| | Statement of Social Security Disability Coalition, Rochester,
New York
I am dedicating the
following testimony in memory of Dane Edwards, who applied for Social Security
Disability benefits in October 2006, because of terminal lung and brain
cancer. When he would call to check on the status of his claim he was told
that he must wait like everyone else, and that he should stop calling to
inquire about the status. He obviously did not have the luxury of time. Dane
will no longer be calling and he never received his benefits. He died on
February 13, 2007 - his SSDI disability claim still waiting for approval at the
NYS (DDS) ODTA.
My name is Linda Fullerton, I
am permanently disabled and currently receive Social Security Disability
Insurance/SSDI and Medicare. I am one who was personally affected by the
problem of disability backlogs, which this hearing is supposed to be addressing
today. I must say right from the start, that I firmly believe (while nobody
from the SSA or Congress will ever admit this), the Social Security Disability
program is structured to be very complicated, confusing, and with as many obstacles
as possible, in order to discourage and suck the life out of claimants, hoping
that they “give up or die” trying to get their benefits! This is how the
government systematically robs you of your money in order to use it for other
purposes. This program which was originally set up to help the disabled is
currently failing miserably at this task, and in fact, in many cases it is
causing devastating, irreversible harm to both their health and financial
wellbeing.
I am also
President/Co-Founder of the Social Security Disability Coalition, which is made
up of thousands of Social Security Disability claimants and recipients from all
over the nation. Our group and experiences, are a very accurate reflection and
microcosm of what is happening to millions of Social Security Disability
applicants all over this nation. As a person who has gone through the Social
Security Disability claims process myself, I know first hand about the pain,
financial, physical and emotional devastation that the
current problematic SSDI process can cause, and I will never be able to recover
from it, since I can no longer work.
I find it disturbing that at
this latest hearing and at past hearings, that glaringly absent from your panel
is representation from other disability organizations such as mine. You
continually choose the same panelists from the legal, disability advocate
community when there is any representation at all. I ask again as I have in
the past, that in future Congressional hearings on these matters, that I be
allowed to actively participate instead of being forced to always submit
testimony in writing, after the main hearing takes place. I often question
whether anybody even bothers to read the written testimony that is submitted
when I see the results of hearings that were held in the past. I am more than
willing to testify via video/phone teleconference before Congress, since I
could never afford to travel, and I should be permitted to do so. I want a
major role in the Social Security Disability reformation process, since any
changes that occur have a direct major impact on my own wellbeing and that of
our members. Who better to give
feedback at these hearings than those who are actually disabled themselves, and
directly affected by the program’s inadequacies! A more concerted effort needs
to be utilized when scheduling future hearings, factoring in enough time to
allow panelists that better represent a wider cross section of disabled
Americans, to testify in person. It seems to me if this is not done, that you
are not getting a total reflection of the population affected, and are making
decisions on inaccurate information, which can be very detrimental to those
whom you have been elected to serve. I propose that Congress immediately set
up a task force made up of claimants who have actually gone through the SSDI
system, that has major input and influence on the decision making process
before any final decisions/changes/laws are instituted by the SSA Commissioner
or members of Congress. This is absolutely necessary, since nobody knows
better about the flaws in the system and possible solutions to those problems,
then those who are forced to go through it and deal with the consequences when
it does not function properly.
If you visit the Social
Security Disability Coalition website, or the Social Security Disability Reform
petition website:
Social Security Disability
Coalition – offering FREE knowledge and support with a focus on SSD reform:
http://groups.msn.com/SocialSecurityDisabilityCoalition
Sign the Social Security
Disability Reform Petition – read the horror stories from all over the nation:
http://www.petitiononline.com/SSDC/petition.html
You will read over four years worth of documented horror
stories and see thousands of signatures of disabled Americans whose lives have
been harmed by the Social Security Disability program. You cannot leave
without seeing the excruciating pain and suffering that these people have been
put through, just because they happened to become disabled, and went to their
government to file a claim for disability insurance that they worked so very
hard to pay for.
My organization fills a void
that is greatly lacking in the SSA claims process. I must take this
opportunity to tell you how very proud I am of all our members, many like
myself, whose own lives have been devastated by a system that was set up to
help them. In spite of that, they are using what very little time and energy
they can muster due to their own disabilities, to try and help other disabled
Americans survive the nightmare of applying for Social Security Disability
benefits. There is no better example of the American spirit than these
extraordinary people! While we never represent claimants in their individual
cases, we are still able to provide claimants with much needed support and
resources to guide them through the nebulous maze that is put in front of them
when applying for SSDI/SSI benefits. In spite of the fact that the current
system is not conducive to case worker, client interaction other than the
initial claims intake, we continue to encourage claimants to communicate as
much as possible with the SSA in order to speed up the claims process, making
it easier on both the SSA caseworkers and the claimants themselves. As a
result we are seeing claimants getting their cases approved on their own
without the need for paid attorneys, and when additional assistance is needed
we connect them with FREE resources to represent them should their cases
advance to the hearing phase. We also provide them with information on how to
access available assistance to help them cope with every aspect of their lives,
that may be affected by the enormous wait time that it currently takes to process
an SSDI/SSI claim. This includes how get Medicaid and other State/Federal
programs, free/low cost healthcare, medicine, food, housing, financial
assistance and too many other things to mention here. We educate them in the
policies and regulations which govern the SSDI/SSI process and connect them to
the answers for the many questions they have about how to access their
disability benefits in a timely manner, relying heavily on the SSA website to
provide this help. If we as disabled Americans, who are not able to work
because we are so sick ourselves, can come together, using absolutely no money
and with very little time or effort can accomplish these things, how is it that
the SSA which is funded by our taxpayer dollars fails so miserably at this task?
