Efficiency is the goal, but claimants are advised to pursue their claims now to get a more fair process. The SSA has published its Final Regulations, making significant changes to the Social Security Disability determination process and procedure. These changes went into effect August 1, 2006. The following is a summary of the changes in the Final Regulations. For a detailed explanation, please see the Federal Register web site at www.gpoaccess.gov/fr .
The New 20 Day “Quick Disability Determinations”
Individuals who are clearly disabled get awarded SSDI or SSI benefits without having to wait too long. The new rule aims to identity those individuals that have a high potential to receive fully favorable decisions, and expedite their process for benefits. A new “Quick Disability Determination (QDD)” unit will handle the claims of individuals who have certain disabilities that are easily verifiable by evidence. This new QDD unit will be comprised of DDS employees who are experienced at making these sorts of disability determinations and have the knowledge and training needed to carry out this function. Each QDD unit will be made up of experienced examiners and a medical expert. A claim will need to be signed-off as qualifying for benefits by both the examiner and expert before benefits are awarded. If an individual meets the QDD criteria for a favorable decision, meaning their disability is one that is highly likely to receive a favorable decision and is easily verifiable by evidence, then the QDD has a 20 day timeline in which to make a favorable determination of the claim. Therefore, such individuals will get favorable decisions within 20 calendar days after their claim is received by the QDD unit from the field office, rather than having to wait for the regular extended periods of time.
The New “Federal Reviewing Official”
A new position at the federal level called the “Federal Reviewing Official,” will be created. This official will review initial DDS determinations upon the request of the claimant. For a long time, there have been complaints that initial determinations were being made inconsistently, unfairly and inaccurately. The new Federal Review Official will seek to ensure that determinations are made correctly at the beginning stages of the Social Security Disability process. This official will have the authority to make a decision as to whether an individual is disabled. The Federal Review Officials will be attorneys, centrally managed, and better suited to perform the function of documenting evidence and writing legally sound decisions as to benefits. An individual may submit evidence at any time while the official is reviewing his or her case, even up until the decision is issued. An individual may request review by a Federal Reviewing Official within 60 days after receiving notice of their initial denial. Further, under this new rule, if a claimant does not make a request for review within these 60 days, they can still request an extension of time to do so even after the 60 day period has lapsed.
The New MVES: Medical and Vocational Expert System
A new Medical and Vocational Expert System (MVES) will be established and it will oversee a national network of medical, psychological and vocational experts. There was recognition of the need for quality determinations at all levels of the Social Security Disability process. The quality, consistency and accuracy of decisions can be significantly enhanced with the use of experts. The MVES will maintain a registry of these experts who can provide assistance to decision makers at all levels of the Social Security Disability process. The rule states that there is currently work being done to create a set of qualification standards for experts that will be published within six months of this rule. The MVES aims to supply a network of experts capable of serving adjudicators across the country. The rule seeks to develop training and certification procedures for all experts that are used in the determination process.
New Time Limits to Submit Evidence to the Judge at Hearing Level
The rule states that an administrative law judge will notify the claimant of the time and place of the hearing 75 days before the date of the hearing. Claimants are now required to submit all evidence no later than 5 business days before the hearing. This will ensure the judge and all experts that will be at the hearing have sufficient time to review the records. There are limited exceptions to this 5-day limit for unusual or unavoidable circumstances. However, late evidence will only be allowed under these narrow exceptions if the evidence would affect the outcome of the case. Therefore, it is now of utmost importance that claimants submit all evidence they want considered in their case in a timely manner. The new rule also requires that claimants submit a detailed statement with their request for hearing, which states why they disagree with the Federal Reviewing Official’s decision and how his or her impairments prevent them from working. Also, a claimant may be required to prepare a pre-hearing statement, which needs to address the issues in the case, facts, witnesses, as well as evidentiary and legal basis upon which the claim can be approved. The judge may also request a mandatory pre-hearing conference, which if a claimant does not attend, can lead to dismissal of the case. Therefore, it is extremely important to be organized and punctual at the hearing stage.
Phasing out the Appeals Council and Introducing the New “Decision Review Board”
A new body called the Decision Review Board will be created to correct the decision errors at all levels of the Social Security Disability process. Claimants who receive unfavorable decisions will be allowed to get another review by the Decision Review Board. However, claimants will be required to submit a statement to the board explaining why they disagree with the administrative law judge’s opinion. The old Appeals Council will be gradually phased out as this new Decision Review Board is implemented through the nation.
Always consult with an experienced social security disability professional when you need help getting your disability benefits.
A Jacoby & Meyers professional can help you at all levels of the administrative process to:
- Assist you with your initial SSI & SSDI application, with filing your request with the Social Security Administration for reconsideration, requesting a hearing before an administrative law judge or filing an appeal with the Appeals Council
- Analyze your case under federal Social Security Disability regulations. Obtain a copy of your file from the Office of Hearings & Appeals to ensure that it reflects all your past medical treatment and that all records and documents contained therein are admissible as evidence
- Ask that any prior SSI & SSDI applications for benefits be reopened
- Protect your right to a fair hearing
- Make any necessary Social Security appeals
We are not retained until the contract is countersigned.