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Just How Does Social Security Evaluate Claims?

Earlier this month, The Tennessean ran an interesting piece detailing the newspaper's efforts to obtain information about the workload of Social Security medical consultants.

These doctors, paid by Social Security, make the first decision about whether a claimant is disabled. Their decision can be the difference between a claimant getting benefits in just a few weeks, or waiting years to get through the appeal process.

The federal standard for medical consultants is to review 1.5 files, which can potentially contain hundreds of pages of medical records, each hour. In Tennessee, some medical consultants are claiming to review five files per hours, a pace which is too quick to fully evaluate a claim, according to the article.

It could be why Tennessee as one of the highest denial rates in the country.

The article goes on to detail the case of one man who applied for disability benefits for inoperable colorectal cancer that had metastasized, a condition which clearly entitles a claimant to disability benefits.

His claim was initially denied, and he had to appeal it before getting the benefits he was entitled to.

Unfortunately, such cases aren't unusual.

When the newspaper's owner, USA Today, sought national data about medical consultant decisions through the Freedom of Information Act, they were told that due to the decentralized nature of Social Security offices, this information would cost $2.3 million to obtain.

It might be awhile before that information becomes public (if it ever does), but the good news is that the data that has been released already is helping claimants successfully appeal unfairly denied claims as administrative law judges become aware of what's going on.

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