Now I will relate my own
personal horror story, to give you a first hand look at the havoc, these
backlogs can wreak on a disabled person’s life. On January 14th
1997, due to medical negligence and complications from a simple bump on the
head back on November 3rd 1996, I had major brain surgery (Occipital
Craniotomy) due to 2 forms of strep/1 form of staph infection, which ate their
way through my skull and formed abscess in my cerebellum. As a result of this
Osteomyelitis of skull, I had to have the base of my skull surgically removed
where the brain stem meets my spinal chord. A few months after the surgery I
developed a huge inoperable blood clot in my brain in the left internal jugular
vein. I managed to go back to work for a few years but as a result of the
infections in my brain, and my body’s inability to see that they were gone, I
developed several incurable autoimmune disorders (Scleroderma, Raynaud’s
Disease, Rheumatoid Arthritis, Fibromyalgia, Hashimoto’s Thyroiditis,
Esophageal Reflux Disease, Calcinosis, Telangiectasia) which got progressively
worse over time. By December 6th 2001, I could no longer work and
filed a claim for Social Security Disability benefits. I brought in a stack of
medical records almost 2” thick when I filed my claim at the local office to
prove my disabling conditions, in hopes that it would speed up the process. I
was sorely mistaken, as it took 4 months (March 2002) to process my initial
claims denial. I couldn’t understand how it was possible that anyone could read
about all the medical problems I have, and it not be totally transparent that I
should qualify for benefits, and that I never should’ve been denied in the
first place!
I live in NY State, one of
the ten test states where the Reconsideration phase has been removed. Needless
to say I was still disabled and I immediately filed for an appeal, had to go
through an even more complicated process and was told it would be at least
August of 2003 before I got my hearing if I didn’t die first! On 9/13/02, when I
called the Office of Hearings and Appeals in Buffalo NY to check on my claim
the receptionist told me, that my file was still in the un-worked status,
meaning that nobody was assigned to my claim yet, or even looked at the file at
all since March, when I originally filed my appeal. I expressed my disgust
that after six months in their possession that it had not even been touched
yet! I called them again on 1/23/03 and they told me that STILL nobody had
been assigned to my case and it would be a MINIMUM of five months more or
longer since they were just starting to work on cases that were filed in
November of 2001! The receptionist expressed her sympathy for my cause, and
literally begged me to let others know (especially the government and media) about
how much of a problem they are having. Imagine my surprise when I was calling
them for help and they were begging me – a disabled person, to get them help!
That just proves even further how poorly run the SSD program is. I was told
that there were only 50 employees handling hundreds of thousands of cases.
I
also contacted the Social Security Office of Public Inquiries and the Inspector
General’s office in MD on the problems I was dealing with, and contacted all my
elected officials. In March 2003 I called the hearings and appeals office and
again they said it would be at least August 2003 before someone would look at
my case. I then did some research and found out that I could request copies of
my file (Freedom of Information/Privacy Act) including the reports of the SSD
IME doctor I was sent to, and the notes of the original DDS claim examiner that
denied me, and when I received them, my worst allegations were then confirmed.
Even though I have no real neurological problems they sent me to a neurologist
to examine me, so of course he would find nothing wrong with me, and say that I
did not qualify as disabled. I should have instead, been sent to a
Rheumatologist since most of my problems are caused by autoimmune disorders. I
also discovered that the DDS examiner purposely manipulated my medical
information in order to deny my claim. Even though I filed my disability claim
based on all the physical problems I have, as a PRIMARY diagnosis for
disability, the DDS examiner purposely wrote depression as a primary diagnosis
instead of as secondary one, so of course I would be denied based on that as
well. This was after I had already submitted tons of documents to prove my
PHYSICAL disability – reports/documents that he chose to ignore. I also filed a
formal willful misconduct complaint to the Office of the Inspector General in Washington DC against the DDS office. In April 2003, I requested an immediate pre-hearing
review of my case on the grounds of misconduct and additional physical
evidence. In order to get that process going I had to fax the OHA copies of
their own regulations, since the person I spoke with there had no clue what I
was talking about. Once they got all my paperwork to request the review, a
senior staff attorney, and then a hearing and appeals judge granted my request
and my case was then sent back to the DDS office that originally denied my
claim. Finally it was seen by a different DDS person who actually knew how to
do their job. In two weeks my case was approved at the DDS level and then was
selected randomly by computer (7 out of every 10 cases get chosen) for Federal
review. It then took another three weeks to be processed there. By this time,
I had wiped out my life savings and lived off my pension from a previous
employer which is totally gone now, due to the enormous wait. One month before
becoming totally bankrupt, homeless, losing my health insurance, and everything
else I had worked for the last 30 years of my life, all the retro pay just
showed up in my bank account and I finally won my case by myself, with no
lawyer representing me, exactly 1-1/2 years to the day from when I originally
filed my claim. I actually received my official approval letter on May 26th
2003.
All
the SSD retro pay I received was spent almost immediately – used to pay off
debts incurred while waiting for approval of my benefits, which are nowhere
near enough to live on for the rest of my life. Plus there is always the
stress of having to deal with the SS Continuing Disability Review Process every
few years, where the threat of having your benefits suddenly cut off constantly
hangs over your head. This is a total waste of taxpayer money since there are
no cures for anything I have, and in fact my health has gotten progressively
worse. In addition to what I originally filed for disability on, I now also
have: Gastritis, Hiatal Hernia,
Diverticulosis, Colitis, Irritable Bowel, severe Anemia, Food Allergies (Celiac
Disease Symptoms) and enough other conditions to fill two 8x10 pages (single
spaced 10pt font). I can understand the SSA wanting to verify that I am still
alive and my contact info, but anymore than that at this point is a total waste
of SSA resources which could be used to process new claims.
