There is some bullshit on 60 minutes right now...

[hollowdweller]

67. It's a complex issue

At the first 2 levels which are adjudicated at DDS, the allowance rates are fairly low.

At the third level of appeal, before an ALJ at the OHA way more are allowed.

Most of what I would consider non deserving people are allowed by the ALJ.

Most DDS's have an internal QA component that essentially plays the devils advocate on iffy cases. Then a certain
percentage of those cases are sent to DQB the federal QA unit. So at the first two levels the case gets intense scrutiny.

At the hearing level the law judge does not have that level of scrutiny. The appeals council reviews some of those decisions but mostly denials so if a law judge allows a case his work will be reviewed less than if he denys . So ALJ's can pretty much allow cases the DDS never could. QA would kick them back if DDS did. ALJ has staff to get the info to support his decision, where the examiner at DDS has to pretty much convince the staff to go his way.

However at the DDS level besides being charged with accuracy as determined by your QA error rate, you are also pushed to produce cases at low mean processing time. Allowing an iffy case requires you to QA proof your decision way more than a denial because you have to often try over and over to get the claimants to give you the information you need, especially the vocational information which can be key. Also you have to wait months and often request info from doctors over and over until they give you the key info you know you need to allow that person. Some people will just look at the case on the surface and on the surface it is a denial. But to dig to allow drives up your mean processing time. Slows your production. Drives up your caseload.

So it's good that there are multiple levels of appeal even though some undeserving slip thru.
ay