Statement of Social Security Disability Coalition, Rochester, New York

As a Social Security Disability and Medicare recipient myself, I wish to discuss below my concerns on how Social Security service delivery challenges affect those two programs. 

Social Security Disability Program Issues

As a person who has gone through the Social Security Disability process myself, I know first hand the financial, physical and emotional devastation that the current SSDI process can cause.  As President/Co-Founder of the Social Security Disability Coalition and author of the Social Security Disability Reform Petition, I see on a daily basis the devastating affect, that problems with this program, has on others all over the country.  I believe that many of the problems an SSD/SSI applicant faces are due to insufficient staffing levels and poor training of current staff.  Since our lives are most directly affected by the inadequacies of the SSA, and must deal with the consequences when it does not function properly, we know first hand where the problems are, and the possible solutions to correct them.  SSA customer service is extremely poor and in major need of improvement across the board.  The Social Security Disability claims process in particular, which should be done quickly, easily, with the utmost respect and compassion for this nation’s most fragile population, has instead turned into one of dread, tedium, disrespect and devastation.  Here is just a small sampling of the constant complaints we receive and issues we face when applying for our SSD/SSI benefits:

• Severe understaffing of SSD workers at all levels of the program
• Extraordinary wait times between the different phases of the disability claims process
• Employees not returning calls, outright refusing to provide information to claimants (due to high work volume/stress levels?)
• Employees greatly lacking in knowledge of Social Security/Federal Regulations - including Freedom of Information Act, Privacy Act, SSD Pre-Hearing review, and hearing on the record processes (due to poor training?)
• Complaints of lack of attention or totally ignoring - claimants concerns and medical records provided (due to high work volume/stress levels?)
• Claimants getting conflicting/erroneous information depending on whom they happen to talk to at Social Security – causing confusion for claimants and major problems including improper payments and financial penalties (due to poor training?)
• Fraud on the part of DDS/OHA offices, ALJ’s, IME’s – purposely manipulating/ignoring information provided to deny claims (rubber stamping of denials to move paperwork off their desks due to high volume of claims and not enough workers?)
• Complaints of lost files and files being purposely thrown in the trash (moving paperwork off their desks due to high volume of claims and not enough workers?)
• Complaints of having other claimants information improperly filed/mixed in where it doesn’t belong causing breach of security (high stress/work volumes can lead to increased mistakes by workers)
• Complaints of backlogs at payment processing centers for initial payments once claim is approved (not enough workers?)
• Employees being rude/insensitive to claimants (due to high stress levels?)
• Poor/little coordination of information between the different departments and phases of the disability process

These complaints refer to all phases of the SSD process including local office, Disability Determinations, Office of Hearings and Appeals, Payment Processing Centers and the Social Security main office in MD (800 number).

High priority should be given to increase SSA staffing levels, and provide better employee training, in all phases of the disability process, especially in the initial contact phases with field offices and DSS offices across the board. Instead we are hearing that staff levels are being reduced as backlogs in the system are increasing!  We fear that inadequate staffing levels and increased work load have caused and will continue to cause “rubber stamping” of SSD case denials across all phases of the disability program in order to meet paperwork processing goals.  Another fear is that we will again experience the “disappearance” or dumping of case files as was discovered in Milwaukee a few years back. 

From GAO/T-HEHS-00-22 - 10/21/99 - SSA Has Had Mixed Success In Efforts To Improve Caseload Management:

“The cost of administering the disability programs reflects the demanding nature of the process: in fiscal year 1998, SSA spent about 4.3 billion, or almost 66 percent of its administrative budget on its disability programs, even though disability beneficiaries are only 21percent of the agencies total number of beneficiaries.”

“The disability process has proved to be a lengthy one that can confuse and frustrate applicants.  Since the early 1990’s, claimants applying for disability benefits have had to wait over a year for a final decision on their eligibility.”

“...because of the multiple levels and decision points in the process, a great deal of time can pass while a claimant’s file is passed from one SSA employee or office to another.  Moreover as a result of these multiple handoffs, and the general complexity of the process, SSA believes claimants have had difficulty obtaining meaningful information about the status of their claims.”