Since
current Medicare eligibility requirements discriminate against disabled
Americans by making them wait for 24 months after their disability date of
entitlement, I didn’t become eligible for Medicare until June 2004, having to
spend over half of my SSD check each month on health insurance premiums and
prescriptions, not including the additional co-pays fees on top of it. I still
continually deal with enormous stress and face the continued looming threat of
bankruptcy and homelessness, due to the cost of my Medicare, HMO healthcare,
co-pays and basic living expenses, not qualifying for any public assistance
programs.
The
American dream has now become the American nightmare for me, since day to day I
don’t know how I’m going to survive without some miracle like winning the
lottery. I’m now doomed to spend what’s left of my days here on earth, living
in poverty, in addition to all my medical concerns since I’m no longer able to
work. Despite what you may hear, Social Security Disability benefits rarely
cover the basic necessities of life. Stress is the worst thing for anyone who
is already ill to have to deal with. Since my health has deteriorated so
rapidly since this experience, I now see doctors several times a month, and my
medical records fill a huge filing cabinet. If one does not suffer from severe
depression before filing for SS Disability benefits, chances are highly likely
that as a result of the current process, they will be able to add that to their
list of qualifying disabilities. I also know for a fact that many people
contemplate suicide because of the destruction and humiliation they are
subjected to. I did not ask for this fate and would trade places with a
healthy person in a minute. In spite of everything, I am not asking for pity or
sympathy for what has happened in my life. I just don’t want anyone else to
have to live like this, which is why I share my story with you today, since you
in Congress have the ability to prevent horror stories like mine from
happening. Nobody ever thinks it can happen to them. I am proof that it can
and anyone reading this, including you, could be one step away from walking in
my shoes at any moment! More of my
personal horror story can be found here:
A Bump On The Head
http://www.frontiernet.net/~lindaf1/bump.html
Keep
in mind a country is only as strong as the citizens that live there, yet as you
can now see, the Social Security Disability process preys on the weak, and
decimates the disabled population even further. While the majority of Americans were shocked at the
reaction of the Federal government in the aftermath of hurricane Katrina, I
wasn’t surprised at all. Nowhere is this more evident, yet rarely mentioned,
than in the way the Social Security Administration has been systematically
destroying disabled Americans for decades. Americans saw when hurricane
Katrina struck, how the poor and disabled were left to die in the streets when
they needed help the most. I shudder to think of how many more lives will be
further ruined or lost, when the mentally and physically disabled victims of
Katrina, other natural disasters, 9/11 victims who survived that day,
but are now disabled and facing a similar fate, and the other disabled Americans in general,
encounter their next experience with the Federal government as they apply for
their SSDI/SSI benefits. Also nothing is heard about the Veterans who are
injured in the line of duty and have to go through this same scenario to get
their benefits too. There are cases of Veterans rated 100% disabled by the VA
who get denied their Social Security Disability benefits and end up living in
poverty on the streets. Horrible treatment for those who protect and serve our
country.
Social Security Disability/SSDI is a disability INSURANCE
plan, yet the disabled are often treated like criminals when they have to apply
for it. The general feeling is that we are all frauds trying to scam the
system and the SSA must “weed out” the frauds by making it as hard as possible
for a claimant to get benefits. In fact the percentage of claims that in the
end, are not legitimate are very miniscule. Nobody in their right mind would
want to go through this process and live in poverty on top of their illnesses
if they could in fact work. In our country you are required to have auto
insurance in order to drive a car, you pay for health insurance, life insurance
etc. If you filed a claim against any of these policies, after making your
payments, and the company tried to deny you coverage when you had a legitimate
claim, you would be doing whatever it took , even suing, to make them honor
your policy, Yet the government is denying Americans their legitimate Social
Security Disability Insurance claims everyday, and it is no wonder why
claimants are outraged!
According to the report: A
Disability System for the 21st Century – Social Security Advisory Board –
September 2006:
“The process itself tends to
make an individual who might have been able to work at an earlier point in time
less and less capable of doing so.”
Now to the hearing backlogs.
As you can see from what happened in my case, and in the thousands of others
still pending, the state DDS office made a bad decision on the initial claim,
and the claimant must now file an appeal to get the proper decision. The first
problem that must be addressed, and major cause for the huge backlog of
disability hearing claims, is the overwhelming denial rate at the initial DDS
level of the claims process. If claims were processed properly at this stage
of the process there would be no need for the claimant to appeal to the ALJ
hearing phase in the first place.
The SSDI/SSI process is bogged down with tons of
paperwork for both claimants and their treating physicians, and very little
information is supplied by Social Security, as to the proper documentation
needed to process a claim properly and swiftly. When you file a claim for
benefits, you are not told that your illness must meet standards under the
Disability Evaluation Under Social Security “Blue Book” listing of medical
impairments, or about the Residual Functional Capacity standards that are used
to determine how your disability prevents you from doing any sort of work in
the national economy, or daily activities, when deciding whether or not you are
disabled. In other words since the process is so nebulous from beginning to
end, the deck is purposely stacked against a claimant from the very start.
