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All Just simply about ClaimsIdeas simply about Reforming the System for the Disabled
by:
Tim Moore
There's an first-class website online promulgated by a Dr. Holden, a former DDS medical consultant. I couldn't help but comment on one of the nice doctor's recent writings in which he does several suggestions for evaluation reform. To get right to the point, Dr. Holden's reform ideas seem to powerfully
revolve about the notions of upgrading the salaries of examiners and instituting a better medical training regime for these workhorses of the system.
Dr. Holden's points are, to several extent, on target. For starters, examiners don't get enough medical training. As a former examiner myself, I don't mind expression that. And I seriously question the entire conception of SDM's ("single decision maker" examiners who can slap decisions on cases without the input of their unit medical consultants----how crazy is that? Examiners are NOT doctors).
Dr. Holden besides questions the soundness of utilizing lawyers--who are now wearing the hats of federal body
law judges--to adjudicate "medical evaluation cases". Personally, I ne'er
actually understood simply why it is that an ALJ (someone with legal training, not medical training) is necessarily needful to control over disablement hearings. Judges are not medical professionals and disablement hearings are not legal court proceedings in the strictest sense. In fact, this is exactly why non attorneys are allowed to represent claimants at such hearings.
I actually have no major problem with any of Dr. Holden's core assertions. However, I guess it's true that we are all, to several extent, limited by our experiences and this holds true for MD's as well.
While Holden's suggestion for much indepth medical training for DDS examiners is a nice one, his suggestions for overall reform miss the REAL PROBLEM (IMO - simply my opinion) with DDS. What's that problem?
Here it is: DQB. As all examiners, reps, judges, and CRs know, a percentage of completed DDS files are sent off to this unit to see if all the i's are dotted and all the t's have been properly crossed. And, interestingly enough, much cases that were MARKED FOR APPROVAL move back reversed i.e. upset than vice-versa.
When a case is returned from DDS, it's like a black mark for the examiner because it directly implies that he or she flubbed up. It's a black mark for the unit supervisor because the return came back to his or her unit. And it's a black mark for the dds administrators because the much DQB returns you get, the worse it does your agency look.
So, human nature being what it is, what is the outcome at all dds locations in the nice old USA?
It means that supervisors tend to exert an iron grip over the examiners in their units. It besides means that supervisors wish always lean much toward denials rather than approvals. And...if a case is one of "those" cases that is right on the line, you can be sure that the examiner won't stick his or her neck out because the likeliness is that the unit supervisor wish have to talk to the examiner simply about his or her decision-making ability, (i.e. imply to them that they better get in line with the program and/or possibly
find a new job).
Now, this may not have occurred to Dr. Holden because he was not an examiner. And it may not have occurred to most reps because they, too, were ne'er
examiners (though several examiners later went on to become attorneys or non lawyer reps). And it surely would-be not occur to an SSA CR
because, for all intents and purposes, they cognize really little simply about the actual disablement evaluation process, aside from the mechanics of taking claims and then process
them once DDS is finished with the medical evaluation.
Of course, I am not expression that we need to fill the spots presently
occupied by ALJ's with level 3 disablement examiners or SSA Disablement Case managers (that is, if they ever actually created such a DCM position). I'm not expression we should get rid of the SDM program (though it wouldn't bother me), or dispense with quality review. But, I do think it's pretty plain that external
quality review has had an insidious effect on DDS claims processing-----with disablement claimants coming out the clean loser.
So, what's the alternative to DQB? In all candor, I don't know. But, regarding such issues (disability system reform from a "structural perspective") possibly that's thing
that the brighter heads in NADR and NOSSCR should chew over and do proposals toward.
Just simply about the author:
The author of this article is Timothy Moore, who, in addition to being a former food stamp caseworker, health care
social worker and AFDC caseworker, is a former disablement claims examiner. He publishes information at Social Safety Disablement Tips and Secrets which features a helpful and informative Social Safety Disablement faq
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