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Claim Review Doctors at Social Security Overworked, Underqualified and Underpaid

Posted Nov 21 2011 11:36am

Social Security medical review system under strain If you have received a claim denial notice from Social Security, you are familiar with the language used in these denials:

We have determined that your condition is not severe enough to be considered disabling.  In deciding this, we considered the medical records, your statements, and how your condition affects your ability to work….Doctors and other people in the State agency who are trained in disability evaluation reviewed the evidence and made the determination based on Social Security law and regulations….

Now it turns out that these “doctors and other people” are not so well trained, nor is it likely that they spent more than a few minutes reviewing your file.

An article in today’s Wall Street Journal entitled Doctor Revolt Shakes Disability Program , the Journal describes a system where Social Security administrators are pressing consulting physicians to work faster and to process more files to deal with a growing claims file backup.

Consulting physicians, many of whom are retired doctors looking to earn extra money are being asked to evaluate medical records outside their areas of specialty (such as a case where a pediatrician was asked to review a complex small fiber neuropathy case, or where an eye doctor was asked to review an orthopedic case).  SSA has also cut the case consulting fee for these doctors from $90 per hour to $80 per hour.

As a result of these changes, consulting doctors are leaving the program, further stressing the system and increasing delays.  One former consulting physician recalled that he was fired when he refused to complete a report about a medical issue outside his area of specialization.

What does this internal upheaval at Social Security mean to you?  I think it is fair to say that any progress SSA has made in reducing delays will be difficult to maintain given the increasing number of filings and the difficulty that the agency has in training and deploying trained personnel.

In my office, I no longer assume that Social Security claims adjustors will have time to track down and request copies of my clients’ medical records, or that they will have time to read these records.   In my office, we are taking more responsibility to obtain these records and to summarize them for the adjudicators, consulting doctors and, ultimately the judges.  If I can make the decision-maker’s life a little easier by giving him a reason to approve my deserving clients’ cases, then everyone will benefit.




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