Many times when medical records are supplied by the claimant, they are lost or
ignored. The proper weight is not given to their treating physicians when
evaluating claims and precious time and money is wasted on fraudulent IME
exams. Claimants are forced to see doctors who are not even specialists in the
diseases for which they are sent to be evaluated. These doctors see you once
for a few minutes, and yet their opinion is given greater authority than a
claimant’s own treating physician who sees them in a much greater capacity?
Something is way out of line with that reasoning, yet it happens every day.
States Of Denial
Since Social Security is
widely known as a Federal program, where you live should not affect your
ability to obtain benefits. Sadly this is not the case. What most don’t
realize is that after you file your initial disability claim at your local
Social Security Office or online, that information goes to a state
DDS/Disability Determination Services facility in the state where you live to
be processed. There, the most crucial part of your disability claim, the
medical portion, is reviewed by a caseworker/adjudicator and medical doctor on
their staff who never sees you, and in most cases never even communicates with
you at all. Then they decide whether or not they feel you are disabled based
on the information that you and your doctors have provided.
Since both Congressman
McNulty and myself are from NY State I will use our state as an example here.
The following is from NYS
ODTA/Office of Temporary and Disability Assistance Website (2006)
http://www.otda.state.ny.us/otda%20internet%20search/ddd/resources/ddd_resources_nysserv.htm
“This year the New York
Division of Disability Determinations is expecting to process 275,000 Federal
disability claims under Social Security and Supplemental Security Income
criteria. It generally takes approximately three months for the disability
team to gather all of the medical and vocational information, evaluate the
impact on daily activities, make a determination and process it through the
Federal system. Claimants usually receive notification of the decision within
15 days after a determination is made.”
For example the following is a compilation of the DDS
allowance percentage rates in NYS and how they compare to the national average
of allowances vs denials:
T2 Initial (SSDI) T16 Initial (SSI) Concurrent Initial (SSDI/SSI)
Allow Deny Allow Deny Allow Deny
NATIONAL AVERAGE
44.2 55.8 36.4 63.6 25.3
74.7
New York Region 51.4 48.6
42.8 57.2 33 67
Buffalo, NY 47 53 33.8 66.2
23 77
Source: Statement by
Witold Skwierczynski – President Representing the National Council of SSA Field
Operation Locals – AFGE, AFL-CIO – Congressional Testimony Before the House
Ways and Means Subcommittee on Social Security on Social Security Disability
Service “Improvement” on June 15, 2006 – National and NYS Data - Office of
Hearings & Appeals – ALJ Favorable/Unfavorable Decision Rates – SSA Program
Totals – Number of cases that were originally denied at the state level and
were appealed to the Federal level, and where DDS decisions were either
overturned, upheld or dismissed.
At an overall average 60% denial rate out of 275,000
applicants, 165,000 people were denied their SSDI/SSI benefits in NYS at the
initial level in 2006. What happened to the 165,000 people who were denied
their SSDI/SSI benefits last year, not including those who have filed appeals
from previous years and are still waiting to get their cases heard?
Social Security Disability Program Problems - Contributing Burden Factor on
Medicaid/Social Service Programs For States
A majority of
SSDI 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. If a healthy person files for Social Service programs and
then gets a job, they do not have to reimburse the state once they find a job,
for the funds they were given while looking for work - why are disabled people
being discriminated against? Claimants who file for Social Service programs
while waiting to get SSDI benefits, in many states have to pay back the state
out of their meager SSDI benefits once approved, which in most cases keeps them
below the poverty level and forces them to continue to use state funded
services. They are almost never able to better themselves and now have to rely
on two funded programs instead of just one. This practice should be
eliminated. In all states there should be immediate approval for social services (food stamps, cash
assistance, medical assistance, etc) benefits for SSDI claimants that don’t
have to be paid back out of their SSDI benefits once approved.
From SSA website ssa.gov
dated 6/3/04:
“In the New York region,
there are 14 offices of hearings and appeal, with a total staff of 560,
including administrative law judges, staff attorneys, decision writers,
paralegal and clerical staff.”
Yearly
Totals Total Depositions Favorable
Unfavorable Dismissals
9/28/02 –
9/30/05 110,950 65, 637 25,307
20,006
Source: Social Security
Administration
According to the figures
above, that is 65,637 mistakes, and lives that were most likely devastated by
the faulty decisions made by the NYS DDS office in the past four years. That
does not take into account the percentage of people again, who are still
waiting for hearings, those that have given up and rely totally on NYS support,
when they may in fact still be entitled to benefits but were too weak to
appeal, and worse yet those who may have died while waiting.
Excerpt from the report:
Disability Decision Making: Data And Materials – Social Security Advisory Board
– January 2001:
“In the last two decades, the
percentage of claims adjudicated at the ALJ level that are allowed has been
considerably higher than the percentage allowed by the DDS’s at the initial
level.”
Here are some of the factors
that the Social Security Advisory Board (SSAB) listed in 2001, that affect the
discrepancies of disability decisions between the State and Federal levels of
the disability determinations process.
During the initial claims
process at the State level, most claims are decided based on a paper review of
case evidence. There is very little, to no communication whatsoever between
the claimant and the adjudicator who makes the first decision on a claim.
There is no face to face contact with an adjudicator until a claimant has an
ALJ hearing.