“Long-standing problems with this process were exacerbated when the number of claims for disability benefits increased dramtically between fiscal years 1991 and 1993 – from about 3 million to 3.9 million, or almost 32 percent.  As a result, SSA’s disability workload began to accumulate during this period.  Most dramatically, the number of pending hearings almost doubled between 1991 and 1993 from 183, 471 to 357,564.”

“At the end of 1998, there were still over 380,000 backlogged hearings.  Moreover, SSA expects claims to begin to increase in the near future as the baby boom generation approaches its disability-prone years.”

“The current process also permits inconsistent decision between the initial and appeals levels.  In 1996, about two-thirds of all those whose claims were denied at the reconsideration level filed an appeal, and of these, about 65 percent received favorable decisions at the hearing level.  SSA has determined that at the initial level, denial cases are more error-prone than are allowance cases.

“This inconsistency of decisions has raised questions about the fairness, integrity, and cost of SSA’s disability program.  In fiscal year 1998, the cost of making a determination at the DDS level was $547 per case, while the cost of an ALJ decision was an additional $1385.”

From - 20 CFR Parts 404, 405, 416, and 422

Administrative Review Process for Adjudicating Initial Disability Claims - Final Rule

RIN 0960-AG31

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/06-3011.htm

[Federal Register: March 31, 2006 (Volume 71, Number 62)]

[Rules and Regulations]

[Page 16423-16462]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr31mr06-22]

Part II - 20 CFR Parts 404, 405, 416, and 422

During the five decades that have elapsed since its enactment, the DI program has provided many millions of disabled American workers and their families with critically needed income support. The SSI program, enacted 34 years ago, has similarly helped many millions of low income disabled individuals meet their basic needs. These two programs are a vital part of the nation's social insurance and income support systems.  The number of disability beneficiaries in our programs has grown significantly over the years. In January 2005, nearly eight million disabled workers and their dependents received DI benefits, double the number of beneficiaries in 1985 (about a 100% increase). Nearly six million disabled adults and children received SSI disability payments, more than double the number in 1985 (a 130% increase).  The adjudication of disability claims now constitutes the major part of our workload and nearly every one of our components has a role in administering the disability programs. In fiscal year 2005, the State disability determination services (DDSs) processed more than 2.6 million initial claims for DI benefits and SSI based on disability or blindness. Our hearing offices processed approximately 500,000 disability claims on behalf of claimants who appealed their denials. 

Yet with these numbers there is talk of cutting staff levels even further?  I am sad to say that since these reports were originally released, that things have gotten much worse by far, and the outlook, even with the institution of the SSA Commissioner’s new regulations, is extremely grim.

Medicare Program Issues

In a recent GAO report GAO-06-715T - Quality of CMS Communications to Beneficiaries on the Prescription Drug Benefit Could Be Improved - released on 5/4/06, those eligible for Medicare Part D are experiences serious problems due to poor service delivery.  1/3 of calls to the 1-800-MEDICARE Help Line received inaccurate, incomplete or inappropriate responses.  Some callers had to wait up to 55 minutes to get through before actually speaking to someone (based on 500 calls made by GAO). 

Another GAO report GAO-05-130 - Accuracy of Responses from the 1-800-Medicare Help Line Should Be Improved - released on 12/8/04, 29% of calls received an inaccurate response and 10% received no response at all (based on 420 calls in July 2004).  This report also states that “Training for CSR’s meets CMS’s requirements, but is not sufficient to ensure that CSR’s are able to answer questions accurately on the help line.”

Since Medicare penalizes beneficiaries who do not meet sign up guidelines and deadlines for the rest of their lives, these mistakes create a serious financial burden on those who can least afford it.  Personally, my own mother has been forced to pay higher Medicare premiums for the rest of her life now, because of the inaccurate Medicare information she received.  We taxpayers should not have to pay for the mistakes of poorly trained government employees. 

In an effort to correct some of these problems I suggest the following be done immediately:

Congress needs to increase funding for all Social Security/Medicare programs so more properly trained staff are put in place to handle the increased work load that the Social Security/Medicare programs are facing.  The number of people eligible for these benefits is only going to increase over time as the American population ages at a faster pace compared to decades of the past.

Since millions of disabled and elderly Americans rely on Social Security Disability, SSI, SS retirement benefits and Medicare as their sole source of income, health insurance and prescription coverage, it is imperative that Congress act immediately to make sure that these programs are administered with the highest priority in regards to expediency, efficiency and accuracy.  Anything less than that could result in disaster, even death for this very fragile population.

