Social Security clogged with disability claims

[WriteDown]

Source: MSNBC

TAMPA, Fla. - For all the talk of an impending crisis in Social Security, one already exists: The system is clogged with hundreds of thousands of disputed disability claims, a backlog so big that some people wait years for a hearing.

Social Security officials blame underfunding, understaffing, a dramatic rise in cases and an increasing number of claims involving hard-to-prove ailments, such as back pain, depression and anxiety.

Even with a $500 million infusion from the federal stimulus program, it could take years to clear the backlog. In the meantime, many of those who have applied for benefits struggle to make ends meet....

Read more: http://www.msnbc.msn.com/id/29997912/from/ET/

[pattmarty]

1. My wife waited over 2 yrs under Bush, until she was approved.

edit to add: On top of that we had to get a "specialist" lawyer to "help". By the way, did I mention he got 24% of any settlement? Yeah, a whole lawyer industry grew up under the Bush delay and turn downs of SS disability.

[WriteDown]

2. Looks like the # of claims is just too overwhelming...

The types of injuries that qualify for disability has also been greatly expanded. I don't know how they'll ever fix this.

[pattmarty]

15. Let me tell ya, the Bush admin made things worse (as with almost everything else).

[Lugnut]

3. My daughter-in-law waited almost three years.

She had to hire an attorney to intervene as well. It's beyond appalling.

[EFerrari]

9. In CA, it's taken that long ever since I remember -- the 80s or something.

I think now people are routinely refused the first time out and are then forced to file again with an attorney.

[Pastiche423]

11. I was thinking

that I was lucky to be living in Calif when I finally applied for SSDI. But actually, I believe it was who was president at the time. In 1993, from the time I mailed in the documentation until I received my 1st check was three months.

The backlog began w/the following president. Could it have been because he underfunded government services? You betcha!

[EFerrari]

12. Wow! That's really great. I used to translate those cases

and it seemed like the worse they were, the more they had to fight to get benefits. Mine was denied in 2000 and I was too worn out to try again. Betcha that happens a lot.

[melm00se]

13. Social security

disability claims have always taken forever to get processed, it's not just a Bush phenomena.

This was part and parcel when I worked for a bank back in the mid 80's to the mid 90's.

I remember reading that somewhere between 60-70% of the cases get shot down on the 1st pass and of those 30-40% need some sort of legal assistance during the appeal process as the paperwork requirements are convoluted as hell.

[notadmblnd]

4. hmmmmm... I just lost my Social Security Mothers Benefits

surviving spouses of minor children are provided with this benefit until their youngest child is 16. The letter SS sent me aid that unless my child was disabled, I would lose my benefit April 1. so far and I've been unable to find employment. To make a long story story short, My son was certified LD back in the 3rd grade. I called SS and asked them what their definition of Disabled is since my son is dyslexic and has asthma. They told me that it wouldn't hurt for me to apply to continue with my mothers benefits. So I filled out the application with hem last week. In the mean time, I'm still looking for employment.

[happyslug]

17. Survivors Benefits is one lump sum, divided among a "Wage Earners" "Survivors"..

Survivors include:
1. Children under age 18 (19 or when your child graduates from high School, if your child is still in high school when he turns 18).

2. Spouses of Wage earners when the wage earner's Children are under age 16.

3. Spouses and ex-spouses, who were married at least ten years OR married to the "Wage Earner" at the time of the "Wage Earners" death and who are disabled themselves. Please note if the Spouses Social Security in their own name exceeds the benefit from their spouse, the spouse only gets one of the benefits and that one must be the larger of the two,

4. Children of the wage earner who are found to have been so disabled prior to turning age 22 that they could NOT work in jobs that exist in Substantial Numbers in the National economy.

Remember, the Survivors amount as a set number, which is divided among a person's survivors equally. If a person was married to 10 spouses at least ten years each, each of the spouses has the right to a share (Along with the spouse who was married to the "Wage Earner" on the day the Wage Earner died, even if that was just for one hour).