Differences in training given
to ALJ’s and state examiners
Lack of clear and unified
policy guidance from SSA
The involvement of attorneys
and other claimant representatives at the ALJ hearing
Excerpts from GAO Report
GAO-04-656 – SSA Disability Decisions: More Effort Needed To Assess Consistency
of Disability Decisions – Washington – July 2004 which can be found at:
http://www.gao.gov/new.items/d04656.pdf
“Each year, about 2.5 million
people file claims with SSA for disability benefits...About one-third of
disability claims denied at the state level were appealed to the hearings
level; of these, SSA’s ALJ’s have allowed over one-half, with annual allowance
rates fluctuating between 58 percent and 72 percent since 1985. While it is
appropriate that some appealed claims, such as those in which a claimant’s
impairment has worsened and prohibits work, be allowed benefits,
representatives from SSA, the Congress, and interest groups have long been
concerned that the high rate of claims allowed at the hearing level may
indicate that the decision makers at the two levels are interpreting and
applying SSA’s criteria differently. If this is the case, adjudicators at the
two levels may be making inconsistent decisions that result in similar cases
receiving dissimilar decisions.”
“Inconsistency in decisions
may create several problems... SSA rulings are binding only on SSA adjudicators
and do not have to be followed by the courts...Adjudicators currently follow a
detailed set of policy and procedural guidelines, whereas ALJ’s rely directly
on statutes, regulations, and rulings for guidance in making disability
decisions...If deserving claimants must appeal to the hearings level for
benefits, this situation increases the burden on claimants, who must wait on
average, almost a year for a hearing decision and frequently incur extra costs
to pay for legal representation...SSA has good cause to focus on the
consistency of decisions between adjudication levels. Incorrect denials at the
initial level that are appealed increase both the time claimants must wait for
decision and the cost of deciding cases. Incorrect denials that are not
appealed may leave needy individuals without a financial or medical safety
net...An appeal adds significantly to costs associated with making a decision.
According to SSA’s Performance and Accountability Report for fiscal year 2001,
the average cost per claim for an initial DDS disability decision was about
$583, while the average cost per claim of an ALJ decision was estimated at
$2,157...An appeal also significantly increases the time required to reach a
decision. According to SSA’s Performance and Accountability Report for fiscal
year 2003, the average number of days that claimants waited for an initial
decision was 97 days, while the number of days they waited for an appealed
decision was 344 days...In addition, claimant lawsuits against three state
DDS’s have alleged that DDS adjudicators were not following SSA’s rulings or
other decision making guidance...However, according to DDS stakeholder groups,
SSA has not ensured that states have sufficient resources to meet ruling
requirements, which they believe may lead to inconsistency in decisions among
states. Furthermore, SSA’s quality assurance process does not help ensure
compliance because reviewers of DDS decisions are not required to identify and
return to the DDS’s cases that are not fully documented in accordance with the
rulings. SSA procedures require only that the reviewers return cases that have
a deficiency that could result in an incorrect decision...Early on, SSA also
provided extensive cross-training of DDS and ALJ adjudicators, although the
scope of its efforts has since diminished...While SSA initially made progress
carrying out efforts to improve policies and training to better ensure the
consistency of decisions, the agency has not continued to actively pursue these
efforts...Although SSA has tried to address these problems, its inability to
resolve them has contributed to our decision to include federal disability
programs on our list of high risk government programs.”
Excerpts from Office Of
The Inspector General – Social Security Administration – The Effects Of
Staffing On Hearing Office Performance – March 2005 - A-12-04-14098
http://www.ssa.gov/oig/ADOBEPDF/audittxt/A-12-04-14098.htm
HEARING OFFICE DISPOSITIONS, TIMELINESS, AND STAFFING
“Over the last 5 years hearing office receipts have
outpaced total dispositions every year resulting in a large increase in pending
claims (up nearly 104 percent) and a worsening of average processing time (up
nearly 24 percent).” .
“OHA might improve its
productivity if it based its staffing allocations on hearing office staffing
ratios, defined as the number of support staff per ALJ... If SSA would define
performance standards for hearing office employees, SSA could determine an
ideal staffing ratio for OHA's hearing offices.”
TRENDS IN STAFFING, PRODUCTIVITY AND TIMELINESS
“The number of hearing office
employees on duty has increased over 10 percent since FY 1999 (see Figure 2).
The number of ALJs on duty at the end of FY 2004 was up more than 2 percent
from FY 1999 levels.”
“However, even with increased
staffing levels, average processing time worsened. Average processing time
increased by over 24 percent since FY 1999, increasing from 316 days during FY
1999 to 391 days during FY 2004. Average processing time has been impacted by
many factors. Some of the factors influencing timeliness that are not under
OHA's control are the number of new hearing receipts (close to 21 percent
higher than FY 1999 levels, see Figure 1) and restrictions on ALJ hiring.”
“Hearing offices with lower
staffing ratios had, on average, worse hearing office disposition rates.”
“Staffing ratios may be a
good indicator for hearing office timeliness.”
“Fluctuating staffing levels
make it difficult for OHA to balance staffing ratios in hearing offices. OHA
must wait for a hearing office with a higher-than-average support staff ratio
to lose an employee before another employee can be hired in a hearing office
that needs more support staff. OHA would be better able to manage hearing
office staffing if it had an ideal staffing ratio for its hearing offices.”
“To determine an ideal staffing ratio for OHA hearing
offices, SSA would need to conduct national performance standards on the work
performed by hearing office support staff.”
