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Post by bartleby on Apr 10, 2014 15:18:54 GMT -5
There should be a "fairly high" pay rate at our level versus the state level. The people we see have progressive illnesses and they don't get better with time. They get worse, especially the ones without medical treatment. Give me any untreated illness, physical or mental, and it will probably worsen with time. Especially as has been noted that we have such a high level of Boomers, ie., 50-65 year olds and their illnesses are degenerative and progressive. It makes me laugh to see that DDS has noted that some 56 year old womon with degenrative disc disease of the lumbar spine and degenerative joint disease of both knees can do medium work. And then they wonder how we can pay so many of them? If you look at the remand rate of the Federal Courts and the Appeals Council, you would think we aren't paying enough. And maybe some of us aren't??
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Post by hopefalj on Apr 10, 2014 15:41:49 GMT -5
On top of that, bartleby, the DDS rarely has a complete medical record at the time of their evaluation. Hundreds of pages of medical routinely get submitted at the hearing request level, typically because claimants have finally obtained a rep.
I have had the opportunity in my tenure to write for both a 90% payer and a 90% denier at various times, although neither is around the office any longer. In my opinion, neither was doing the job very well. The unfortunate thing is that, while the financial impact may initially be a wash with the two types, some undeserving folks are currently on the rolls from the former while deserving folks were dinged by the latter.
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Post by bartleby on Apr 10, 2014 16:02:45 GMT -5
Hopefalj, you are correctomundo. This is very serious business we deal in. I had two claimants cry in my hearing room today. One was a Vet with PTSD and the other was a 45 year old woman that had worked on and off all of her life and never made over $3,000.00 a year. She was also PTSD from a childhood incident. At this point I had medical records that supported their limitations with attention and concentration and dealing with other people. I pay or deny based upon the Regulations, however, if I feel that there is something lacking in the record I will ask the Rep about it or send it out for a CE or do whatever I can to establish what limitations the claimant has. It may not be rocket science, but it is damn hard work and I am exhausted at the end of the day and the end of the week. Each claimant deserves 100%.
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Post by JudgeRatty on Apr 10, 2014 16:36:27 GMT -5
Hopefalj, you are correctomundo. This is very serious business we deal in. I had two claimants cry in my hearing room today. One was a Vet with PTSD and the other was a 45 year old woman that had worked on and off all of her life and never made over $3,000.00 a year. She was also PTSD from a childhood incident. At this point I had medical records that supported their limitations with attention and concentration and dealing with other people. I pay or deny based upon the Regulations, however, if I feel that there is something lacking in the record I will ask the Rep about it or send it out for a CE or do whatever I can to establish what limitations the claimant has. It may not be rocket science, but it is damn hard work and I am exhausted at the end of the day and the end of the week. Each claimant deserves 100%. Amen. Most excellent post. This is the issue... We are dealing with lives here. Our decisions affect people in a profound way. This is a huge responsibility. Both for the individual claimant and society. Pay or not, we need to get it right and that is not an easy task. After all the "easy" cases should technically be paid at the lower level. But like others have said above, the lack of medical development or worsening in condition totally change the picture by the time we see the case. The whole reason I got into this game is because it is a very technical medical area of the law. We must understand both medicine AND law to do a good job. It is not your average law job for sure and anyone who thinks so is totally missing the point.
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Post by privateatty on Apr 10, 2014 18:32:03 GMT -5
What about the other end of the spectrum where at least 2.8% of the Judges don't pay cases that should be paid? I don't see Congress getting the knickers in a twist about those folks--after all they are the ones sleeping under the over pass and eating dog food when they can get it. I should know as in another lifetime some of those folks were calling me.
Getting back to the thread and on point, AA's pay cases that shouldn't be paid and don't pay cases that should. Little wonder your job is so frustrating.
Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D."
One thing where I work is that the common demoninator is that we are all attorneys. I value your opinion. Isn't the real issue that we all need to foster an environment of discourse and reasoned application of the law? If we know that a Judge is consistently wrong then we all owe a duty to apply the higher duty--justice.
I know I sound like a pollyanna. But i never ever want to sign a decision where I am being challenged and not given the lawyers their day in Court.