Now your child is turning 16, thus you lose your right to survivors benefits, but the total survivor amount stays the same. i.e. starting April 1, your child will get an amount equal to what you and your child received prior to your child's 16th birthday.

[notadmblnd]

21. I hope you're right, but I didn't get a letter saying his benefit was going to increase

It would make the difference of keeping my house or losing it. When I spoke to SS last week, the woman who took my application didn't mention my son's benefits increasing.

[Systematic Chaos]

5. My claim was approved almost lightning quick. I was floored.

It took barely 3 months from the date I applied online, for my first check to show up. Then again, my medical references probably inundated them with thousands of pages of various files which clearly show that between my diagnosed and yet undiagnosed problems, I'm pretty screwed up.

[aquart]

7. My sister, too. Suddenly there was a check in her mail.

Since her husband had just been laid off, it was the prettiest check she'd ever seen.

[bkkyosemite]

6. It took me 4 years.

[prolesunited]

8. If you're having problems

contact your congressperson's office. The better ones have ombudsmen who help clear through the red tape.

[Akoto]

10. I'm going through this right now.

My first application received a form letter rejection in three or so months, which is fast. I'm now into my appeal with the help of an attorney. She believes we'll win by the time we go before a judge, but admits that it's probably gonna be a while.

In the meantime, I can't afford the nerve blocks and physical therapy which would probably alleviate a lot of my suffering. I just have to make do with medications and, as symptoms demand, hot baths or ice packs. Not where I pictured myself being at age 24. ;)

[Systematic Chaos]

14. Aw jeez...! That's horrible.

I only just turned 40, so I kinda know how it feels. Granted, a lot of my problems are weight-related, but I've already been told several times that much of what I'm going through was probably inevitable - just the weight problem sped it up. I have veins so tiny that it takes the best phlebotomists 2 or 3 tries to draw blood from me (and we're talking knuckle joints, fronts of my wrists, and other rarely-used places), and only one suitable candidate between both my arms for a PICC line (most people have between 6 and 8 good veins to my 1), and that's already been invaded three times. I wish I would have been smart enough to speak up when I was a little kid and my legs would go completely numb on me every time I was asked to sit on the floor. :(

[hollowdweller]

16. The claims are not backed up at my office

The claims where I'm at are assigned to the DDS within days of when they file at the DO.

There were times back in the 80's where there was a backlog but right now delayed case rates and mean processing time is down. Also now the disability claims are all electronic. So if a DDS gets behind on claims or if the doctors who review the claims get really backed up the claims can be sent to other consultants or other DDS's so they don't get backed up. I'm not sure if all DDS's have the electronic files now but it's been a godsend.

I'm talking about DDS. Now at the third step of the appeal process the hearing before the ALJ's I have heard that's really backlogged in a lot of states and if I am not mistaken I remember something about Obama actually budgeting more than they were asking for to try to help.

In some areas a lot of SSA employees are old and when they retire it's harder for the newer folks to get up to speed. Also most gov't jobs don't pay a lot so in some really economically booming areas it's hard to retain fully trained employees.

For people puzzling about qualification it is complicated. But you can view the regulations that doctors that work for SSA use at this link:

http://www.ssa.gov/disability/professionals/bluebook/

Normally at the initial or reconsideration level the longest delay in processing is documenting a persons allegations. Remember there is a strong functional component to the regulations. Meaning just a diagnosis of most things will not get your allowed. It has to be severe enough to where it really impairs your functioning. Since doctors mainly treat symptoms they don't always take the detailed findings needed down. So you have to go to exams. That adds time. Also some doctors notes are totally illegible. You wait two months for them to come in and then you end up having to schedule an exam anyway.

If you read the criteria at the links above, and actually submit your medical records when you apply it can dramatically speed things up.

Hope this helps.