CONCLUSION AND RECOMMENDATIONS
Hearing office staffing
levels rose more than 10 percent since FY 1999 and OHA achieved a record
national disposition rate in FY 2004. However, increased staffing levels have
not been as effective in decreasing national average processing time. Staffing
ratios may be a good indicator for hearing office disposition rates and
timeliness, especially in hearing offices with low staffing ratios. In most
hearing offices with below average staffing ratios, disposition rates were
below national averages and average processing times were above national
averages. National performance standards for the work performed by hearing
office support staff could help OHA management determine an ideal staffing
ratio. Furthermore, it does not appear OHA awarded file assembly contracts
based on any of the hearings key workload indicators, nor could we find any
evidence OHA determined the effect that the additional human resources (file
assembly contractors) have had on staffing ratios, disposition rates or average
processing time for hearing offices that had received file assembly contracts.
To improve overall staffing
at the hearing offices and assist OHA in meeting its performance goals, we
recommend SSA:
Consider developing an ideal
national staffing ratio to assist OHA in allocating staff to hearing offices;
and
Consider prioritizing file
assembly assistance for those hearing offices that have staffing ratios below
the national staffing ratio.
Early Case Screening and Analysis by Administrative Law Judge - In Early Case Screening, ALJs examine unassembled
cases from the Master Docket and may issue immediate on-the-record favorable
decisions. Screening helps eliminate standard delays and additional expense associated
with holding a hearing. Screening also helps identify cases that need further
development which helps move the cases along at an earlier stage. In FY 2003,
ALJs screened about 66,000 cases and issued favorable decisions to
approximately 21,600 claimants, and screened 70,781 cases resulting in over
25,000 on-the-record decisions in FY 2004.
Short Form Software for Fully Favorable Decisions - OHA's hearing offices use standardized software to allow ALJs to
create fully favorable decisions. In FY 2003, ALJs wrote over 23,600 decisions
and 18,750 decisions in FY 2004 using the Short Form Software for Fully
Favorable Decisions, which reduced handoffs and further delays.
Bench Decisions - In Bench Decisions, an
ALJ issues a decision as soon as the hearing is over. ALJs issued over 1,100
favorable decisions from the bench in FY 2003, and issued 3,350 decisions in FY
2004.
Expanding Video Hearings -
Video Hearings enhances OHA's ability
to expeditiously schedule hearings in remote sites. In FY 2003, OHA prepared
and published final regulatory changes, which permit OHA to schedule video
hearings without obtaining advance consent from the claimant. At the end of FY
2003, OHA had video hearing equipment in 35 sites. The total number of fully
operational video hearing sites was 162 at the end of FY 2004.
Dragon Naturally Speaking, Speech Recognition Software - Dragon Naturally Speaking, Speech Recognition
Software assists ALJs and support staff with drafting decisions. In FY 2003,
OHA distributed the software to more than 1,000 decision writers and ALJs.
Digitally Recording Hearings - Digitally
Recording Hearings is a new method of recording hearings that replaces OHA's
aging audiocassette recorders with notebook computers. The notebooks have
state-of-the-art software to record hearing proceedings in a digital file that
can be stored on a hard drive, a local server and in the electronic folder. The
entire digital recording rollout is expected to be completed early in 2006.
Case Processing and
Management System - OHA implemented
the Case Processing and Management System (CPMS) in all 10 Regions in FY 2004.
CPMS is OHA's new case tracking system and a critical component of the Agency's
Electronic Disability Project (eDib). CPMS provides users in OHA hearing offices
with a system to control, process and produce management information on
disability hearings. CPMS includes the following functions: initiative appeals,
case receipt, case development, ALJ review, scheduling features, information
about hearings, case closing and management information.
Centralized Screening Unit - At the
beginning of the third quarter of FY 2004, OHA established an early case
screening program at OHA Headquarters, which was authorized by the Commissioner
during the second quarter of FY 2004. Employees in the Centralized Screening
Unit screened cases from across the country for on-the-record decisions, with
priority consideration given to hearing offices with receipts and pending
levels above the national average and support staff levels below the national
average. The objective of the Unit is to expedite the decision-making process
and reduce the pending levels in the hearing offices. Through the end of the
third quarter of FY 2004, the Centralized Screening Unit received over 2,500
cases and screened approximately 1,484 cases. Of the cases screened, 463 (29
percent) received fully favorable decisions.
The following are
recommendations by the Social Security Disability Coalition for Congressional
legislation and SSA regulations. We believe that these improvements to the
initial phase of the disability claims process, will help to alleviate the
hearing backlog problem, since there will be less need for appeals to the
hearing stage, if claims are handled properly from the onset.
All money that is taken out of American’s paychecks for
Social Security should not be allowed to be used for anything else other than
to administer the program and pay out benefits to the American people.
Increase staffing levels and training throughout the SSA instead of cutting
back staff which is currently being proposed at a time when the population’s
need for these services due to disability/age is increasing.
Currently we call for a
thorough investigation of the state DDS/Offices of Temporary Disability Assistance,
as to the large number of questionable denials of claims, which are then
overturned at the Federal level, their enormous backlogs and processing times.
Lack of staff and proper training can lead to a “rubber stamping” of claim
denials. We recommend the increase of staffing levels, proper training of all
staff at the state level and the creation of an independent oversight panel for
these offices to maintain quality service.
Create independent oversight
panel (possibly the GAO) to investigate the problems including major backlogs
at all levels of the SSDI/SSI claims process.
