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A Social Security Disability Claim Denied By Fault Of The SSA - Are Any Of Them Held Accountable For Their Mistakes?

Houston, TX |

Consider the scenario of a social security disability claim that ends up taking many, many years to get approved. The claim suffers from many mistakes throughout each stage of the 5 step process and involves the local SSA, DDS, ODAR, the AC, and an ALJ - each has contributed to the delay of benefits.

For this scenario, the claimant has written to each department trying to point out the many errors of record yet nothing was ever corrected. If in the end the claimant can show the claim should have been approved at the initial stage (before any hearing), is there ever any reprimand to those involved that contributed to the constant errors? If not, what is to keep them from making the same mistakes again? What happens when a claimant suffers from a total collapse of due process?

Attorney Answers 4

Posted

If there were consequences upon reversal of a claim in terms of reprimands to decision makers early in the social security disability appeal process there would indeed be blood running in the halls of the state DDSs. Arguably the same claim at initial may not be the same claim at reconsideration in the sense that later important medical evidence may have become available at recon. While I would agree with the notion that accountability is a problem in any institution, particularly government, I would see great potential for unfairness in punishing earlier deniers when a later decision-maker says yes.

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Posted

Thanks for replying. I understand what you are saying about how a claim can change during the 5 steps based on new evidence, but my scenario only considers the issue when (for whatever reason the claim was finally approved), if that same exact evidence was in the record even at the initial level and DDS just disregarded it all. I've read many reports where studies have shown (and even past DDS workers have admitted) most of these employees don't even understanding most of the diseases that pass their desk, yet they were either required to deny the claim or they were persuaded. I just don't understand how the system can complain about their backlogs yet they are the ones causing a claim to be passed back and forth for years because no one is doing their job properly. Maybe it's self-inducing job security, but I find it repulsive that there is nothing anyone can do about a system that is apparently broken. It is my believe that those in power to make change simply don't for reasons unknown. I was just wondering if there was something in place similar to EAJA (where the government would be held somewhat accountable for erroneous denials), but at the earlier stages of the process. I think the whole system would run much smoother if the government was held accountable for their lack of due process.

Stanley F. Denman

Stanley F. Denman

Posted

You make so very good points. The system is very flawed.

Posted

The short answer is there is no "reprimand" to anyone at SSA for their decisions, and nothing prevents them from making the same mistakes or same kind of decisions. That is how the system is set up and, unfortunately, the client suffers. There is no remedy for the client - except perhaps an EAJA fee for the attorney if the case has o go to Court and the government's positions was so egregious that the court agrees SSA was not "substantially justified" in making the decision it made, which could reduce the fees the client has to pay the attorney.

Best of luck to you!

The exact answers to questions like this require more information than presented. The answer(s) provided should be considered general information. The information provided by this is general advice, and is not legal advice. Viewing this information is not intended to create, and does not constitute, an attorney-client relationship. It is intended to educate the reader and a more definite answer should be based on a consultation with a lawyer. You should not take any action that might affect your claim without first seeking the professional opinion of an attorney. You should consult an attorney who can can ask all the appropriate questions and give legal advice based on the exact facts of your situation. The general information provided here does not create an attorney-client relationship.

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Thanks for replying. I've read other peoples' concerns about how they think their lawyer is purposefully (according to them) causing the ALJ to deny the claim just to take the claim to federal court. Is there "more money" to be awarded to the lawyer if a claim is won at the federal level? If so, that seems like that's an invitation for ethically-challenged lawyers to prolong the claim as much as possible. I know there are "things" that can be done to punish unethical behavior "after the fact", but what happens when a claimant feels their lawyer is currently practicing these types of questionable tactics? Does a claimant has to wait until the decision has been made before they can report certain behavior? I know this is a tricky area because if a claimant believes their lawyer is up to no good and reports them (and no unethical behavior was discovered), wouldn't that create an awkward relationship for the claimant and lawyer? Is there a way a claimant can contact a third-party to explain the circumstances and get an opinion of whether that behavior "should" be reported?

Posted

Each level of review accords you the right to appeal the decision and to cite the errors. The term "error" falls into two categories: legal and factual. You are the expert in the facts of your case, but unless you are an attorney practicing SS law, it is highly unlikely that you have the legal knowledge to spot and understand all of the legal errors, and whether those errors may be "harmless" errors. You sound very frustrated and appear to have been through many levels of review, although I do not see federal court listed in your question. You also do not state whether your claim was ultimately approved. I strongly suggest, that if you have not yet been approved, seek the advice of an experienced Social Security attorney regarding the next level of appeal, or the advantage/disadvantage of filing a new claim. If you were finally approved, then it is indeed unfortunate that the process was so frustrating for you. There are no reprimands to those who reviewed your case at any level - it comes down to each reviewer's "interpretation of the evidence" which is why you have the right to appeal. Good luck to you.

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Posted

"but unless you are an attorney practicing SS law, it is highly unlikely that you have the legal knowledge to spot and understand all of the legal errors, and whether those errors may be "harmless" errors." Kind of an insulting comment I think. "highly unlikely" surely doesn't mean "possible". Maybe you are used to dealing with claimants who don't have the intellect to actually read and research disability law. I certainly don't need a degree in law to know when errors have been made. I stopped reading after the insult.

Asker

Posted

"highly unlikely" surely doesn't mean "NOT possible". I've studied the facts of my claim for over 3 years including POMS, SSR's, Hallex, and read over 150 applicable federal case's. I think that's plenty of research material to know where the errors are in my claim not to mention whether they are harmless or not.

Posted

The fact that a claim was eventually approved does not by itself mean that there was fault upon the agency. There are many complex rules and regulations that Social Security must follow in evaluating a claim. Even in cases were we use the same information to get a case approved that was submited with the initial claim does not mean that the agency intentionally denied this claim.

Your only rights, unfortunately, are to file your administrative appeals. In some cases, we have had cases expedited when we were able to show an obvious adminstrative error, like Social Security using the wrong date of birth.

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Posted

Thanks for replying. I swear, I must have that one in a million claim where so many apparent errors were made but never corrected. For example, I have passed the 3 year mark on my claim yet I should have been approved from the initial application. I clearly qualify at steps 1 and 2 of the 5 step process, and I believe my claim should have been approved at step 3 because I meet a listing. There are 2 criteria for listing 14.09C1, and my medical records have clearly noted where I have the required fusion (in fact, not only do I have the SI joint fusion, but also have severe fusion throughout my spine). The second criteria requires fixation at 45° from the vertical. I have four radiology reports stating I exceed that measurement. In all the appeals process language, they (the SSA/DDS/AC/ODAR/ALJ) for some reason are stuck on the criteria of step 4 (it's as if they have completely overlooked the step 3 evidence). Even then, my 3 RFC reports from my doctors have marked my limitations well below sit/stand/walking 2-3 hours a day (and that's including pain). Like you mentioned with using the wrong date of birth, I think the major error of my claim is that the SSA screwed up my AOD in the beginning and entered an AOD that is 8 years beyond what I submitted. The AC has already approved of the AOD I submitted, yet someone, somewhere, something is still screwing around with my claim. I'm confident I will get a fully favorable decision once the proper person does their job properly - in the meantime, I feel as if I have wasted over 3 years of stress over what I'm positive will be a decision based upon the same evidence as I had on day one. This is why I think it's maddening that no one can be held accountable for such crucial errors.

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