[bkkyosemite]

18. Many people applying for SSD are denied the first two times and not until they get an attorney do

they have a chance at getting approval. It took me three times and the last with an attorney and a court ordered vocational expert. That Administative Law Judge after hearing from the expert and all the medical documentation approved me fully in 7 days. My attorney had told me and the paperwork had stated it could take 90 days for his decision. I waited four years of anguish to have a judge after hearing everything fully approve within one week. This was years ago but it is not a fast system for those who are going through it. Mine was in 1994. I think it is a travesty for many claimants.

[happyslug]

20. The ALJ must have wrote the decision him or herself

That is the only time I had a decision within a week, the ALJ wrote the opinion herself. signed it and then sent it to Baltimore to be mailed.

[bkkyosemite]

26. Yes I believe he did.

[hollowdweller]

30. Vocational aspect is one where atty can help.

If you do not meet the criteria, but your condition is judged to impair your abilitiy to work to the point that the pool of jobs you CAN do is very limited then you can be allowed. This is more possible the older you are.

For instance say you have a younger guy with a back problem that was a pipefitter. Then you have an older guy, over 55, exactly the same back problem but that guy say worked for 20 years as a pipefitter.

Neither has findings that would meet the criteria in the Blue book but when the doctors review it they say both men still have the ability to do light work. Well due to the age of the older guy and his lack of transferable skills it is likely that he can be allowed on a Medical Vocational basis. The younger guy has to meet a tougher standard because the way it is set up he's younger, had not worked as long and can learn a new job like a telemarketer or something.

The thing is with the vocational thing it's really tricky because even some older workers could be considered to have transferable skills depending on their job duties. A lot of times the ALJ will impose additional restrictions on what a claimant can do and that tips the scale toward a voc allowance because they have more leeway in setting restrictions. Also many times the vocational analysis will be more in depth due to the use of a vocational expert at the ALJ level and he gets allowed that way.

[happyslug]

19. In Johnstown OHA it is over a year just in that office.

Generally, it takes almost a year from when someone gets their "20 day letter" (The letter telling them the appeal is in the "Office of Disability Adjudication and Review" (ODAR) The new name for what was know for years as the Office of Hearings and Appeals (OHA) has been received by ODAR and a hearing is set).

Generally, it takes just a few months for the local Social Security Office to determine if someone is disabled or not under the rules set forth by Social Security in SSA's "Program Operations Manual System (POMS)". If you meet the POMS you are automatically disabled, the problem is the POMS are NOT up to date, in fact reflect what SSA thinks Social Security Law should be NOT what it is.

On the Other hand, the Administrative law Judge (ALJ) opinion is re viewable by the Federal District Court so it tends to follow what Social Security Law IS NOT what SSA thinks it should be. Thus the problem is NOT the local office, but what SSA tells the Local Office to do.

if the ALJ's were applying the same law as the Local Office, the reversal rate should be a normal reversal rate of 5-6% NOT the 50-75% that is normal at the ALJ level. In my opinion it is this dual layer of laws that is the problem, if SSA would just get its POMS in line with its won Regulations, Rules and decision of the Courts, this whole procedure would be sped up, but SSA (And Congress) likes the delay, hoping some people will NOT appeal for an ALJ hearing (Or even better, look for and get a job, wishful thinking in my opinion but it is a good explanation of the differences at the two levels).

As to the year delay, it was only six months five to six years ago, but has become longer and longer over the last few years. One of the reason is we only have three out of six ALJ Position filled. It is so bad we are using Video Hearings with the Judge from elsewhere in the Country hearing out cases. You get use to it after a while, seeing the Judge on a Large Video screen, just like I see Bankruptcy Judges nowadays.

[KamaAina]

22. Tell me about it. We haven't even had one out here for months!

For the whole state!!

http://archives.starbulletin.com/2008/04/03/editorial/commentary.html

As a lawyer representing disabled people who have been denied Social Security disability benefits, I am deeply concerned about the current situation in our Honolulu Social Security hearing office.

Most of these hearings are litigated before an administrative law judge. The judge who has capably handled claims for Hawaii for many years has recently had some health problems, and has been off on sick leave since about November.

