SSA Continues Prejudicial Policy

Monday, September 28th, 2015

A few years ago, the Social Security Administration (“SSA”) began a program using the misnomer “quality” review. This program uses an imbalanced approach that only considers decisions where Administrative Law Judges (“ALJ”) approve disability benefits, so the program’s alleged of purpose of seeking greater consistency is fallacious.

I have had several more cases pulled for quality review in just the past few weeks. Not surprisingly, all were approvals. Today, yet another fully favorable ALJ decision was approved, and immediately pulled for quality review. There was an overabundance of medical and vocational evidence supporting the ALJ’s decision, including operative reports, multiple functional assessments, an FCE, and contemporaneous clinical records.

Hypocritically, the SSA failed to conduct a quality review on the State agency decision that had previously denied the claimant’s Social Security Disability (“SSD”) application. The State agency ignored: (a) the conclusions of the treating sources in favor of her own non-medical opinion; (b) the claimant’s subjective complaints even though typical for someone with the claimant’s medical conditions; (c) the requirements for sedentary and light work. The State agency simply denied the application because the claimant properly refused to attend an unnecessary consultative examination (“CE”) that would have violated the Social Security rules and regulations.

The State agency lied and said that it did not contact a treating doctor because there was none, which is patently belied by the medical reports in the SSA file, as well as the claimant’s application. Each treating doctor was ready, willing, and able to perform the CE. The State agency also lied by claiming that there was no indication there was opinion evidence from any source, which is also belied by the medical reports in the SSA file. To make matters even worse, the State agency expunged critical and supportive evidence from the claim file.

I advised the SSA that it was incumbent upon it to conduct an investigation into the State agency’s misconduct. Instead of investigating the State agency’s decision denying SSD benefits where evidence of improper processing was presented, the SSA investigated the ALJ’s decision approving SSD benefits where there is no evidence of improper processing. So much for caring about the consistency and quality of decision.

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