Doctors contracted by the state to review disability applications often processed claims quickly and denied most of them — making big money along the way.
Tennessee has among the highest rejection rates for disability applications in the nation, rejecting 72 percent of all applicants in 2017. The national average for denials was 66 percent.
Here’s what else a USA TODAY NETWORK – Tennessee investigation found:
Doctors who review disability claims are paid per application
That means the faster they work, the more money they make. The federal standard is 1.5 cases per hour. More than half of all Tennessee contract physicians exceeded that. One doctor averaged a case every 12 minutes.
Some applications contain just a few pages. Others include hundreds of pages of doctor’s notes, hospital reports, X-rays, lab results and employment records. Doctors must write a brief report to justify their findings, too.
Outside experts and former and current state employees say it’s impossible to review cases so quickly without making mistakes that lead to wrongful rejections of disability benefits.
Seven high-volume doctors billed for more than $1 million each between fiscal 2013 and 2018. Some made more than $400,000 in a given a year.
“It’s like a cash register,” said one contract physician. “From our perspective it’s unethical. From a consumer’s point of view it can be a tragedy.”
Some doctors have a history of misconduct
At least two doctors under contract with the state are convicted felons. Two other physicians had their medical licenses placed on probation. Another physician had his license revoked twice in the past 20 years and now works on a restricted license that bars him from treating patients.
Man with stage 4 cancer rejected
A doctor who reviewed the disability application for Alan Chrisman, who has stage 4 colorectal cancer, concluded he wasn’t too sick to work. The former stonemason had a golf ball-sized tumor and about a foot of his intestine removed. He lost 40 pounds and sometimes is unable to sit or stand. Still he received a rejection letter after a contract doctor reviewed his file.
Mistakes unlikely to be caught
Chrisman’s denial was later reversed after he hired a lawyer. Another doctor obtained hospital discharge forms that showed his cancer was inoperable and had metastasized.
The truth, though, is that fewer than 2 percent of all rejections are reviewed by the Social Security Administration, so mistakes are unlikely to be caught.
Denials may be appealed, but in the 2017 fiscal year, at least 9,570 people died waiting for their appeals to be heard.
As part of this investigation, the USA TODAY NETWORK – Tennessee examined 5½ years of data for physicians and psychologists who review disability applications. For more stories like this that matter to you and your family, subscribe today.
by Paul B. Burkhalter Managing Partner of Morgan & Weisbrod, Board Certified in Social Security Disability Law.