Conditions on SSA "Compassionate Allowance" List Get Quicker Decisions

Social Security added 12 new medical conditions to the list of "Compassionate Allowance" or "CAL" conditions in July 2011. This brings the number of Compassionate Allowance conditions to 100. Claims based on conditions in the CAL list are decided more quickly.

According to SSA, "the [CAL] initiative is designed to quickly identify diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal, but sufficient, objective medical information.

"If the condition does not meet these strict criteria, it will not be designated as a CAL case.

"All CAL-identified conditions are entered into the Predictive Model (PM) and are selected for CAL processing based solely on the claimant’s allegations listed on the SSA-3368 (Disability Report—Adult) or SSA-3820—(Disability Report—Child). Like Quick Disability Determinations (QDD), CAL cases will receive expedited processing within the context of the existing disability determination process." Program Operation Manual System (POMS) DI 23022.015

Go to www.socialsecurity.gov/compassionateallowances/ for a list of conditions qualifying for CAL 

processing.

http://www.disabilityfacts.com/

A Flake in the Blizzard of Recent Attacks on SSDI

Dear Mr. Cavuto, I heard part of your interview with Dan Mitchell of the CATO Institute this afternoon. From hearing that segment I can say that Mr. Mitchell needs to do some homework on Social Security Disability Insurance (SSDI).

He expressed the view that only a "handful" of people genuinely qualify for SSDI benefits; that there is a cadre of doctors who grant disability benefits to people for pay; and that many people don't deserve benefits because the program was designed to compensate people who have serious injuries like the loss of a leg in an industrial accident.

I am well aware of major defects in the SSDI program, having practiced disability law since 1983. The flaws I heard Mr. Mitchell describe are not prevalent.

The prevalent defects of SSDI include:

o Many people lack adequate medical care and therefore can't establish whether or not they meet the medical requirements;

o Difficulty obtaining specific medical documentation for Social Security causes many disabled people to struggle 2 or 3 years for benefits while their health declines.

Also, a large part of the public misunderstands the SSDI program:

o Many people like Mr. Mitchell think doctors grant or deny disability benefits, though doctors only furnish evidence that may/may not lead Social Security to grant benefits;

o Many people like Mr. Mitchell confuse state workers' compensation with federal SSDI. Workers' compensation is the primary compensation system for people injured by industrial accidents. SSDI is primary for everyone else. Confusing the two often causes flaws of workers' compensation to be attributed to SSDI.

There is a crisis in SSDI, which Congress has ignored and disguised over the years by shifting money to SSDI from the Social Security retirement fund, instead of instituting fundamental reform.

Rather than swinging in the dark, people like Mr. Mitchell should do their homework and attack the real flaws in SSDI. These flaws can misdirect scarce benefits to less severely disabled people and make thousands of severely disabled individuals wait years for benefits they need, deserve and paid for with mandatory deductions from their paychecks throughout their working lives.

Sincerely, Doug Smith, publisher, Disability Workbook for Social Security Applicants
August 23,2011

Starting a Social Security disability insurance claim

This succinct description of the forms needed to start a disability insurance claim appeared in the Modesto Bee on January 24, 2011. The text was furnished to the paper by the SSA.

"Q: What is the difference between the disability application and the disability report? Do I have to complete both?

"A: A disability application is a claim for Social Security disability benefits. A disability report provides information about your current physical or mental condition that we need to process your disability application. To establish a claim for disability benefits, you need to file a disability application, submit a disability report, and provide an authorization to release medical records. The best place to start is at www.socialsecurity.gov/applyfordisability"

Disability Facts does not, however, agree that the best place to start a claim is on the Internet, for the reasons stated in our post of December 16, 2010. We think an SSA office is the best place to start a claim, and the runner-up method is by telephone and mail.

Is it safe to file a claim online in 2010?

A Social Security (SS) claims representative says filing claims online is like "tossing blank applications up in the air and hoping for the best."

Page 31 of our 2008 Disability Workbook recommends "Avoid the SSA Internet application procedure for now . . ." We continue to hold this view in 2010.

A union that represents SS claims representatives (CR's) surveyed members about issues to report to Congress. The result published this year include 560 comments. Comments about the SS Internet application process were more often negative than positive.

The question asked of the CR's is:

"Question 26: If you have any comments or concerns about Internet claims or recent policy changes that you would like AFGE to present to Congress, please complete the following."

Perhaps the most negative response on Internet claims said [spelling in original]:

"internet claims are like tossing blank applications up in the air and hoping for the best - they are just a way of keeping claims off the calendar so they don't get a scheduled appointment."