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Post by chessparent on Apr 10, 2014 19:22:51 GMT -5
What about the other end of the spectrum where at least 2.8% of the Judges don't pay cases that should be paid? I don't see Congress getting the knickers in a twist about those folks--after all they are the ones sleeping under the over pass and eating dog food when they can get it. I should know as in another lifetime some of those folks were calling me. Getting back to the thread and on point, AA's pay cases that shouldn't be paid and don't pay cases that should. Little wonder your job is so frustrating. Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D." One thing where I work is that the common demoninator is that we are all attorneys. I value your opinion. Isn't the real issue that we all need to foster an environment of discourse and reasoned application of the law? If we know that a Judge is consistently wrong then we all owe a duty to apply the higher duty--justice. I know I sound like a pollyanna. But i never ever want to sign a decision where I am being challenged and not given the lawyers their day in Court. Well, that's why we are called attorney "advisors." Some of us really do "advise." I think that nuance gets lost once we start using acronyms in place of full titles on a daily basis and start thinking of AA 's as "writers."
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Post by hopefalj on Apr 10, 2014 19:29:34 GMT -5
Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D." I had a much longer response to this, but I'd like to keep myself out of trouble. With the right judges, I do just what you've set forth here, and they are usually responsive. But part of the reason a problem judge is a problem judge is because they don't give a flip about what anyone else thinks.
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Post by JudgeRatty on Apr 10, 2014 19:32:45 GMT -5
What about the other end of the spectrum where at least 2.8% of the Judges don't pay cases that should be paid? I don't see Congress getting the knickers in a twist about those folks--after all they are the ones sleeping under the over pass and eating dog food when they can get it. I should know as in another lifetime some of those folks were calling me. Getting back to the thread and on point, AA's pay cases that shouldn't be paid and don't pay cases that should. Little wonder your job is so frustrating. Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D." One thing where I work is that the common demoninator is that we are all attorneys. I value your opinion. Isn't the real issue that we all need to foster an environment of discourse and reasoned application of the law? If we know that a Judge is consistently wrong then we all owe a duty to apply the higher duty--justice. I know I sound like a pollyanna. But i never ever want to sign a decision where I am being challenged and not given the lawyers their day in Court. Well, that's why we are called attorney "advisors." Some of us really do "advise." I think that nuance gets lost once we start using acronyms in place of full titles on a daily basis and start thinking of AA 's as "writers." Bingo! Yep totally agree. After all we (attorney advisors) have more time to totally review the record and compare to the testimony and can point out anything that may not jive with the instructions. And hey if it doesn't change the outcome no biggy but I would rather point it out than just assume. And sometimes it does change the outcome. My goal is to do what I can to avoid remand. Now sometimes no matter what we do the AC remands, after all the record is never closed. But getting it right the first time is the goal.
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Post by JudgeRatty on Apr 10, 2014 19:35:57 GMT -5
Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D." I had a much longer response to this, but I'd like to keep myself out of trouble. With the right judges, I do just what you've set forth here, and they are usually responsive. But part of the reason a problem judge is a problem judge is because they don't give a flip about what anyone else thinks. So true and that part sucks. Yep every office has those I bet. Mine does. Hard to fix things and you can see the AC agreement rate sinking as you write the decision. Thankfully those are in the super minority.
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Post by privateatty on Apr 10, 2014 19:52:07 GMT -5
Well, I get that hoefalj and Sratty. And that is why I asked the question, but then you knew that.
People need to think outside of the Management box--all sides. If an AlJ doesn't care about your opinion 100% of the time--and it isn't just you, but all atttys and a matter of "I'm the ALJ"; then, yes, obviously there is a problem.
My problem here isn't the fact that we have outliers but rather how to fix that because outliers populate all walks of life. And I think everyone has to be on board; attys, management and fellow ALJs. And it is the latter and the Union politics that have to answer here too. Who is the big dog, the Claimant or the ALJ?
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Post by statman on Apr 10, 2014 19:57:00 GMT -5
I have had AAs go to me and say that they disagree. I will listen and change if they are correct. However, most of the time I do not, and so I have a reputation.
For what it is worth,I have the lowest pay rate in my office and the lowest remand rate. I do not care either way. I just try to follow the regulations and the evidence.
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Post by prescient on Apr 10, 2014 21:15:30 GMT -5
Wouldn't it be nice if we heard stories of AA's going to their Judges and saying "you know Judge, I think you got this one wrong and here is why: A, B, C and D." . What you may think is wrong when looking at all the evidence, someone else may see completely differently. The reality is that 75% of the cases at the hearing level are judgment calls, while the other 25% are clear pay/denials. If a case clearly has something procedurally wrong, then I would hope all of us would be bringing this to the ALJs attention to have it corrected. Likewise, if there are severe impairments with no corresponding limitation in the RFC, then that needs to be fixed too. Now that we are being held accountable for the remands we draft, the old ALJ argument of "well if the AC doesn't like it, they can just send it back" isn't working with me anymore. But for those cases that you just think should be paid or denied, for no reason other than your personal interpretation of the evidence led you to a differing conclusion, I think there's little value in trying to convince an ALJ that their decision is "wrong." .