Consolidation/Coordination
– The Disability Common Sense Approach
For the future, the most
ideal customer service scenario would be to have ALL phases of the disability
claims process be handled directly out of the SSA field offices. Since
SSDI/SSI are Federal benefits why has a State DDS level been added to this
process at all? We must question why this common sense solution is not being
instituted as part of the DSI. We ask that SSA, Congress and the GAO look into
reforming this program in such a way that ALL who handle benefit claims are
Federal employees and consolidate ALL phases of the SSDI/SSI process into the
individual SSA field offices throughout the nation. More Federal funding is
necessary to continue to create a universal network between all outlets that
handle SSDI/SSI cases so that claimant’s info is easily available to
caseworkers handling claims no matter what level/stage they are at in the
system. Since eDib is not fully functional at this time, and even when it is,
keeping as much of the disability process as possible in the SSA field offices
would dramatically cut down on transfer of files and the number of missing file
incidences, result in better tracking of claims status, and allow for greater
ease in submitting ongoing updated medical evidence in order to prove a claim.
In addition, 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 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.
Strict enforcement of, and
fines to be instituted for, violation of Federal Regulation CFR20 404.1642 Processing
Time Standards to be monitored by the
GAO.
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]
For every day over the
threshold for Title II & Title XVI claims under Federal Regulation CFR20
404.1642 Processing Time Standards, daily compounded prime bank interest is to
be paid by the SSA to claimant as compensation.
Strict monitoring and
enforcement of Federal Regulation CFR20 404.1643 Performance Accuracy Standard by the (GAO) Government Accounting
Office and not the SSA
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.
If the state offices cannot abide by the Federal
standards as stated above, we recommend that these duties be removed from the
states and turned back over to the Federal government for good.
Also a new regulation needs
to be legislated for case processing standards for Title II & Title XVI
claims for hearings by ALJ and Federal Appeals courts.
For ALJ hearings, the hearing
must be completed, decision made and processed within 3 months of initial
denial at DDS level. For every day over the 3 month deadline for processing,
compounded prime bank interest is to be paid to claimant as compensation.
For Federal Appeals court
hearings, the hearing must be completed, decision made and processed within 3
months of initial denial at the ALJ level. For every day over the 3 month
deadline for processing, compounded prime bank interest is to be paid to
claimant as compensation. Again these regulations would be strictly enforced
and monitored by the GAO.
Expand use of Federal
Reviewing Official position to all 50 states as soon as possible.
Expand Emergency Advance
Payments (EAP), Presumptive Disability (PD), and Presumptive Blindness (PB)
Provisions to include those applying for Title II (SSDI) benefits. We also ask
Congress legislate for these benefits to take effect for ALL disability claims
immediately upon a claimants request for an appeal, after the initial denial at
the DDS level, until a satisfactory decision is reached, or all levels of
appeal are exhausted on that disability claim. In addition these benefits
would not have to be paid back by the claimant no matter what the outcome of
their claim is.
Disability benefits
determinations should be based solely on the physical or mental disability of
the applicant. Neither age, education, work experience should ever be used
when evaluating whether or not a person is disabled, as long as they meet the
non-medical requirements for receiving benefits. If a person cannot work due
to their medical conditions – they CAN’T work no matter what their age, or how
many jobs or educational degrees they had.
Too much weight at the
initial time of filing, is put on the independent medical examiner’s and
DDS/OTDA caseworker’s opinion of a claim. The independent medical examiner
only sees you 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/OTDA office never sees a claimant. There needs to be more oversight
that disability decisions be based with controlling weight given to the claimant’s
own treating physicians opinions and medical records in accordance with (DI
24515.004) SSR 96-2p: Policy Interpretation Ruling Titles II And XVI: Giving
Controlling Weight To Treating Source Medical Opinions. Even though
this policy ruling is in place, this is very often not happening.
All doctors who are licensed
to practice medicine should be trained and required to fill out Social Security
Disability forms for their patients who need them. FREE copies of medical
records to be provided to all people with disabilities (unless it could be
proven that it is detrimental to their health) upon request. This is crucial
information to ensure that claimants are receiving proper healthcare and a
major factor when a person applies for Social Security Disability.
In cases where SS required
medical exams are necessary, they should only be performed by board certified
independent doctors who are specialists in the disabling condition that a
claimant has (example – Rheumatologists for autoimmune disorders, Psychologists
and Psychiatrists for mental disorders). These exams 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 – any transportation or travel expenses
incurred for this travel by the claimant, must be reimbursed or provided by the
agency requiring the exam. Audio and/or
videotaping of all IME exams to avoid improper conduct by doctors. Copy of
IME doctors findings must be sent to claimant free of charge within one week of
exam unless deemed detrimental to a patient’s health at which point it would be
sent to their treating physician instead.
More communication between
caseworkers and claimants throughout all phases of the disability process.
Review of records by claimant should be available at any time during all stages
of the disability determination process. Before a denial is issued at any
stage, the applicant should be contacted as to ALL the sources being used to
make the judgment. It must be accompanied by a detailed report as to why a
denial might be imminent, who made the determination and a phone number or
address where they could be contacted. In case info is missing or they were
given inaccurate information the applicant can provide the corrected or missing
information before a determination at any level is made. This would eliminate
many cases from having to advance to the hearing or appeals phase.
Remove regulation that
requires SSDI recipients pay back the State for any assistance they receive
while waiting for their Federal Benefits to be processed. They should require
any payback from the Federal Government itself NOT the disability claimants
retro benefits.
The SSA “Bluebook” listing of
diseases that qualify a person for disability should be updated more frequently
to include newly discovered crippling diseases such as the many autoimmune
disorders that are ravaging our citizens. SSD's current 3 year earnings window
calculation method fails to recognize slowly progressive conditions which force
people to gradually work/earn less for periods longer than 3 years, thus those
with such conditions never receive their 'healthy' earnings peak rate.
