When Social Security disability medical consultants make mistakes when determining whether an individual qualifies for benefits, people can go without medical care and income for years. With more than 720,000 people in line to have their cases heard, many claimants die before their ALJ hearings.

Speeding Through Disability Claims

Recently, a USA TODAY NETWORK investigation found that some medical professionals don’t spend enough time reviewing claims. The investigation revealed that doctors review as many as five cases per hour when the federal standard for reviews is 1.5 files per hour.

The combination of understaffing and a large number of cases leaves more room for error and incorrect claims denials. One of the main reasons why medical consultants are racing through the review process is because they are paid by the case. As a result, many details are overlooked, leading to wrongful denials.

The NETWORK investigation discovered that one doctor in Tennessee failed to locate a hospital discharge paper that would have proven that a patient’s colorectal cancer had become metastatic and inoperable. The patient would have qualified for disability, but the doctor denied the claim. To obtain benefits, the claimant had to appeal his denial.

It’s important for medical consultants to thoroughly examine SSD applicants’ papers, as application files can include hundreds or thousands of pages of lab test results, medical records, work histories, and doctors’ notes. The doctor’s opinion is a crucial part of determining whether or not an applicant is qualified for social security disability benefits.

A medical consultant’s incorrect determination could cause disability applicants who should qualify for benefits to go without medical care, income, or housing. If claimants appeal, they could wait for months or even years for their chance to be heard.

Insufficient Data Centralization

The absence of centralized data is another factor contributing to wrongful disability denials. When the NETWORK investigation called for a Freedom of Information Act request regarding doctor performance data in each state, the SSA responded that it would take 72,100 hours to collect the information. That could entail up to 60 employees working full-time without taking any time off for a full year.

This lack of centralized data raises concerns about how the SSA can ensure disability claims are adequately reviewed.