Other negative comments include:

"Many walk-in applicants express extreme frustration with their efforts to file online, including those who are tech-savy, and ask me why they are steered to the Internet to file a complex application w/o assistance."

Another CR said "They will come in and say they have filed by internet, but there will be no application on the system. This is one of the many complaints by the public."

And another " . . . the agency has not been properly funded to insure that technology and staffing can comply with policy. Our technology is simply outdated for the complexity, thus all claims are error prone."

And another "Almost all internet disability claims are incomplete in one way or another and need additional development. This results in major delays in sending the applications to DDS and increased time for a medical decision to be made."

The comments as a whole suggest that there are at least two problems with online application: computer literacy and Social Security literacy. One CR opined:

"As people become more and more comfortable with using internet services, there will be an ever-increasing problem with incorrect payments, disadvantageous choices, missed entitlements and on and on."

The responses were published online by American Federation of Government Employees Local 3272 at: http://tinyurl.com/32qnybr

© 2010 Pds-Third Floor Publishing LLC, All Rights Reserved

Social Security disability - why not conferencing and collaboration at the reconsideration level?

Decision makers at SSA’s first level of appellate review (“reconsideration” in most states) find it hard to assess claimants’ credibility and subjective symptoms because they do not see the claimant. Therefore cases which turn on these questions tend to get passed upstairs to Administrative Law Judges (ALJs) instead of being awarded by reconsideration level decision makers. These cases typically are ones that don’t satisfy a Listing and require assessment of residual functional capacity (RFC).

Being passed up to an ALJ can add between 9 and 28 months to the process of getting a decision, according to SSA figures dated May 25, 2007 obtained by the National Organization of Social Security Claimants’ Representatives (NOSSCR).

Put another way, claimants whose cases require assessment of credibility or subjective symptoms potentially wait up to 28 months for decisions that might take only 3 months if rendered at the reconsideration level. This is avoided in only the best documented cases.

Here is evidence of a fundamental flaw in SSA’s disability decision process: SSA seems ill-equipped to render a favorable decision at the reconsideration level in that class of cases that do not satisfy a Listing and require assessment of credibility or subjective symptoms.

Is it equal or fair treatment when one class of disabled claimants can get awards in 3 to 6 months, while another class can only get awards in 9 to 28 months.

SSA can remedy this flaw. If claimants and their representatives meet with SSA reconsideration decision makers in person or by video-conference, the reconsideration decision maker can see and speak with claimants and determine their credibility and authenticity of subjective symptoms. We understand that most Social Security district offices have video conferencing capability. Moreover, SSA and claimants when conferencing can freely discuss the need for additional evidence and collaborate in obtaining it quickly. This would not only mean quicker awards for disabled people, but also fewer cases being added unnecessarily to the caseloads of Administrative Law Judges (ALJs).

If only 10 percent of appeals had been removed from the ALJ caseload in 2006, this would have meant 50,080 fewer requests for a hearing. The 2006 ALJ caseload would have been 450,726 instead of 500,806. Most important, many disabled individuals would have received desperately needed cash and medical benefits much sooner.

Social Security field office staff shrinking

Social Security field offices lost 873 staff members between October 2005 and September 2006. Field office managers see the agency moving away from community-based services, and toward Internet and telephone services. This was discussed at a meeting of Social Security managers on September 12. Fewer staff members means less help for people struggling with Social Security disability forms.

Individuals with concerns about shrinkage in Social Security field office staffs can express their views to Senators and Members of Congress. The U.S. Capitol telephone number is: (202) 224-3121. Give your ZIP code, and operators will direct your call to the appropriate Senate or House office. When the office answers, ask for the staff member who handles Social Security.

With elections coming up, callers probably will find many listening ears on Capitol Hill.

(Information from minutes of a National Council of Social Security Management Associations executive committee meeting dated September 12, 2006, online at the NCSSMA website. )

To follow developments in Social Security disability, visit: www.disabilityfacts.com

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Should Social Security close offices to the public one day a week, to see if employees work better?

Should Social Security close its offices to the public one day a week, to test whether or not employees process their work better? The Commissioner of Social Security floated the idea of testing this in thirty offices, in remarks made at a ceremony August 9, 2006, at the SSA Teleservice Center in Auburn, Washington.

Also discussed was the possibility of closing SSA offices one day a month if Congress fails to provide the funding SSA believes necessary to support all its programs in the current mode.

Sources: Minutes of a conference call among leaders of the NCSSMA (National Council of Social Security Management Associations) dated August 16, 2006 posted on the Internet; and an August 2006 posting by the General Services Administration (GSA) on the region 10 web page.

To follow developments in Social Security disability, visit: www.disabilityfacts.com

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