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Doctor Revolt Shakes Social Security Disability Program

In almost every Social Security disability claim, at some point, the Social Security Administration will call in an “independent” doctor to review the claimant’s file and to make a decision regarding the claimant’s disability. These doctors are paid a low amount of money to review a large volume of cases. That’s obviously a bad situation, and according to an article in the Wall Street Journal it’s going to get much worse in the near future. Anyone with an interest in Social Security disability should read the entire article. Here are excerpts:

Earlier this year, senior managers at the Social Security Administration in Baltimore, frustrated by a growing backlog of applications for federal disability benefits, called meetings with 140 of the agency’s doctors.

The message was blunt: The number of people seeking benefits had soared. Doctors had to work faster to move cases. Instead of earning $90 an hour, as they had previously, they would receive about $80 per case—a pay cut for many cases which can take 60 to 90 minutes to review—unless the doctors worked faster. Most notably, it no longer mattered if doctors strayed far from their areas of expertise when taking a case.

“The implication there was that you really didn’t have to be that careful and study the whole thing,” said Rodrigo Toro, a neurologist who analyzed cases for the Social Security Administration for more than 10 years. Some doctors, including Dr. Toro, quit following the changes. Others were fired. In all, 45 of the 140 left within months, the agency said.

The upheaval, described by current and former doctors and agency officials, is the latest strain on a cash-strapped program struggling to deal with a giant influx of applications.

In targeting the doctors, the Social Security Administration says it is seeking to overhaul a part of the disability-review process that can be both expensive and slow.

But many doctors and former agency officials say the changes threaten the quality of decisions. Several doctors said medical opinions were now prone to inaccuracy since many specialists don’t have the backgrounds to make decisions outside their areas of expertise. The new policy could make doctors more likely to award benefits to those who don’t qualify and deny benefits to those who are entitled, these doctors said.

After the procedures were implemented in Baltimore, an eye doctor was assigned back-pain cases, several doctors said. A dermatologist reviewed the files of someone who had a stroke. A gastroenterologist reviewed the case of someone with partial deafness, the doctors said.

All of the medical consultants working in the program went to medical school or had other extensive training, preparing them for the wide range of cases that might cross their desks, according to interviews with more than 10 of the program’s current and former doctors.

But many of the doctors haven’t practiced outside their specialty in decades, if at all, making the complexities of disability cases even harder to analyze, several doctors said.

Doctors who specialize in nerve disorders “would be hard pressed to evaluate diabetes and heart disease and … leukemia,” said James McPhillips, a doctor who left the program in April once he realized the changes that were coming.

The federal disability system is designed to help people who can no longer work. For many, it represents the social safety net of last resort. Successful applicants receive a monthly stipend and access to federal health-care programs, often for life.

Through a combination of high unemployment, an aging population and an uneven process for awarding benefits, the disability system is under strain and could run out of reserves within six to seven years, say budget experts. That would make it the first major federal entitlement program to go bust in recent history. Applications and appeals, meanwhile, are accumulating in a giant backlog, in part because of the deep and lasting economic slump.

The disability application process has many layers, including hundreds of state-based field offices that accept applications and administrative law judges who weigh appeals.

In addition, the Social Security Administration spends millions of dollars each year on more than 2,000 medical consultants who scour the medical records of Americans who believe they have a disability so severe they can’t work. Most doctors work for the state agencies that administer the program and are sometimes the only people with medical expertise to review claims. Others, like those in Baltimore, contract directly with the Social Security Administration.

Many medical consultants are retired or semi-retired doctors seeking additional income and working under contract, meaning they can be fired with little cause.

The Baltimore office is considered the flagship, according to several doctors and John Delpaine, who oversaw medical consultants there before retiring in December. In its procedures and structure, Mr. Delpaine said, the office sets the standards for offices throughout the U.S.

Bob Kraft

I am a Dallas, Texas lawyer who has had the privilege of helping thousands of clients since 1971 in the areas of Personal Injury law and Social Security Disability.

About This Blog

The title of this blog reflects my attitude toward those government agencies and insurance companies that routinely mistreat injured or disabled people. As a Dallas, Texas lawyer, I've spent more than 45 years trying to help those poor folk, and I have been frustrated daily by the actions of the people on the other side of their claims. (Sorry if I offended you...)

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