There have been many stories from the mainland about delays in hearing offices around the country, but until recently Hawaii ranked ninth in the nation for speed of processing -- although that still meant people here waited a year for a hearing. Now the wait is indeterminable because no cases are being scheduled at all.

What should happen in a situation like this is that the Social Security Administration's regional office in San Francisco would make an arrangement to have the hearing docket handled by a visiting judge. For some reason this has not happened, and there have been no Social Security hearings in the state of Hawaii since November.

And no mention is even made of the videoconferencing. :eyes: Maybe they ought to try that.

edit: this is even spilling over into the overall budget. Dept. of Human Services ran out of money to fund General Assistance before the end of the year, and had to cut benefits in half. That's right, half. The DHS director is blaming this largely on the SSA backlog, which is keeping people on the GA rolls longer than DHS had anticipated.

[happyslug]

29. San Francisco is in the Western Time Zone (GMT -7), Hawaii is GMT -10

Pacific Time Zone:
http://wwp.greenwichmeantime.com/time-zone/usa/pacific-time/

Hawaii Time Zone:
http://wwp.hawaii-time.com/

Thus you have a 3 hour DIFFERENCE in time between Hawaii and the California (Four hours during the Winter Months when California reverts to Standard time from Daylight Savings time, Hawaii observes Standard time all year round). Four hours is half the work day. So you could have hearings from 9:00 am to noon, Pacific Time (Which is Noon to 3:00 pm Hawaii Time). Noon to 1:00 pm is traditional lunch, thus you can re-start hearing at 1:00 pm Pacific Time, but that is 4:00 pm Hawaii time and most SSA offices close at 4:30, thus nit much time for a hearing. Realistically you only have two hours a day to hold hearing via Video conference (Remember Hawaii also tends to take noon to 1:00 pm off for lunch, cutting out hearings at 9:00, leaving only 10:00 pm Pacific time as the first starting time after Lunch in Hawaii).

While it is possible to work through Lunch, sooner or later some mid-day break has to occur, and that leads to modification of the above time line, not a fundamental change in it.

In my practice Video hearings have always been within the same time Zone, for it is just easier to schedule, both offices involved in the Video Conference do NOT have to think in more then one time zone (i.e. you can assume that in both offices 9:00 is 9:00 NOT 9:00 Eastern, 10:00 Central, 11:00 Mountain, Noon Pacific, 2:00 Alaska, 3:00 Hawaii, and as to Hawaii is it 2:00 for Hawaii may still be on Standard time, while the rest of the Country is on Daylight Saving time).

I suspect the time shift is the biggest problem when it comes to Video Conferences in Hawaii, but remember, Video Conferences are still experimental and you must agree to it. I agree to Video Conference for if I demand a face to face hearing, that may add three to six months to the already one year waiting period at the ODAR level.

One other factor may be that California Administrate Law Judges (ALJs) are holding out for the extra money (Travel and per diem pay) to hold the hearings in Hawaii as a traveling ALJ and that SSA is refusing to pay them per diem (And remember the Judges get pay for mile if they take their own car, but that can only occur within a given area such as California). The Administrative Law Judges (ALJs) may prefer to drive to someplace in California and get the per mile and per diem pay rather then fly to Hawaii just for the extra in pocket money. I do NOT believe that is the case but it is possible.

[KamaAina]

32. Actually the difference is two hours when California and the mainland "fall back" to standard time

three at present. This comes up all the time in terms of various nationwide teleconferences, which are usually scheduled in the afternoon Eastern time so as to include us (and Alaska).

So that'd give us three whole hours to hold hearings during the few remaining months when "standard" time is in effect.

But still, two or three hours a day is better than no hours a day. Perhaps more than one hearing could be going on simultaneously during the brief window?

[hollowdweller]

28. You obviously know the system.

The ALJ's allow people that could never be approved by DDS because of their greater leeway in applying the regulations. The decisions made by DDS are reviewed by an internal QA and a Federal Quality branch DQB and a lot of the allowances by ALJ's would be rejected if reviewed under those same standards.

