DDS is dysfunctional.
The 1st appeal of a denied disability claim goes to the Disability Determination Services known as DDS.
1. In 20% of my cases the client is obviously disabled and it requires no expertise in medicine or law to determine this. In 37 years I have never lost a case in this category, yet DDS denied 100% of these cases.
2. I have had a few cases in which it is simple to determine the individual is disabled. In these cases I presented to DDS all the necessary medical documentation and legal analysis to prove disability. DDS denied 100% of these simple cases. Disability benefits were later awarded in 100% of these simple cases by the Administrative Law Judge (ALJ).
3. The time it takes DDS to deny a case keeps getting longer. It often takes 4 – 8 months for DDS to deny an appeal.
4. It is not unusual for an appeal at DDS to get lost. It is not unusual for DDS to deny a case and fail to tell the claimant and the attorney.
5. More than 50% of the time when I call DDS, my phone call is not returned.
The OHO offices in North Carolina are pretty dysfunctional.
The second appeal of a denied disability claim goes to the Office of Hearings Operations known as OHO. North Carolina has four (4) OHOs in Raleigh, Greensboro, Fayetteville and Charlotte.
6. The time it takes for a hearing to be held is extreme and unpredictable. It used to take 24 months for a Hearing to be scheduled. Recently, Hearings have been scheduled as quickly as 6 months. The honest answer is I simply do not know how long it will take for Hearing to be scheduled.
7. The Judge usually does not make a decision on the day of the Hearing. The decision is mailed to my client and myself. It normally takes 2 – 5 months to get the decision after the hearing.
8. Many of the Judges I present cases to are unfamiliar with the file (i.e. the ALJ had not read the file before the hearing).
9. I submit a legal brief in every case. I do a detailed analysis of the medical records and discuss the applicable legal regulations that indicate my client is entitled to disability benefits. I believe the brief I write is the most important service I provide my clients. In many cases the ALJ does not read my brief. Our legal system which is based on individuals being represented by trained advocates (lawyers) cannot function effectively if the Judge will not read the legal brief of the attorney.
The OHOs are the most effective component of the disability appeal process. I have found the vast majority of ALJs to be professional, knowledgeable and fair. I attribute the problems at OHO to be due to inadequate resources. I believe the ALJs are doing a good job under difficult circumstances.
The Appeals Council is dysfunctional.
A denial by an ALJ can be appealed to the Appeals Council known as the AC.
10. The time it takes the AC to decide an appeal keeps getting longer. It currently takes 15 months to get a decision from the AC.
11. Years ago I found the AC to conduct a fair review and more than 50% of my appeals were remanded for another hearing. In recent years the AC’s denial rate has increased to an astronomical 85%. Today remands from the AC seem to be determined by random luck.
Federal Judges in North Carolina favor the Social Security Administration.
A denial by the AC can be appealed to the United States District Court. North Carolina has three (3) District Courts.
12. The Judges in the Western District deny 84% of the disability appeals they review. Those cases that are remanded seem to be determined by random luck.
13. In the Eastern and Middle Districts the denial rate on disability appeals ranges from 26% to 87% indicating a wide difference in attitudes among the Judges. Hence, the prospect for success in the Eastern and Middle Districts usually boils down to luck in terms of which Judge the case gets assigned to. It is an unfortunate statement about a Court of Law when the primary factor that determines the outcome of the case is “luck”.
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We live in an imperfect world. The administration of the Social Security disability program is complex. We must keep in mind that this program helps more than 10 million disabled Americans.
Unfortunately, for individuals who have become disabled but not yet been awarded benefits, the appeal procedure for disability claims is currently broken. Your claim is likely to take three years, and the final decision on your claim will be partially affected by random luck.