the Post. I guarantee my decisions are better than flipping a coin. I realize the quotes form the ALJs reflect a level of frustration, but they reflect poorly on the ALJ corps as a whole.
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Post by x on Oct 21, 2014 20:19:55 GMT -5
Included in the push for policy compliance is a steady drumbeat by the Deputy Commissioner on the theme that there are too many unsupported less-than-sedentary allowances. There is no balancing drumbeat as to any subset of unsupported affirmations. The DC is not pressing for a particular outcome in any given case, so qualified judicial independence is not invaded, but he is stepping as close to the line as possible without going over. This accounts for some small part of the dropping allowance rate unless a thousand ALJs are uniformly indifferent to the guidance of their 4th?-level boss.
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Post by bartleby on Oct 22, 2014 7:15:31 GMT -5
hal3000, I appreciate your veiwpoint, however, you note, "Judges of all kinds hear extremely complex and sophisticated matters every day, and have no prior knowledge or experience in the area, at all." The next sentence should be, "That's what lawyers are for." Most other Judges are versed in the law and rule on the law, the lawyers/experts present the evidence from both sides. We only have one lawyer and one side of the story. We have to be the "other lawyer" and present the other side of the story and then rule on it. Other Judges hear both sides of the story. They do not research the medical records or investigate the facts of the case. They rely on others to do so for them. It gets even easier if they have a jury to rely on. As you say, "What they do have expertise in is listening to all of the facts, evaluating the evidence (presented??), and applying the correct rule of law to the specific facts." We only get one side of the facts presented to us and often on a biased platter. We have to interpret and know the evidence prior to the hearing. Believe it or not, this does require some astuteness in interpreting medical records and knowing what positive examinations are needed to arrive at what diagnoses to be supportive of the claimant's allegations.. How can you possibly suspect fraud if you don't know what is truly going on? How can you assess credibility. How can you assess whether a medical source statement or treating physician statement is supported by the medical records, if you don't know or understand what they mean?? The Agency should issue a desk guide noting what exam findings support what diagnoses or at least make sure Judges know what a Merck Manual is. As usual, JMHO...
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Post by redryder on Oct 22, 2014 8:25:27 GMT -5
This is a little off point but still something ALJ-watchers should read. This week the Wall Street Journal had an article about the SEC opting to have more of its legal actions held before the SEC ALJ corps than going into federal district court. The defense bar is apparently having a stroke because there is only one adjudicator--the ALJ. No option for that jury who surely understands the complex SEC regulations and statutes as well as the SEC ALJ. And they are raising some of same issues I have read here: SEC ALJ is a pawn of the agency, due process, etc. So far it does not appear the defense has had much, if any, success keeping their cases out of the clutches of the ALJ corps and getting back into the district courts.
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Post by Deleted on Oct 22, 2014 14:38:39 GMT -5
That's an interesting read. One wonders how this thing could have been in the works since 2008 (6 years) and we're still testing? Not being critical. Maybe it does take that long. Just seems like a long time. I asked one of our VE's about it and she forwarded me an article. It's very dry stuff, but some of the history of the DOT is interesting. The article was published in 2009. The Rehabilitation Professional 17(2), pp.63-84 www.skilltran.com/RehabPro_17_2_pp63-84.pdfNoteable quotes: The DOT was first developed in the 1930s and currently contains 12,761 job descriptions or definitions in a narrative, highly structured fixed format. Subsequent editions of the DOT were published in 1949, 1965, and 1977. The 1st Edition contained 17,500 job titles with 550 occupational groups. The DOL has not formally updated the DOT since 1991. Instead, the DOL developed an entirely new system, the Occupational Information Network (O*NET). The first O*NET database was released in December of 1998. The 12,000+ unique occupational descriptions of the DOT were compressed to about 1,100 occupations in this first version of O*NET. Table 1 identifies the dates of last update for all DOT titles. Over 80% of the DOT titles were last reviewed over 30 years ago.