A major bottleneck in the disability process is the state DDS offices and their inability to process SSD/SSI claims properly.  As a result these Federal regulations are constantly being violated on a daily basis: 

Code Of Federal Regulations Part 404 – Federal Old-Age, Survivors And Disability Insurance (1950- ):

404.1642 Processing time standards http://www.ssa.gov/OP_Home/cfr20/404/404-1642.htm

(a) General. Title II processing time refers to the average number of days, including Saturdays, Sundays, and holidays, it takes a State agency to process an initial disability claim from the day the case folder is received in the State agency until the day it is released to us by the State agency. Title XVI processing time refers to the average number of days, including Saturdays, Sundays, and holidays, from the day of receipt of the initial disability claim in the State agency until systems input of a presumptive disability decision or the day the case folder is released to us by the State agency, whichever is earlier.

(b) Target levels. The processing time target levels are:

(1) 37 days for title II initial claims.

(2) 43 days for title XVI initial claims.

(c) Threshold levels. The processing time threshold levels are:

(1) 49.5 days for title II initial claims.

(2) 57.9 days for title XVI initial claims.[46 FR 29204, May 29, 1981, as amended at 56 FR 11020, Mar. 14, 1991]

 404.1643 Performance accuracy standard  http://www.ssa.gov/OP_Home/cfr20/404/404-1643.htm       

(a) General. Performance accuracy refers to the percentage of cases that do not have to be returned to State agencies for further development or correction of decisions based on evidence in the files and as such represents the reliability of State agency adjudication. The definition of performance accuracy includes the measurement of factors that have a potential for affecting a decision, as well as the correctness of the decision. For example, if a particular item of medical evidence should have been in the file but was not included, even though its inclusion does not change the result in the case, that is a performance error. Performance accuracy, therefore, is a higher standard than decisional accuracy. As a result, the percentage of correct decisions is significantly higher than what is reflected in the error rate established by SSA's quality assurance system.

(b) Target level. The State agency initial performance accuracy target level for combined title II and title XVI cases is 97 percent with a corresponding decision accuracy rate of 99 percent.

(c) Intermediate Goals. These goals will be established annually by SSA's regional commissioner after negotiation with the State and should be used as stepping stones to progress towards our targeted level of performance.

(d) Threshold levels. The State agency initial performance accuracy threshold level for combined title II and title XVI cases is 90.6 percent.

To date the Social Security Administration has determined that it can take up to 1153 days (3-1/4 years) for a claim to be processed if it is denied at every level which often occurs.  The SS Commissioner has stated that she hopes to reduce that wait time by 25% or down to 2-1/4 years, yet she has passed regulations which will force thousands more into the already backlogged Federal Court system which could end up increasing wait times to even longer than the 3-1/4 years.  This is appalling, and shows that she is totally out of touch with the realities that disability applicants face.  I am sure that if she, or anyone else in the Federal government had to endure living under the conditions that a 2-1/4 year or longer wait time for benefits brings, in addition to the hardships caused by one’s disabling conditions, they could not fix the system fast enough. 

We ask that the SSA create the position of Disability Claims Manager – New decision maker position to combine the disability claims responsibilities of SSA field office personnel with DDS staff and that position be a Federal employees instead of State contract employee to insure proper training and consistency of operations and disability decisions throughout the country.  It is more than apparent that the states have been greatly lacking in their duties of processing SSD/SSI claims in a swift and proper manner.

