Originally Posted by Janke

Thanks. My main point in this analysis is that disability claims ARE approved at the initial level.

I also think there are multiple reasons that 23% of approvals are done at the hearings level.
1. Poorly prepared claims have missing information and the claims rep w ho takes the claim has limited time to spend assisting the claimant and the DDS analyst has limited time to search for information that is not provided. Some claimants believe that the medical records speak for themselves and that is simply not true when it comes to disability decisions.

2. Time has gone by. A marginal medical condition has gotten worse; an expected improvement in functioning has not happened; the claimant has had more medical tests and exams and there is more evidence.

3. ALJ's see claimants. DDS analysts do not. The visual and verbal interaction is one more piece of evidence that the ALJ has that the DDS analyst does not have.

4. ALJ's have greater discretion in applying the rules than DDS analysts. They are expected to and allowed to interpret law. DDS analysts do not have law degrees and have more tight control on the decisions they make. But this judicial discretion also creates what SSA calls 'outlier' ALJ's. Some (one in West Virginia comes to mind) approved virtually every claim that came before him and cherry picked the claimants belonging to one attorney. Everyone can see how that smacks of collusion to defraud, not what is correct for an ALJ. But then there are also the 80 year old ALJ who thinks that if he can still work, so can just about everyone else and denies almost all claims. So, there are many claims that are approved by an ALJ that just cannot be approved by the DDS analyst.

5. When a lawyer takes a case to an ALJ, the hearing is really a lawyer to lawyer conversation. And lawyers like to talk law. They like to talk to lawyers and make arguments. I think there will always be a bit of the good ol' boy (or girl) club between reps and ALJ's. And I think that can factor in to decisions as well.