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Post by ssalawman on Oct 22, 2014 15:38:30 GMT -5
Ok, now that I have more time...this is to respond to ssalawman's comments: The ALJ decision pay rate has been declining for MANY reasons. First, the lower level has been paying more cases up front at the initial and recon levels so there are fewer "pay" cases coming to hearing. As I mentioned earlier, the VSU, NSU, and the informal remand process took many of the "easier" pay cases and paid them OTR (that's on the record for you outsiders...no hearing held). So all this scooping up of the pay cases makes the pool of cases getting to hearing level a bit skewed. Also, throw in the economy and you have more people applying for disability and hence more cases that are not supported by medical evidence etc. So just looking at stark statistics alone without knowing the inner workings of SSA leaves you with a false sense of what is happening. There are always other factors to consider. Just like anything, there are always other sides of the story. I do not know what your background is ssalawman, but I sense a deep disappointment for the SSA system and can't imagine you are an ALJ applicant. Maybe you are an ALJ and you are not happy in your job. If that is the case, please, retire/quit/change careers now. I would love to be an ALJ and I will do a good job and do it happily. Have a good one peeps! Sratty: You seem to be regurgitating what the Agency wants people to believe but the statistics don't support it. The lower levels have NOT been paying a higher percentage of cases. 2011: Initial level 34%, recon 12%; 2012: Initial level 33%, Recon 12%; 2013: Initial level 33%, recon 11%. The only decline we have seen in recent years is at the ALJ level. AC figures have been steady over the past three years with Allowances between 1-2% and remands at 17-21%. The Federal Courts have also been consistent with their outcomes over the same time period. Allowances of 2-3% and remands at 42-46%. You are correct regarding my deep disappointment with the SSA system. Thankfully I am in a position where I can, in my own small way, help to effect change in the system. Part of my duty is to confront untruths that are being stated as fact by the Agency, insiders, and the media. Its clear to anyone who has been around for the 20 plus years that I have that while there are ups and downs in how claims come out, the DRASTIC change at the ALJ level in recent years is the result of a conscious effort on the part of the Agency to reduce approvals. Fraud, rubber stamping, and outlier Judges are the terms du jour. But no focus is being placed on the large number ALJS with approval numbers in the 20s or below. And that is the disgusting part of this entire process.
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Post by JudgeRatty on Oct 22, 2014 15:54:50 GMT -5
Ok, now that I have more time...this is to respond to ssalawman's comments: The ALJ decision pay rate has been declining for MANY reasons. First, the lower level has been paying more cases up front at the initial and recon levels so there are fewer "pay" cases coming to hearing. As I mentioned earlier, the VSU, NSU, and the informal remand process took many of the "easier" pay cases and paid them OTR (that's on the record for you outsiders...no hearing held). So all this scooping up of the pay cases makes the pool of cases getting to hearing level a bit skewed. Also, throw in the economy and you have more people applying for disability and hence more cases that are not supported by medical evidence etc. So just looking at stark statistics alone without knowing the inner workings of SSA leaves you with a false sense of what is happening. There are always other factors to consider. Just like anything, there are always other sides of the story. I do not know what your background is ssalawman, but I sense a deep disappointment for the SSA system and can't imagine you are an ALJ applicant. Maybe you are an ALJ and you are not happy in your job. If that is the case, please, retire/quit/change careers now. I would love to be an ALJ and I will do a good job and do it happily. Have a good one peeps! Sratty: You seem to be regurgitating what the Agency wants people to believe but the statistics don't support it. The lower levels have NOT been paying a higher percentage of cases. 2011: Initial level 34%, recon 12%; 2012: Initial level 33%, Recon 12%; 2013: Initial level 33%, recon 11%. The only decline we have seen in recent years is at the ALJ level. AC figures have been steady over the past three years with Allowances between 1-2% and remands at 17-21%. The Federal Courts have also been consistent with their outcomes over the same time period. Allowances of 2-3% and remands at 42-46%. You are correct regarding my deep disappointment with the SSA system. Thankfully I am in a position where I can, in my own small way, help to effect change in the system. Part of my duty is to confront untruths that are being stated as fact by the Agency, insiders, and the media. Its clear to anyone who has been around for the 20 plus years that I have that while there are ups and downs in how claims come out, the DRASTIC change at the ALJ level in recent years is the result of a conscious effort on the part of the Agency to reduce approvals. Fraud, rubber stamping, and outlier Judges are the terms du jour. But no focus is being placed on the large number ALJS with approval numbers in the 20s or below. And that is the disgusting part of this entire process. I am not simply regurgitating. I am an SSA insider and was a rep prior to that. I have actual knowledge of the process from both a senior attorney perspective and a HOD perspective. So, if you are not an insider, not an ALJ candidate, not an ALJ, and are disgruntled by the SSA system....why on earth are you on this board? To spread your disappointment and your claims of a "conscious effort on the part of the Agency to reduce approvals?" I think you meant to post on the other board. (sorry ALJD..I know, I know....get along and don't flame . Now with all of that said, I do agree that there should ALSO be a focus on the ALJs who are on the outside of the bell curve to the extremes whether pay or not. But using statistics without taking into consideration the other factors involved leaves little truth. The lower level has been paying more cases....net numbers. You did not address that there are going to be less cases that are paid at the hearing level when SSA has several programs in place to PAY those cases before they get to hearing. We do actually review cases for on the record decisions, and the very years you cite are the years that there has been a push for OTR cases to help pay the cases that should be paid and not waste resources on a hearing. Sorry if this offends you, but the people at SSA (including me) work very hard as public servants. Slinging mud has never been helpful so I will stop here.
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Post by ssalawman on Oct 22, 2014 16:38:53 GMT -5
According to SSA's own study, SAA and ALJ OTRS had been on the decline since FY 2008, so it again appears that your explanation is not supported. Patiently waiting for the next line of BS you try to throw out......