The need of lawyers/reps to
file claims and navigate the system adds another cost burden to the claimant.
The automatic percentage for payment of representative’s fee, and current high
cap on that fee out of a claimant’s retro pay is proving to be 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” thus not properly representing the claimant. In cases where
claimant uses a paid representative, and is found in fact to be disabled,
any/all expenses incurred for the representation of that claimant should be
paid by the SSA. Also the SSA should provide claimants with a listing in every
state, of FREE Social Security Disability advocates/reps when a claim is
originally filed as well.
Institute a lost records fine
– if Social Security loses a claimants records or files, an immediate fine
(TBD) must be paid to claimant, since lost records will cause a major delay in
claims processing, which can be major detriment to claimant’s health and
financial wellbeing.
When a veteran has a
disability that is 100% service connected, receives VA benefits approval for
that rating, and it is deemed by the VA that they can no longer work, that
veteran should automatically be approved for their Social Security Disability,
as long as they also meet the Non-Medical requirements for SSDI/SSI benefits.
In addition all VA doctors should be trained and required to fill out Social
Security Disability forms for their patients, whose VA disability rating is
less than 100%, but may still be unable to work due to their disabilities and
require SSDI/SSI benefits. This will eliminate many applicants from the
hearing/appeals phase of the program.
More Federal funding is
necessary to create a universal network between Social Security, and all
outlets that handle SSD/SSI cases so that claimant’s info is easily available
to caseworkers handling claims no matter what level/stage they are at in the
system. 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 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 Bluebook Listing of Impairments.
Currently the 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. The resulting devastation on their lives, often totally eliminates
the possibility of them ever getting well enough to ever return to the work
force, even on a part time basis. Then, sometimes weeks after they are finally
approved for SSD/SSI benefits, they receive a “Ticket To Work” packet in the
mail. A cruel joke to say the least and it is no wonder that the disabled fear
continuing disability reviews, utilization of the Ticket to Work Program, and
distrust the Federal Government! Yet ironically once they are approved they
are allowed to earn up to $900 and still receive benefits. Confusing to say
the least. The Ticket to Work Program is often viewed as a carrot and stick it
to the disabled approach. We recommend in addition to the current Ticket to
Work Program, the creation of an Interim (transitional) SSDI disability program
for those who are chronically ill, but still may be able to work a few hours a
week/month. Say a claimant would be eligible for $1000 disability benefit if
approved for full SSDI benefits. They would apply for interim disability to
start and for every month they could not work they would get a full check. For
those months that they could work they would be paid the difference or nothing
based on the percentage of the $1000 benefit they would earn by working that
month. They would be eligible for full Medicare benefits from the onset. When
their illnesses progressed to a point that working is no longer an option, full
SSDI benefits would automatically kick in.
We also urge Congress to pass the following
legislation:
Waiting period for initial
payment of benefits should be removed instead of the current five month waiting
period from disability date of eligibility. The withholding of five months of
benefits greatly adds to the financial burden of a claimant, and compromises
their financial status to a point, that most can never recover from due to their
inability to work. Until this is instituted, prime rate bank interest should
be paid on all retro payments due to claimants, as they are losing this as well
while waiting for their benefits to be approved. It should be kept in mind
that many Americans do not even have health insurance let alone private
disability plans. Then factor in, that once you are unable to work for an
extended length of time, and are either terminated by your employer, or make
the agonizing decision to never return to work again for the rest of your life,
those employer sponsored benefits often expire and you are left with nothing –
no employer sponsored health or disability insurance! Studies have shown that
most in this country have about two weeks worth of financial resources to live
off of, and that is assuming that they are healthy, yet currently it is
expected that a population who can no longer work, go without five months of
pay and wait several months to several years to have their disability claims
processed.
Immediate eligibility for Medicare/Medicaid upon
disability approval with NO waiting period instead of the current 2 years. The
current two year waiting period causes even further harm to an applicant’s
already compromised health and even greater financial burden on a population
who can least afford it, since they cannot work. This also forces many to have
to file for Medicaid/Social Service programs who otherwise may not have needed
these services if Medicare was provided immediately upon approval of disability
benefits.
Both of these current regulations are a major
contributing factor to the lasting poverty that claimants have to deal with as
part of the aftermath of filing for Social Security Disability benefits.
Changes in these regulations would greatly enhance the quality of life for
disabled Americans.
I am well aware as I write
this, that there are some who have abused the system and that is a shame,
because it casts a bad light on those who really need this help. Yet, there
are ways to “weed them out”, without causing harm to legitimate claimants. It
is time that the government fixes the problems, so that the people who really
need this help can access it as soon as possible, instead of being treated as
frauds, and criminals on trial, when they need to file a claim for benefits.
Social Security, SSDI, SSI and Medicare are great programs when they function
properly, and have helped millions of Americans who may never have survived
without them.
Most of us were once hard
working, tax paying citizens with hopes and “American dreams” but due to an
unfortunate accident or illness, have become disabled to a point where we can
no longer work. Since we can no longer work due to our disabilities, we are
often considered "disposable" people by general and government
standards. In addition our cries and screams are often ignored, many
preferring that we just shut up or die. Does that mean we are not valuable to
our country, or give the government/society the right to ignore or even abuse
us? We are your mothers, fathers, sisters, brothers, children, friends and
acquaintances and remember that disease and tragedy do not discriminate on the
basis of age, race or sex. Wake up America! If you think this couldn’t happen
to you – you could be DEAD wrong!
I ask that you please act
urgently on these items, as millions of American’s lives depend on you. Thanks
very much for your time and consideration.
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