Articles from prior issues of The Advocate

July/August, 2000

Reflections on the SWADE Conference
Hearing Officer Panel
by Lizz Salinas

One of the more interesting sessions at the SWADE conference this year (yes, I am a Hearing Officer!) was the Hearing Officer (HO) panel headed up by the standing chair of the NADE HO committee, Keith Odom, of New Mexico. Accompanying Keith was our very own, Mac Crone, Supervisory HO, from the Houston ODH (Office of Disability Hearing), and a visiting HO supervisor, Joan Scarlata, from the Arkansas DDS. Results of a recent HO survey were shared and discussed, as well as some ideas that will be brought to the NADE Board for clarification from SSA.

Mac Crone provided a detailed history of the Hearing program, and pointed out that the ODH workloads are dependent on the number of CDR cessations that are processed by DDS. Social Security has always done CDRs in “fits and spurts”, so the ODH workloads naturally vary as well. DDSs have been inundated with Hearing assignments after periods of change in SSA policy or legislation that affects the disability program. Congress reinstated the Medical Improvement standard with P.L. 97-455 in 1983. Beneficiaries were then entitled to face-to-face hearings, with the right of representation, and were encouraged to produce new evidence or additional medical records to support their appeal. The McGeorge School of Law began their training of HOs and has been instrumental in shaping the program ever since. However, CDR workloads became discretionary in 1985, and HO workloads fizzled. Then came new legislation regarding DAA and Welfare Reform (P.L. 104-193), and the ODHs were again inundated. In the last few years, there has been much attention given to the Hearing Program, and most states have expanded their programs, at least temporarily, to deal with the high volume of DC and Age 18 Redets. At one point, the Texas DDS had 27 HOs to cope with the sky-rocketing workloads!

The results of a survey conducted by Keith Odom were also shared. Questions dealt with length of hearings (average about one hour), number of hearings a week (up to 9 in some states), whether HOs handle both the pre-hearing case and the hearing cases (not recommended). One state did not reverse hearing decisions “on the evidence” if a continuance was possible, and always held the hearing (HOs can reverse decisions without a hearing in some cases). Safety and workload issues were also addressed. Discussion also centered on HO safety, workloads, and other types of duties that HOs could perform in times of low assignments. Some HOs conducted face-to-face interviews with HIV-positive claimants, developed other projects, worked initial claims, conducted training, etc. when assignments were down. HO decisions are also subject to a Federal review now and there has been only one return that the group was aware of. Hearing decisions have been reviewed in the past, but Federal reviewers generally agreed with the HOs and discontinued their review as unnecessary. Since the HO actually observes the beneficiary, it is difficult for a reviewer to reverse a decision or “substitute” judgement. If a HO and their supervisor cannot agree on a hearings decision, the file can be sent to Baltimore for assistance (this is rarely needed, by the way).

Clarification was needed on a few questions: Are HOs empowered to make an “equals” decision, or do these decisions have to be signed by a State Agency Medical Consultant (SAMC). SSA will be consulted on this issue. Texas currently requires the HO to route such a decision to the medical section for review. Also, the definition of an “ex parte” decision was discussed. A HO is not allowed to seek SAMC consult or any other information (records, third party contact, etc.) after a hearing unless the results of such contact are shared with the beneficiary in writing. But can HOs ask general questions of a SAMC without this being considered ex parte? Clarification will be sought, but most HOs felt that general, non-case specific questions could be asked. For example, there may be an obscure medical term or abbreviation in the records that a SAMC would immediately recognize. Such questions should not be considered ex parte. (Are you familiar with the term “FLK”? That is “Funny Looking Kid” to you!)

Joan Scarlata offered many tips or good practices for all DDS employees, HOs included. She encouraged us all to keep a good balance between quality and production. In particular, she emphasized the importance of remembering that there is a human being behind each claim we handle. Try to treat each person with dignity and remember they have feelings too. Good advice, Joan!