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Post by JudgeRatty on Oct 22, 2014 17:45:00 GMT -5
No thanks. You hate SSA and anything I say will provoke yet more trash talk. I am proud of my work, love my job, and respect the Corps. Have a good one. Time for me to take a nice break from the board. Have a good one peeps.
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Post by funkyodar on Oct 22, 2014 17:48:07 GMT -5
No one will dispute the fact that the pay rate has decreased. Lies, damn lies and statistics, aside.
It has gone down. The issue, ssalawman, is why. From your initial post you posited there has been some edict from the commissioner to pay less cases. Despite the evidence, you said.
So, while it is easy to show a pay rate decline (which I assume you offer as some sort of res ipsa proof of your theory), I still await your supporting evidence. Where is this edict written? Was it spoken at some meeting, training session or conference call?
What I have seen is an agency recognizing that past pushes to reduce the hearing backlog has led to many cases getting paid without regard to policy compliance. Why? Because it is easier and faster to pay leading to more dispositions. You cite the concerted effort to reduce the less than sed rfc pays. Perhaps it would surprise you to know that, by policy, a less than sed rfc was always supposed to be rare. That's always been the case. But in the great push for numbers, many judges simply relied on a less than sed rfc without sufficient evidence to support it and ssr 96-9p to pay the cases. I've seen rfc findings along the lines of "can't persist for 8 hours". That's not even an rfc, much less policy compliant.
Now, ask yourself this: Is it wrong to not pay a claim if following policy and regs means it doesn't qualify to be paid just because some noncompliant judge might have paid it in the past?
I suppose, if your position is a determination to comply with policy and the law leads to a reduction in the pay rate and is therefore a nefarious plot to not pay people, we are at an impasse. I just haven't seen it, heard it or read it and it goes against every iota of training I've just completed. If there is such a plot, I'd think the aljs would have to be in on it.
Now, I do agree that a judge that denies 90% is doing a disservice to the same degree that is done by one paying that percentage. But, there has long been appeals council and court oversight of denials. Pay cases have long been without that review. Remedying that deficiency is an area that has been the subject of some recent edicts. As it should be.
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Post by privateatty on Oct 22, 2014 18:37:48 GMT -5
This is a little off point but still something ALJ-watchers should read. This week the Wall Street Journal had an article about the SEC opting to have more of its legal actions held before the SEC ALJ corps than going into federal district court. The defense bar is apparently having a stroke because there is only one adjudicator--the ALJ. No option for that jury who surely understands the complex SEC regulations and statutes as well as the SEC ALJ. And they are raising some of same issues I have read here: SEC ALJ is a pawn of the agency, due process, etc. So far it does not appear the defense has had much, if any, success keeping their cases out of the clutches of the ALJ corps and getting back into the district courts. This is all about billable hours--dressed up as "we can't get proper justice before a SEC ALJ". USDC--unlimited discovery and the concomitant legal fees--to be paid by a deep pockets client. And the SEC ALJs are just in the way of lining the law firms' pockets. Of course a certain journalistic bent is carrying water for this nonsense. We used to have a saying when I practiced--"he/she wants to depo the doorman".
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Post by hal3000 on Oct 22, 2014 19:17:53 GMT -5
The answer to your Questions, Bart, is if the ALJ doesn't understand the medicine, again, get an ME. The answer is not to completely do away with the legal/judicial model of public administration.
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Post by Deleted on Oct 23, 2014 7:11:01 GMT -5
There are lots of reasons why the overall pay rate for ALJ's may have decreased. It's not hard to come up with some very plausible ones of the top of one's head. For the record, mine has actually increased slightly. Go figure.
Demographics. The population of applicants is changing, and aging. If more potential baby-boomer applicants move over age 62 into retirement age, the need for disability among people in that age group could decrease. Less 60 something applicants, pay rate decreases.
Supply/Demand: There have been a lot of approvals over the last decade. If I was working as a claimant's rep I might notice that a lot of the low-hanging fruit, the easy cases, are missing. They have already been paid. If all that's left are young people, pay rate decreases.
Economics: The economy took a huge hit a few years ago and has been on the rebound. As the unemployment rate drops, and more people have an option whether to try to return to work or apply for disability, I think a drop in the number of successful applicants would be expected? Now, the obvious point is that a worker who is capable of going back to work shouldn't be eligible for the program, right? But, I am thinking of the very common 55-year-old worn out worker. In my area, that's in the oil and gas industry. Whereas the 55 year old with the bad back might grid out, if they're paying a bonus offshore, he might suck it up a few more years because the money is too good. So, better economy, pay rate decreases.
But, to answer the original posting, in the 5+ years I have been doing this, no one in the Agency has ever pressured me to pay or not pay a case. They don't care. They just want the cases moved in volume. They care about whether the case has been waiting for my signature for more than 10 days. They don't care whether I paid it or not.
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