Should your Doctor determine if you get Social Security Disability or SSI in Texas?

Ideally, a Social Security Disability or SSI claimant's doctor (treating physician) should determine whether or not a claimant is awarded disability benefits. After all, this is the same individual who is responsible for monitoring and treating the patient and who is in the best possible position to determine the prognosis and functional outlook (Social Security Disability eligibility always hinges on functionality, i.e. whether or not a person can perform work activity) of the patient.

However, if this was the case, then the social security administration would no longer need nearly as many disability examiners who work on reconsideration appeals nor as many judges who render decisions at the hearing level. Because so many more correct decisions would be rendered at the disability application level, making the need for appeals far less.

Here's why it will never be the case that Social Security Disability decisions in Texas will rest on the opinions of treating physicians.

A. The social security administration has an inherent distrust of personal doctors.

B. The social security administration has the unstated goal of keeping the number of disability approvals down.

Regarding A, I speak from the position of being a former examiner and as someone involved in disability representation. The simple truth is that a detailed supportive statement from a doctor at a disability hearing can make or break a case, while the same letter when viewed at the disability application or request for reconsideration appeal level may be all but ignored.

Why the difference between the two? Because decisions that are made at the first two levels of the system are made by disability examiners and examiners are tightly controlled by their supervisors. In other words, the Social Security Disability and SSI system keeps a close rein on how many approvals these examiners make (chiefly through the threat of external quality control, which tends to focus on approved cases, not denied cases).

Hearing level decisions in Texas, by contrast, are made by independent federal administrative law judges. I've actually heard disability examiners and field office claims reps complain about the number of approvals made by these judges and make statements along the lines of "that decision would never have been made by an examiner" or "those judges make crazy decisions".

However, the decisions issued by judges tend to be better, because judges do not have supervisors and are free to render decisions as they personally see fit. And, perhaps, because they do function independently, disability judges give far more credence to the opinions of treating physicians.

Regarding B, does the social security administration attempt to keep approvals on cases down? I think the numbers speak for themselves. Seventy percent of disability applications are denied by disability examiners. Of those individuals who are denied and decide to file a request for reconsideration an even higher percentage of 85 percent are denied. Yet, of those who persist and go to the hearing level, more than half are eventually approved.

Why weren't these cases approved at the very beginning of the disability process? Because the disability system is, sadly and unfortunately, set up to discourage claimants. And, yes, this does work. Thousands of individuals who are denied never appeal. They give up. This, of course, is something a claimant should never do. Because the odds of being approved lie in the claimant's favor...if they simply refuse to give up and follow the appeals process.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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