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ADMINISTRATIVE OVERSIGHT? TOWARDS A MEANINGFUL “MATERIALITY” DETERMINATION PROCESS FOR DUAL-DIAGNOSIS CLAIMANTS SEEKING DISABIL-

Date: 
04/01/2004
Author: 
Mazin A. Sbaiti
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The Note advocates for SSA to institute safeguards to protect MIDAA claimants whose cases present meritorious disabilities, from the risk of being erroneously deprived of benefits due to procedural circumstances beyond their control. Adjudicators at all levels need guidelines to follow in evaluating MIDAA cases and in analyzing the evidence presented during materiality determinations. Because adjudicators are supposed to be laypersons, SSA should not rely on their expertise to inquire further into the nature of disorders. Nor should SSA presume that it will be obvious to adjudicators which cause is at the root of a particular impairment. For these reasons, claimants need safeguards to protect them from misfeasance during the inquiry. Failure to establish such safeguards makes the propensity for lay adjudicators to arrive at premature and erroneous conclusions in any MIDAA case unacceptably high, risking the claimant's right to a “meaningful” materiality determination hearing.

Part I of this Note introduces the disability determination procedure and discusses how the CAAA altered the DDS by including a materiality determination procedure. The next three parts outline the hurdles to a meaningful materiality determination.

Part II presents the “hard cases” that arise under the new materiality determination procedure, concluding that these cases should be afforded a presumption of disability.

Part III summarizes some of the evidentiary complexities involved in determining materiality, and describes the often hidden infirmities in the evidence upon which these determinations are based.

Part IV discusses how the standard of review and allocation of the burden of proof create a significant barrier to attaining redress in the courts.

Finally, this Note concludes by outlining some suggested measures that could be taken to resolve these dilemmas.

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