Thursday, January 03, 2008

Invisible Disabilities and Disability Adjudication

Disability is an interesting concept in the sense that some physical and mental conditions are, in a relative sense, overt and visible, while other conditions, those that functionally limit individuals to the extent that they could be termed "disabled" and unable to work, are less visible. Sometimes, these conditions are referred to as invisible disabilities, simply because their effects and the limitations they impose are not so easily seen.

Unfortunately, a large segment of the nation seems burdened with the notion that, for an individual to be actually be disabled, they must, if they possess a physical impairment, be wheelchair bound; if they possess a mental impairment, they must be psychotic, have down syndrome, or have an intelligence quotient so low that they are incapable of living alone or engaing in a normal range of daily living activities.

This attitude, unfortunately, affects even disability examiners, the individual who render decisions on social security disability and SSI cases. As an examiner, I found it fairly common for fellow examiners to openly scoff at allegations (conditions that are listed on a disability application) such as depression, attention deficit hyperactivity disorder, bipolar disorder, fibromyalgia.

With attitudes like this, held by the individuals who actually review disability claims, is it always possible to receive a fair and impartial evaluation on a disability application? In my own opinion, the system is much more subjective than most people are aware. For example, if you were to send a case profile through several different units of a state disability processing agency, you might find, depending on the particulars of the case, that you received as many approvals as denials.

A more obvious example, of course, of the subjective nature of disability claim adjudication is the great difference in decisional outcomes between the lower levels (the initial claim and reconsideration levels) and the disability hearing level. In the disability application pool, seventy percent will be denied. In the pool of cases for which the first appeal (the reconsideration) has been filed, roughly eighty-five percent will be denied. Yet, from this combined pool of cases, for those claimants who choose to have a case decided by an administrative law judge, the chances of ultimately winning hover in the 50 percent range.

Without a doubt, outcomes change dramatically at different levels of the appeal system. But why is this? Do some claimants see a worsening of their medical condition?. Yes, in some cases. And, in some instances, claimants simply age into an allowance (i.e. become old enough, while their claim is pending, to benefit from age-based vocational rules).

However, in most cases, neither factor is likely to account much for the huge difference in approval rates between the lower levels and the hearing level. Subjectivity is more likely the answer. Subjectivity and a system whose inherent qualities pave the way for individual unit supervisors (of a state disability processing agency) to impose their own subjective standards on the individual claims examiners who are attached to their units. None of which would be a problem were it not for the fact that disability unit supervisors have a built-in resistance to issuing approvals in the form of quality assurance returns (cases that have been screened by QA units and returned to their originating units for errors---these cases typically tend to be cases that were marked for "approval" versus cases that were marked for "denial").

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