What Is the Role of a State Agency Reviewer in a Social Security Disability Case?

 Posted on May 23, 2019 in Social Security Disability

Although Social Security disability insurance is a federal program, it relies on state agencies to evaluate claimants. In Illinois, the office of Disability Determination Services within the Department of Human Services will assign medical experts to review an applicant's medical history. The state reviewers' opinions are then submitted to a Social Security administrative law judge (ALJ), who must consider the record as a whole before making a final decision as to whether the applicant meets the legal criteria to receive disability benefits.

Social Security Failed to Consider 400 Pages of Records in Illinois Man's Disability Case

The state agency reviewers can only do their job properly, however, when they actually have access to all of the relevant medical evidence. Unfortunately, that is not always the case. For example, an Illinois federal magistrate judge recently ordered Social Security to conduct a new hearing for a disability applicant after it came to light the state agency reviewers never considered 400 pages of medical records relevant to the case.

The plaintiff in this case, George K. v. Berryhill, suffers from a number of physical impairments. Initially, the plaintiff's problems revolved around his back, which he seriously injured at work in 2011. But starting in 2015, the plaintiff also began to suffer from seizures and other “seizure-like activity.”

The plaintiff applied for disability benefits in 2014. A Social Security ALJ denied the application in 2017. The ALJ's decision largely relied on the conclusions of two state agency reviewers, who only considered the plaintiff's medical records from 2012 and 2013. That is to say, the reviewers did not look at any of the medical evidence tied to the plaintiff's seizure problems, which began in 2015–after the reviewers completed their assessment.

This was a major red flag, according to the magistrate. Indeed, the magistrate observed there were “nearly 400 pages of medical records the state-agency physicians never considered in this case.” And these records revealed “significant, new, and potentially decisive developments in Plaintiff's health that could have affected both physician's assessments” of his disability status. After all, the magistrate explained, a seizure disorder “is not an insignificant medical issue, particularly if it is not well controlled and an individual is having recurring syncopal episodes, as Plaintiff's was.”

The magistrate went on to explain that based on all of the available medical records, the plaintiff is not capable of “prolonged standing” or able to drive a car. These and other “functional limitations” needed to be considered by the state agency reviewers. That does not necessarily mean the plaintiff qualifies for disability benefits, only that he is entitled to a new hearing where the agency reviewers (and the ALJ) have considered the entire record.

Speak with an Illinois Disability Benefits Lawyer Today

Denial of Social Security disability benefits is often based on incomplete evidence. One way to help ensure the government does not overlook anything is to work with an experienced Chicago Social Security disability attorney. Contact Pearson Disability Law, LLC, at 312-999-0999 today to schedule a free consultation.

Source:

https://scholar.google.com/scholar_case?case=14651321028180627016