In order to correct these Federal regulation violations and speed up the claims process, more effort should be made to thoroughly review a disability claim at the start, giving more proper weight to claimants treating physicians opinions and medical records, which is part of Social Security law, but is often not followed when making decisions throughout the claims process.   Too much weight at the initial time of filing, is put on the independent medical examiner’s and SS caseworker’s opinion of a claim.  The independent medical examiner only sees the claimant for a few minutes and has no idea how a patient’s medical problems affect their lives after only a brief visit with them.  The caseworker at the DDS office never sees a claimant.  Often claimants are sent to doctors who are not even qualified to comment on a patient’s disabling conditions as their medical expertise is not appropriate for the conditions that the claimant has.  In cases where SSD required medical exams are necessary, they should only be performed by board certified independent doctors who are specialists in the claimant’s disabling conditions (example – Rheumatologists for autoimmune disorders, Psychologists and Psychiatrists for mental disorders).  Independent medical exams requested by Social Security must only be required to be performed by doctors who are located within a 15 mile radius of a claimants residence.  If that is not possible – Social Security must provide for transportation or travel expenses incurred for this travel by the claimant.  If more attention was given to the patient’s treating physician’s reports and test results, it would cut down on the need for SS to spend money on Independent Medical examinations.  When an IME is necessary, sending the claimant to a proper IM examiner for their conditions, would save time and money for the SSA and reduce unnecessary stress to the claimant, instead of wasting these resources on unqualified examiners.  We also agree with the establishment of a Federal Reviewing Official (RO) level of review, that would issue decisions based on review of record.  As mentioned previously, we feel that currently not enough time is spent looking at the medical records supplied by applicants and this results in premature denials and more ALJ hearings.  

There should be more effort on the part of SS to assist applicants throughout the entire disability claim process, including ongoing contact with claims examiners and assistance with developing the medical file to ensure all pertinent medical evidence is in the file. We ask that Congress institute some new requirements.  First, review of records by a claimant should be available at any time during all stages of the SSD/SSI determination process, not only after a case is denied the first time, which is currently the case.  Also before a denial is issued at any phase of their claim, the applicant must be contacted immediately, and given a detailed report as to why a denial might be imminent, who made the determination, and a phone number, fax number and address, where ALL the sources being used to make the judgment can be contacted.  This way for anything that the SSA file is missing, or inaccurate information was given, the applicant can now provide the missing or corrected information before a determination is made.  We also ask that when a denial is imminent, that the applicant be given an additional 3 week time period to submit new evidence in order to further prove their disability status.  Currently, SSD/SSI cases take so long to process, that a majority of claimant’s conditions worsen from the time it takes to initially file a claim, until a final decision is made on it.  Since claim status is very hard to track throughout the claims process, it makes it very difficult for applicants to submit new evidence to further prove their disabilities as their health conditions deteriorate over time.  Ease of claim status tracking and better communication throughout the claims process would eliminate many cases from having to advance to the hearing and appeals phase, which again would save the SSA time and money to be used elsewhere in the system.

The Federal quality review process often adds at least an additional 4 week waiting period to claims processing, and often targets approvals rather than denials and in the future should focus more on why cases are denied rather than approved.  To better streamline and to further speed up the claims process – the DRB (Decision Review Board and Federal Quality Review processes should be combined.  

More Federal funding is necessary to create a universal network between Social Security, SSD/SSI and all outlets that handle these cases so that claimant’s info is easily available to caseworkers handling claims no matter what level/stage they are at in the system.  Even with the institution of E-Dib there are still many problems in this area.  All SSA forms and reports should be made available online for claimants, medical professionals, SSD caseworkers and attorneys, and be uniform throughout the system.  One universal form should be used by claimants, doctors, attorneys and SSD/SSI caseworkers, which will save time, create ease in tracking status, updating info and reduce duplication of paperwork.  Forms should be revised to be more comprehensive for evaluating a claimant’s disability and better coordinated with the SS Doctor’s Bluebook Listing of Impairments. 

A majority of SSD claimants are forced to file for welfare, food stamps and Medicaid, another horrendous process, after they have lost everything due to the inadequacies in the Social Security Disability offices and huge claims processing backlog.  Congress should pass regulations that all SSD/SSI case decisions must be determined within three months of original filing date.  When it is absolutely impossible to do so, a maximum of six months will be allowed for appeals, hearings etc – NO EXCEPTIONS.  Failure to do so on the part of the SSA, will constitute a fine of $500 per week, for every week over the six month period - payable to claimant in addition to their awarded benefit payments, and will be paid immediately along with their retro pay upon approval of their claim.  In addition the SSA will also be held financially responsible for approved claimants who lose property, automobiles, IRA’s, pension funds, who incur a compromised credit rating or lose their health insurance as a result of any delay/failure to fully process their claim within the initial allotted three month processing period.  If a claimant is denied during the three month period but appeals and is finally found to be disabled SSA must retro equivalent compensation of losses incurred by the claimant from original disability date of eligibility. 

