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USCG CWO4

Does Anyone Know Why Its Longer For More Complex Claims?

16 posts in this topic

I recently retired and submitted my BDD claim. There were multiple items claimed and from what I have read it will take longer to get my claim processed. As a matter of fact they estimate late Dec 2012 to April of 2013 and I filed and had my C & P exam in February but my retirement date was 01 May. I understand that it will take longer for my claim because there are more items and its more difficult, but do they take the easier claims and put them on top of the pile? Don't they process claims in the order in which they are received? If so this would mean all claims would take about the same amount of time.

I am a patient man so I understand it will take time, just curious about the process.

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Not to be a smartass, but the title to your post answers the question it asks...In my experience though, they're not "supposed" to put more difficult claims at the bottom of the pile, they work them in order in which they were received. Now, I know many members here may flame me, but remember, that's how it is "supposed" to work!!

Semper Fi!

P.S. I've been waiting on a very simple dependents claim now for the better part of a year, so I hope you are a vvvvveeeerrryyy patient man...!

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Complex = lots more to do!

I initially filed with help from the state commission on vets affairs, and the guy wrote it up with a whole lot of claims... depression, anxiety, back problems, sleep problems... on and on. This was not smart, it just confuses the raters (it shouldn't but it does...) I eventually filed for reconsideration after being denied outright. On the second round, I had some assistance from a social worker in the PTSD unit who focused on this.

When I was finally awarded, it was for PTSD solely. All else either fell under this category or was ignored. So, yes, simple and bare bones probably stands a better chance. If the rater is very responsible and attentive, and there are lots of contentions, then they have to follow through on a number of things, C&Ps for several issues, etc. If they are NOT as responsible as they should be it just looks like work!

I would say, don't ignore serious issues, but it is probably to your benefit to keep it as simple as possible.

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This is what I thought was happening. It's an extract from the NY Times article from June.

http://www.nytimes.c...ner=rss&emc=rss

"The employees also complained about the performance review process used to measure their productivity, saying it reduced the quality of work and hurt morale. The process requires claims processors to complete a certain number of files per day. People who fall short can be denied promotions or fired. Those who meet or exceed quotas become eligible for bonuses.

The workers said those quotas encourage processors to take shortcuts that often lead to mistakes, or to focus on easier cases over complex ones. And when in doubt, processors tend to deny claims, the workers said, because denials are generally faster."

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Yes, I saw this. On one of the other well known websites, a moderator who alleges he was a DRO trainer gave an entirely different view point suggesting that Va employees erroneously award benefits because its faster than a denial.

While I knew this former DRO was feeding us with KRAP, I was pleased to get it refuted by employees who work there. It makes me wonder what else this DRO posted when he knew it was false.

A denial has to be faster. There are no calculations and retro to figure out, and multiple signatures are not required for a denial. They simply "cut and paste" the letter, and fill in a reasons and bases for denial. While awards also have a "reasons and bases", a Veteran is unlikely to ever dispute the "reasons" your benefits were awarded.

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Yes, that the more you claim the longer it takes to get the claim settled. Claims are worked first in first out... but that does not mean that a claim that was submitted after your claim is decided after your claim.. it means you claim is started first and however long it takes to connect the dots is how long it takes to get a decision. It happends a lot that a newer claim is decided before older ones and this happends because some claims are submitted with everything necessary to decide it. while other claims are received with no information and the VA has to get medical records, and request c/p exams.

As to a denial being harder than an approval.... this is true!

Approvals are really easier because to get an approval all the facts are know and the facts justify the award

Denials however must be justified......they are not faster....

And I doubt that few awards are ever given if a denial is warranted, but ironically many denials that turn out to be incorrect.....

Just like that effeciency report we got in the Army (EER, SEER etc... ) the rater must justify his comments with facts, it is a lot eaiser to tell the truth and rate correctly that it is to make something up and rate down....

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