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Post by Radoy Knuf on Apr 10, 2014 22:02:02 GMT -5
As people wait for their hearing they get older. They move from a grid category of not disabled to a grid disabled with the change of age categories even if the alj finds the exact same rfc that denied them at the state level. Wanna fix that congress? Congress responds: Why?
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Post by dudeabides on Apr 11, 2014 7:23:31 GMT -5
The letter says that "RCALJ Bede testified that several ALJs in his region had inappropriately high reversal rates." Page 5. As an outsider, I am not sure I understand this.
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Post by dudeabides on Apr 11, 2014 7:28:42 GMT -5
Sorry, my last transmission was garbled! Not enough coffee yet.
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Post by JudgeRatty on Apr 11, 2014 7:31:41 GMT -5
The letter says that "RCALJ Bede testified that several ALJs in his region had inappropriately high reversal rates." Page 5. As an outsider, I am not sure I understand this. Question: Does a High Reversal Rate = A High Allowance Rate? Really Dumb Question: Can a GRANT be reversed? I recognize that if an ALJ denies a claim, then the a claimant can appeal. My question: If the ALJ GRANTS the claim (in whole)can SSA appeal? Does it? How can you be reversed if you GRANT an appeal? PS: Contrary to popular belief, there IS such a thing as a "dumb question." If you are in Washington DC and ask "Is there a Starbucks near here?" That is a dumb question. Reversal in this sense is a pay case. The ALJ is "reversing" the last determination by the State agency. If the case is "affirmed" then the ALJ is affirming the last State agency determination, which would be a denial of benefits or a denial of the appeal. There are blended cases if you will, where the claimant was found disabled but he/she is appealing the onset date. The AC does own motion reviews of pay cases, and they may not feel it is supported and it gets remanded. Then there are the cases where the claimant requests review of a case for either an onset issue or an unfavorable decision. There is no one on the SSA side to appeal as there is no opposing counsel at the hearing. However, the AC does have the power to reverse an ALJ denial of benefits and just pay the case at that level, and they have done so, not often that I have seen, but it does happen. More frequently they remand for further development on a particular (or many) issue. It is not until the Court level that OGC is on the side of SSA to have someone arguing for the agency.
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Post by JudgeRatty on Apr 11, 2014 7:35:50 GMT -5
Sorry, my last transmission was garbled! Not enough coffee yet. Doe a High Reversal Rate = a High Denial Rate? If only denials can be appealed, then high reversal must mean high denials? Nope, see the last post. Reversal means reversing whatever the decision was so if at the hearing level, the ALJ can "reverse" the State agency unfavorable determination and thus find the claimant disabled. At the AC level, the AC can reverse an ALJ unfavorable decision and pay the case outright. No remand. And denials are typically appealed by the claimant but there may be a partially favorable case where the claimant is appealing the onset date. And favorables get reviewed by the AC on their "own motion." Typically though, the AC reviews cases due to the appeal by the claimant in which they request review.
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Post by dudeabides on Apr 11, 2014 7:39:56 GMT -5
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Post by JudgeRatty on Apr 11, 2014 7:43:25 GMT -5
My focus was on when can the ALJ be reversed? Can/does anyone appeal if an ALJ Grants a disability claim in toto? Who would do so?
There is a short window, 60 days, for the Appeals Council to review a decision on it's own motion. So just because a claimant receives a favorable decision (a reversal of the lower level determination) and is found disabled, not out of the woods yet. www.ssa.gov/OP_Home/cfr20/404/404-0969.htm
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Post by hopefalj on Apr 11, 2014 7:48:06 GMT -5
My focus was on when can the ALJ be reversed? Can/does anyone appeal if an ALJ Grants a disability claim in toto? Who would do so?
There is a short window, 60 days, for the Appeals Council to review a decision on it's own motion. So just because a claimant receives a favorable decision (a reversal of the lower level determination) and is found disabled, not out of the woods yet. www.ssa.gov/OP_Home/cfr20/404/404-0969.htmAnd to add to this, it's a rarity when a favorable decision is reviewed by the AC. I'm not sure I've even had any that I've written reviewed over the past 13 months.
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