Testing of alternative disability determination models extended

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The Social Security Administration (SSA) announced that it is extending the selection of cases for two alternative Social Security Disability benefits (SSD, SSDI) determination models. The models affected are the “single decisionmaker test” and the “prototype.” Testing will be extended from September 28, 2012 until no later than September 27, 2013 for both models.

Current disability application and appeal process

The current disability determination procedures create a seven-step application and appeal process. The first four steps are before the Social Security Administration and consist of the initial application for Social Security Disability benefits and three levels of administrative review for denied applications:

  • Initial application
  • Reconsideration (in almost all states)
  • Administrative Law Judge (ALJ) hearing
  • Appeals Council

The Appeals Council is the final level of review before the SSA, and all subsequent appeals are handled in federal court. There are three levels of review in federal court:

  • Federal District Court
  • U.S. Court of Appeals
  • U.S. Supreme Court

When reviewing Social Security Disability benefit appeals, federal courts look at whether the SSA’s decision is supported by substantial evidence and whether it acted according to law.

Disability application and appeal process modifications under test models

In the “single decisionmaker test” model, the disability examiner is given the authority, in most cases, to make the initial disability determination without first obtaining the signature of a medical or psychological consultant. This modification to the procedures has the potential of simplifying and expediting the initial application process.

In the “prototype” model, the disability examiner is also given the authority to make initial disability determinations without the signature of a medical or psychological consultant but differs from the “single decision maker test” in the way disability denials are reviewed by the SSA. Under the “prototype” model, reconsideration – the first level of review – is eliminated from the administrative review process, meaning appeals will go straight to the Administrative Law Judge (ALJ) for a hearing. These tests seem to focus on speed as opposed to making accurate medically based decisions.

By eliminating one level of review, the “prototype” model has the potential to expedite the appeals process, thereby saving time, money or both. However, at the reconsideration stage (which is a paper review), claimants are allowed to submit more evidence to supplement their initial application, creating a more fully developed record for the ALJ hearing, should the case proceed to that point. It remains to be seen how eliminating reconsideration may affect a claimant’s ability to obtain a successful appeal. Social Security has tested the elimination of the reconsideration level before in parts of the country with poor results.

Securing the representation of a capable and knowledgeable Social Security Disability attorney to help shepherd a claim for disability benefits through the complex application and appeals process is often the best choice one can make. Experience shows that the earlier a representative gets involved, the greater the chance of success.