It would be very cool if DDS could have the leeway to allow that the ALJ's have. Would save a lot of money and the claimants lawyers fees. However that would also take a lot of time because part of the greater allowance rate with ALJ's is also due to having the claimant right there and answering questions and records submitted by the attorney.

People that actually meet the listings are usually allowed by DDS. Where the ALJ's stand out is when the claimant's case is "iffy" and they are Equalled to the listings or allowed on medical vocational basis.

[KamaAina]

23. Sadly, not exactly LBN for people with disabilities

including several DUers:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=250&topic_id=353&mesg_id=353

:argh: :banghead:

[exman]

24. finally got my hearing!

I applied for SSDI in Oct '03. I have now gotten a notice to attend a video hearing in Grand Rapids Michigan. I live in Petaluma Ca. The Judge deciding my case is in San Rafael Ca. (20 miles away). I moved (from San Rafael) in August 08, and submitted four change of address notices,two by mail and two in person. They have not yet been able to process my change of address. My SS documents go to my former address. Why they expect me to do a video hearing from Michigan when the hearing is 20 miles down the road... I would not trust these people to empty the trash. I wonder whose files are they reviewing? I have been homeless, unable to work for many years.
Dealing with this is making me crazier.:crazy:

[goodgd_yall]

25. SS disability process is messed up

I read an article in my local newspaper also on this topic. It stated how 62% of those who get a hearing get approved for disability payments. Now, what is wrong with that picture? Why don't they get it right the first time? Just think of how much money the SS administration would save by cutting down on initial rejections and, consequently, cutting down on hearings. And, of course, the number of people who suffer while waiting for their hearing would be greatly reduced.

[cap]

27. the disability system is a joke

my in-law's husband had a very unusual heart problem where his heart was literally exposed to the open. Poor man had tubes sticking out of him all over the place. There were the top docs in Philly all looking at him 'cause his case was so unusual. My in-law applied for disability on his behalf and was constantly turned down. He was flat on his back in intensive care for months.

She asked me what to do. I said the system is broken and you can't just walk up to the window and ask for what's due ya' that you've paid taxes for all along. You gotta know someone who knows someone. Even though this is a very obvious case. So she got someone to intervene on her behalf and wrote a letter to the judge. One week later she got her check.

The check was not backdated to the date that she had originally filed. So she only got the money going forward.

Sad, sick, dysfunctional system preying on those who are vulnerable.

[JeanGrey]

31. I have cancer. I was approved immediately.

[Lugnut]

35. I was approved immediately as well.

I have incomplete spinal cord injury so there's not much to argue about.

I hope your treatment program is successful.

[williesgirl]

33. Took me 2-1/2 yrs and then it was the Administrative Judge that finally approved it w/help from atty

I swear they're told to just keep denying until that hearing finally happens. I must say though that everyone I've talked to or met with since it was approved has been very knowledgeable, helpful and friendly.

[bitchkitty]

34. God, compared to some of the folks posted on this thread,

I am extremely lucky. About 2 hours ago, I received my letter of approval in the mail, along with $16,000 back pay.

This is my 2nd time on disability, the first time they denied me and I had to go to court. This time they approved me right off. I make a point of not reading my medical records or test results, because I have refused to acknowledge my illness. It is unwelcome. I just try to feel the best that I can every day, so I guess the records confirm that I might be sicker than I thought. But I sure don't feel sick right now - I feel blest!

Anyone who gets denied - get a good lawyer. They will take your case on contingency and get a chunk of your back pay, but it's worth it. Shop around - speak to people who have taken their cases to court. Check out disability forums and do your research on the best lawyers. If you're in Oregon, Martin Cohen in Lake Oswego is awesome. He represented me after I was denied in the first case, which we won. He also represented a friend of mine with back injuries (hard to prove) and got her permanent disability too.

So glad I didn't have to pay a lawyer, but it's worth it because you can get results. NEVER walk into a courtroom without a lawyer!