Slepian Smith, PLLC

Arizona SSDI rejection rate high after doctors' file review

A recent investigative journalism piece revealed that some doctors hired to review applications for Social Security Disability Insurance or Supplemental Security Income may be working too fast to achieve a high degree of accuracy. The Nashville Tennessean said in May that the federal government does not have data readily compiled about doctors in each state who review medical and other records to determine whether claimants are disabled and eligible for SSDI or SSI benefits.

When the USA Today Network made an information request about these doctors' workloads and the speed with which they work, the government said it would cost more than $2 million to compile the information requested.

Application processing

When a person applies to the Social Security Administration, or SSA, for SSDI or SSI, the federal agency collects the necessary information and determines financial, age, work history and other elements of eligibility not related to medical impairment. To determine whether the claimant meets the federal definition of disability required for benefits, the SSA sends the file to Disability Determination Services - DDS - a state agency that contracts with the SSA to assist with processing these applications.

DDS gets outstanding medical records from the claimant's own doctors and, if necessary, sends the claimant for consultative examinations, or CEs, to assess any aspects of impairment for which evidence is insufficient. The SSA prefers to use the applicant's own treating doctor for a CE, but DDS may send the person to an independent doctor.

Physician reviewers

After developing the medical record, a doctor on staff or contracted with DDS usually reviews the file to determine whether the claimant is disabled. The Tennessean said that in that state, doctors were "reviewing up to five files per hour," with the expectation being only 1.5 cases in an hour. DDS pays physician reviewers by the application, not per hour, so there is an incentive to move quickly.

Applications, however, can include "hundreds or thousands of pages" of evidence, so it is hard to imagine how a doctor could accurately assess disability in 12 minutes on average.

The Tennessean said that in fiscal year 2018, state reviewers of disability applications denied 65%, but in Arizona, DDS denied more than 70%.

This investigation underscores the importance of involving an attorney as early in the SSDI or SSI claims process as possible. A lawyer will see that the medical record is adequately developed, and that the DDS doctor's determination of disability is supported by the medical record. If a denial is contrary to the evidence, legal counsel can take steps to have the claim reviewed.

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