FM/CFS/ME RESOURCES - Disability Claims Delayed As Backlog Increases

 

 
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 Disability Claims Delayed As Backlog Increases

Social Security Disability Backlog a 'Disaster' Steadily lengthening delays in the resolution of Social Security disability claims have left hundreds of thousands of people in a kind of purgatory, now waiting as long as three years for a decision. Two-thirds of those who appeal an initial rejection eventually win their cases.

But in the meantime, more and more people have lost their homes, declared bankruptcy or even died while awaiting an appeals hearing, say lawyers representing claimants and officials of the Social Security Administration, which administers disability benefits for those judged unable to work or who face terminal illness.


The Backlog

The agency's new plan to hire at least 150 new appeals judges to whittle down the backlog, which has soared to 755,000 from 311,000 in 2000, will require $100 million more than the president requested this year and still more in the future. The plan has been delayed by the standoff between Congress and the White House over domestic appropriations.

There are 1,025 judges currently at work, and the wait for an appeals hearing averages more than 500 days, compared with 258 in 2000. Without new hirings, federal officials predict even longer waits and more of the personal tragedies that can result from years of painful uncertainty.


Tough Standards

The disability process is complex, and the standard for approval has, from the inception of the program in the 1950s, been intentionally strict to prevent malingering and drains on the treasury. But it is also inevitably subjective in some cases, like those involving mental illness or pain that cannot be tested.

In a standard tougher than those of most private plans, recipients must prove that because of physical or mental disabilities they are unable to do "any kind of substantial work" for at least 12 months - if an engineer could not do his job but could work as a clerk, he would not qualify - or prove that an illness is expected "to result in death."

In a recent interview, the commissioner of Social Security, Michael J. Astrue, said that outright fraud was rare but that many cases on appeal were borderline. In addition, widely publicized charges in the 1970s that money had been wasted on recipients whose conditions improved led to tighter scrutiny.


Initial Applications Often Denied

Of the roughly 2.5 million disability applicants each year now, about two-thirds are turned down initially by state agencies, which make decisions with federal oversight based on paper records but no face-to-face interview. Most of those who are refused give up at that point or after a failed request for local reconsideration.

But of the more than 575,000 who go on to file appeals - putting them in the vast line for a hearing before a special federal judge - two-thirds eventually win a reversal.

Mr. Astrue and other officials attribute the high number of reversals to several causes. Those who file appeals tend to be those with stronger cases and lawyers who help them gather persuasive medical data. During the extended waiting period, a person's condition may worsen, strengthening the case. The judges see applicants in person and have more discretion to grant benefits in borderline cases.


Major Changes Needed for Progress

Requiring face-to-face interviews at the initial stage could reduce the number of appeals, Mr. Astrue said, "but given the huge volume of cases coming through, it would be incredibly costly, and the Congress is not willing to fund that."

The growing delays in the appeal process over the last decade resulted in part from litigation and financing shortages that prevented the hiring of new administrative law judges. In addition, the number of applications is rising as baby boomers reach their 50s and 60s.

"Once the system got overloaded, it fell farther and farther behind," said Rick Warsinsky, legislative director of the National Council of Social Security Management Associations, which represents managers from the agency.

The extended delays can also mean extra burdens for state welfare agencies. In New York State, about half the 38,000 people now waiting on disability appeals, for an average of 21 months, are receiving cash assistance from the state, said Michael Hayes, spokesman for the Office of Temporary and Disability Assistance.

Mr. Astrue, the latest of several Social Security commissioners to promise speedier decisions, said the agency had already taken steps to ensure quicker initial approval for those most clearly eligible and was holding more hearings by video.

But by all accounts, a major increase in money, judges and support staff will be needed to have a significant impact.

Mr. Astrue said that if the budget impasse continued for too long, leaving the agency budget at its current level, "not only will we not do any hiring, we're looking at furloughs."

A first step of raising the number of judges to 1,200 will require at least $100 million extra for the agency beyond the $9.6 billion that President Bush has proposed for the 2008 fiscal year, Mr. Astrue said. Within a wide-ranging, $151 billion health, education and labor bill passed in November, the Democratic-controlled Congress voted for a $275 million increase for the agency. But Mr. Bush vetoed the bill, calling it profligate.

If the stalemate continues, the government will probably operate on the basis of continuing resolutions, which will keep agency spending at last year's level and doom the plan to add judges.

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