Institute a lost records fine – if Social Security loses a claimants records or files an immediate $1000 fine must be paid to the claimant.  Fines of this nature would dramatically cut down the number of lost files by the SSA. 

We are not in favor of any changes that would result in more hearings, lesser back payments or a greater reliance on attorneys for claimants to receive benefits.  The claims process should be set up so there is no need whatsoever for claimant paid legal representation when filing for benefits and very little need for cases to advance to the hearing and appeal stage since that is where the major backlog and wait time exists.  A great number of ALJ decisions are currently appealed due to rampant bias against claimants, fraudulent behavior and poor performance by the ALJ’s currently serving.  The need of lawyers/reps to navigate the system and file claims, and the high SSD cap on a lawyer's retro commission is also a disincentive to expeditious claim processing, since purposely delaying the claims process will cause the cap to max out - more money to the lawyer/rep for dragging their feet adding another cost burden to claimants.  Instead, SS should provide claimants with a listing in every state, of FREE Social Security Disability advocates/reps when a claim is originally filed in case their services may be needed.

The current continuing disability review/CDR process in itself - the threat of possible benefits cut off, and stress of a review by Social Security again, is very detrimental to a patient’s health.  Many who under SS guidelines, still qualify for benefits are being forced into hearing situations and overpayment issues due to mistakes or outright fraud on the part of the SSA, which cuts then off from receiving their vital benefits.  Many people suffer from chronic conditions that have NO cures and over time these diseases grow progressively worse with no hope of recovery or returning to the work force.  This factor needs to be taken into consideration when reforming the CDR process.  In those cases, total elimination of CDR’s should be considered or a longer period of time between reviews such as 10-15 years rather then every 3-7 years, which is currently the case.  This would save the SSA a great deal of time, money and paperwork which could then be used to get new claimants through the system faster.  It is often said that these reviews are done to prevent fraud.  Nobody in their right mind would want to live under the conditions that the majority of SSD claimants and recipients are forced to endure.  Most would much rather have their health back and the jobs that once had before their lives were changed by illness or accidents. 

The Ticket To Work program needs to be revised - SSA forces the disabled to go through years of abuse trying to prove that they can no longer work ANY job in the national economy due to the severity of their illnesses in order to be approved for benefits.  Then, sometimes weeks after they are finally approved for SSD/SSI benefits, after their health and finances have been totally destroyed beyond repair, they receive a “Ticket To Work” packet in the mail.  A cruel joke to say the least, and a total waste of SS funds.  It is no wonder why many disabled Americans distrust the Federal Government!  If more resources were put into processing disability claims faster, the chances of possible health improvement and eventual return to any sort of work activity would be greatly increased.

Congress needs to pass regulations now that prevent tax payer contributions and SS budgets for Social Security programs to be used for anything else other than to pay Social Security benefits and funds necessary to administer its programs properly.

Currently disabled Americans are forced to wait 2 years to be covered under Medicare A, B, or D.  Congress needs to legislate a change to remove the 24 month waiting period so that coverage under all parts of Medicare would start immediately for ALL SSDI/SSI recipients, upon disability date of eligibility. 

Congress should pass legislation to remove ALL late enrollment penalties for ANY part (A, B, or D) of the Medicare program.  Medicare is supposed to be there to keep people healthy, not force them into having coverage, and penalize them into poverty for the rest of their lives, if they miss a sign up deadline.  Medicare should be a healthcare program that rivals any private insurance coverage offered, and one that people would rush to sign up for on their own without the fear of penalties.

Until these issues are addressed, disabled Americans will continue to suffer at the hands of a Federal government program that was originally put in place to help, not harm them.  Current census data states that 18% of the US population is disabled and surely that number will continue to rise.  As we head into a crucial election time in November, it is extremely important for the current and future members of Congress to take our concerns very seriously.  We may be disabled but we still vote!

Social Security Disability Reform Petition – read the horror stories from all over the nation:

http://www.petitiononline.com/SSDC/petition.html

Social Security Disability Coalition – offering FREE knowledge and support with a focus on SSD reform:

http://groups.msn.com/SocialSecurityDisabilityCoalition

Please check out my website at:

http://www.frontiernet.net/~lindaf1/bump.html

“I am disabled and my vote counts too!”