New Instructions For Attorney-Advisor Decision

     Social Security has issued new instructions for Attorney-Advisor (AA) decisions (also called Senior Attorney decisions0 after claimants requests a hearing before an Administrative Law Judge (ALJ). The idea is that clearly meritorious claims would be quickly approved by AAs. The AAs would not deny any claims. If the AA couldn't approve a claim, the claimant would still get an ALJ hearing. The point of the AA decisions is to help reduce the backlog of pending requests for hearings.

     The AA decisions have been around for many years. Since 2010 when Republicans gained control of the House of Representatives there have been few AA decisions. Not coincidentally, the hearing backlog has mushroomed. The AA reviews conducted in recent years seemed to me to be a waste of resources. I would get a call from an AA saying they were reviewing a case. The AA would ask for certain pieces of medical evidence and demand that the evidence be submitted in two weeks or less. That's completely unreasonable. Most medical providers don't respond to requests in that kind of timeframe. When I told an AA that I couldn't get the evidence in within the timeframe they were giving, I was told that the AA couldn't hold onto the case any longer. However, it was often the case that I had already requested, obtained and submitted the records that the AA wanted suggesting that the AAs weren't reviewing the files too closely before calling. It didn't seem to matter what records were submitted or how strong the case was. We wouldn't get any action from the AAs. The AAs seemed to be almost incapable of approving a claim. They were just spinning their wheels. The agency would have been better off if the AAs were drafting decisions for ALJs.

     We'll see how these new instructions are implemented but I see no evidence in them that there will now be large numbers of AA decisions. In past years when there were many AA decisions, cases were selected for AA review based upon profiles of claims likely to be approved by ALJs. The profiles were top secret but it wasn't hard to see the

pattern -- mentally ill claimants and older claimants. I though the profiles worked pretty well. I never understood why they were abandoned unless the point was to hold down the number of claims approved by AAs. The new instructions suggest to me that cases will not be selected for review based upon profiles. Here are the selection criteria in the new instructions:

  • New and material evidence is submitted;
  • There is an indication that additional evidence is available;
  • There is a change in the law and regulations; or
  • There is an error in the record or another indication that a fully favorable decision may be warranted.

      I suppose the "another indication that a fully favorable decision may be warranted" language would cover profile selection but I can't think of a reason why they wouldn't say they intend to use profiles. The first two criteria could be used to cover virtually any case with a pending request for hearing. Reviewing virtually all cases wouldn't be a good thing. There's too much effort wasted on cases where the AAs can't or won't issue a favorable decision.

     The instructions suggest that there will be a two level process. One person will hand select a case for AA review and then another will actually do the AA review. That's labor intensive. The instructions carefully forbid an AA from actually reviewing a case that he or she has selected for review, suggesting a process that almost requires that two AAs agree before an AA decision is issued.

     It looks like there won't be that many AAs participating in the process. Only those selected to a national "team" will be allowed to participate. The instructions themselves say the "team" is a "small group."

     After an AA decision is issued there will be four different levels of "quality review" which suggests a deep uneasiness with AA decisions.

     It still looks like the agency thinks that holding down the number of disability claims approved is far more important than dealing with its hearing backlog. I hope to be pleasantly surprised but I'm not expecting much from this. Meanwhile, the hearing backlog continues to grow.

Category: Advisor

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