Social Security Disability Fraud Investigations

The Social Security Administration uses Cooperative Disability Investigation (“CDI) Units to investigate potential fraud.  The CDI units work with the Office of Inspector General (OIG) as well as state and local law enforcement agencies.  Such investigations take place during the entire application process, and also during continuing disability reviews.  Investigations can be generated by state agency employees, SSA employees, private citizens, anonymous sources, and law enforcement agencies.  During the investigation, the CDI Unit can interview the application, interview third parties, conduct surveillance, and/or examine the claimant’s social media accounts.  It appears such investigations are expanding.

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Video Hearing Opt-Out

A few months ago SSA published rules regarding video hearing procedures. The rules provide that SSA will notify the claimant prior to the hearing that the hearing may be conducted by video teleconferencing. The claimant has the opportunity to object to the procedure and demand an in-person hearing, but must do so in writing within 30 days.

New Ruling SSR 14-1p

SSR 14-1p should be consulted in any case involving chronic fatigue syndrome. If you suffer from Chronic Fatigue Syndrome and are unable to work, contact The Hamilton Firm for a free consultation.

2013 Appeals Council Statistics

In fiscal year 2013, the Appeals Council took approximately one year to process requests for review. Almost 77% of the requests were denied by the Appeals Council.  In other words, the Appeals Council refused to review almost 80% of the requests filed. Approximately 17% of the requests resulted in a remand. About 1% of the requests for review by the Appeals Council resulted in a favorable decision.

If the claimant is denied, the decision on whether to re-file for benefits or appeal the decision to the Appeals Council is very difficult.  If you decide to appeal to the appeals council, it will probably take at least a year to get a decision, and about 80% of those requests will not even be reviewed.  If you decide to appeal your claim to the Appeals Council, make sure your attorney or representative is able and willing to consider taking the case to Federal Court.

Evaluating Medical opinions

The regulations require an ALJ to evaluate every medical opinion. 20 CFR 404.1527(b): “we will evaluate every medical opinion we receive.”  The evaluation must comply with 20 CFR 404.1527(d).  Remember, a treating source opinion should not be rejected absent “good reasons.”  Id.

GAF Scores must be properly considered by the ALJ

A recent case from the Eastern District of Tennessee resulted in a remand on a number of important issues. The first issue discussed in this post concerns GAF scores:

The ALJ rejected the Global Assessment of Functioning (“GAF”) scores. The ALJ reasoned that GAF scores “are not based on standardized norms and admittedly provide only a snapshot impression of an individual’s psychological status. . . .” (Tr. 16). The ALJ further stated that “detailed observations and descriptions in a provider’s notes are a vastly superior reflection of an individual’s true functional abilities than a shorthand GAF score. . . .” (Id.). As Plaintiff notes however, the ALJ does not cite to any observations and descriptions from treating providers to contradict the assigned GAF scores. Plaintiff argues the ALJ rejected the numerous GAF scores in the record that would support a finding of severe social and occupational impairment (Tr. 16). A review of the record shows that from the time of Plaintiff’s alleged onset date through the date of the hearing in this matter, treating psychologists and psychiatrists at the VA, almost without exception, rated Plaintiff’s GAF at 50 and on one occasion 45. (See, e.g., Tr. 763, 780, 783, 790, 1044 and 1068). In light of the multiple GAF scores in this range, I conclude a fuller explanation of the reason for their rejection is required. I note that the GAF scale shows 41 to 50 as serious symptoms but the range of 51 to 60 reflects moderate symptoms. There may be reasons why the ALJ concluded the scores  did not reflect serious symptoms but the articulation of those reasons is for the ALJ and not this court.

Reynolds v. Colvin, 2014 U.S. Dist. Lexis 8450 (E.D.Tenn. Jan. 3, 2014)

Request for Hearing

A common question I am asked is, “how long will it take until I get a hearing?”  Unfortunately, it takes a long time to get a hearing.  For example, in Chattanooga, where most of my hearings take place, the average time between the filing of a Request for Hearing and the actual Hearing date is currently about 14 months as of November 2013.  In Atlanta, it takes about 15 months.