The beneficiary rolls of the Social Security Disability Insurance (SSDI) program are increasing rapidly, as is public and legislative scrutiny over the process. The Social Security Administration (SSA) is making major changes. A recent article on the Wall Street Journal’s blog outlines six changes currently underway for the SSDI.
Occupations: When considering an applicant for SSDI, the agency must evaluate the applicant’s employment prospects. Currently, it tasks vocational experts to match the applicant with potential occupations. But these experts are supposed to use a “dictionary” of occupations that has not been updated since 1991. It still includes anachronistic occupations like “blacksmith,” and, more importantly, it does not reflect the technology boom of the past twenty years. Numerous jobs working with computers are well-suited to physically disabled individuals. Rewriting the dictionary is a huge job that may not be completed until 2016 at the earliest.
Grid Use: Administrative law judges who rule on SSDI applications use a decision-making tool known as the “grid” to help them decide whether an applicant qualifies for benefits. It accounts for age, education, disability and other factors. But like the occupation dictionary, the grid has not been updated in years, and it does not reflect the ability of some people to work productively into advanced ages. Additionally, some judges believe it is too easy for lawyers and other experts to tailor applications to the grid so that an award of benefits is more likely.
Disclosure: Currently, SSDI attorneys may withhold medical records that weaken a client’s case for disability benefits from submissions. Many believe that this practice should not be allowed, and some claim the SSA has backed down from pressure against implementing a rule against it in the past. An agency official recently stated the SSA would soon propose a rule preventing the withholding of relevant information from applications, but the official would not elaborate on the nature of the proposal.
Caseload: To deal with large case backlogs, some judges have, in recent years, handled upwards of 1,000 cases per year. Many judges claim due diligence on so many cases is impossible. The agency has now placed a cap of approximately 800 cases per year for each judge.
Third-Party Groups: The SSA and its inspector general are investigating whether doctors and lawyers are facilitating fraud in disability applications. This investigation only began recently, and no targets or findings have yet been identified.
Judges’ Job Description: It is very difficult for SSA judges to be removed from their positions. For some, the post amounts to a lifetime appointment. But the agency is changing the job description to clarify that judges are subject to supervision and to oversight from various parties. The SSA has also intensified scrutiny over the judges’ casework and can recommend additional training for those whose results (e.g. the percentage of applications approved) fall outside the norm.
As the SSDI continues to grow, it is important to keep the program modern and to remain vigilant against fraud so that the benefits of future, worthy applicants are not endangered.
In American politics, partisan gridlock is the norm. It is therefore not terribly surprising that Congress has so far delayed reforming Social Security for retirees. After all, reforms to extend the program’s solvency would require increases to payroll taxes, cuts to benefits, or both – all politically toxic proposals. And the program’s trust fund is forecast to be solvent until 2035 – a virtual eternity in the political world.
Social Security Disability Insurance (SSDI) is another story altogether. That program draws from a separate trust fund – one that is forecast to be depleted in 2016. If that happened, benefits could only be paid to the extent they were covered by incoming payroll tax revenue. That would mean an immediate benefit cut of some 20 percent to each and every disabled beneficiary.
One temporary solution is actually quite simple. A small portion of revenues from payroll taxes could be reallocated from the retirement program to disability. Reallocations are nothing new – Congress has enacted them at least six times already, most recently in 1994. According to Social Security Administration chief actuary Stephen Goss, shifting just one tenth of 1 percent of revenues would bring the forecast depletion date of both trust funds in line with each other.
To be clear, this would accelerate the depletion of the retirement program’s trust fund, and thus it is not necessarily a politically simple fix despite being logistically simple. But the reallocation itself would not result in any workers having to pay more in taxes, nor any beneficiaries – retired or disabled – suffering a cut in benefits. This should spare the measure from significant controversy, as past reallocations have been.
The SSDI program has recently faced intense scrutiny and criticism because of its rapidly swelling roll of beneficiaries. There is a sense among some that fraud is rampant in the program and that unemployed baby boomers who do not yet qualify for retirement benefits are freeloading despite being physically capable of work. This makes disabled Americans pawns in games of political brinksmanship as Congress argues over fiscal policies and debt ceilings.
The reality is that while examples of fraud may be found in the SSDI program, its growth was predicted by simple demographics. Baby boomers are nearing retirement age. The rate of physical disability among those age 40 is half that of 50-year-olds, which itself is half that of 60-year-olds. Moreover, women’s increased participation in the labor force over the last several decades means they are increasingly eligible for disability benefits.
Millions of Americans depend on disability benefits to make ends meet, and many more depend on retirement benefits for the same. Reforming both these programs in order to make them solvent long into the future may be a lengthy political process. In the meantime, reallocating funds to SSDI is the right thing to do to protect the livelihood of those who depend on it.
According to the Government Accountability Office (GAO), the Social Security Administration (SSA) has made significant overpayments to some recipients of Social Security Disability Insurance, causing some of those individuals a great deal of trouble. The SSA is reluctant to admit the mistakes, but worker advocacy groups and beneficiaries’ attorneys say the agency is to blame.
The GAO recently conducted an audit that shows the SSA overpaid $1.3 billion in benefits over a two-year span. While some portion of that figure may be attributed to fraud, many innocent beneficiaries have received erroneous payments and have either tried to stop them or have not realized what was happening.
Steve Lord, a director at the GAO in charge of investigations and audits, says that the SSA should reallocate its resources to prevent such mistakes.
“Right now getting people off the [disability] rolls is secondary,” Lord told CNN. “They have to balance their resources between getting people off the rolls and getting people on the rolls.”
The SSA touts the accuracy of its accounting as nearly perfect, despite tight funding and an increased workload. The agency has lost approximately 11,000 employees since 2011. Meanwhile, as Baby Boomers age and become more prone to disability, the beneficiary rolls and applications have swelled.
Recent high-profile stories by media outlets such as NPR’s “This American Life” and CBS’s “60 Minutes” have highlighted limited instances of fraud within the Social Security Disability Insurance program. It is possible that these programs have left the public with a skewed understanding of the scope of the problem. Unfortunately, the SSA’s own response to concerns about the overpayments may be contributing to a narrative of widespread fraud and abuse.
Cheryl Bates-Harris of the National Disability Rights Network says the agency is quick to attribute the errors to malicious intent on the part of beneficiaries.
“It doesn’t want to admit it’s culpable, so it throws the responsibility on the beneficiaries . . . but there are critical failures within its system,” Bates-Harris told CNN.
In cases where the SSA makes an overpayment, the administration is likely to catch the mistake at a later date and then tell the recipient they must pay back the difference. This can be a serious setback for financially struggling families, who are very likely to have spent all available income on their living expenses already.
To avoid overpayments, be sure to report a change of income or a new job to the SSA right away. If you know you are being overpaid, notify the agency and keep a careful record of the amounts overpaid. If possible, keep the funds in a separate account.
If you receive a notice of overpayment that you believe to be erroneous, you may request a reconsideration. If you know you were overpaid, but you believe you were not at fault or you cannot repay the money, you can request a waiver. Whatever decision the agency renders in these procedures may be appealed, which is often a lengthy process. In all cases, when in doubt, consult with an experienced Social Security disability attorney.
Appealing a Social Security disability claim can seem like a daunting task, but the chances of that claim being successful increase significantly with the help of a qualified attorney.
Many claimants balk at the idea of hiring an attorney because of cost, but they often do not realize that there is no up-front cost in SSDI representation. Everyone has the right to be represented during the appeals process and the Social Security Administration has strict rules about the fees associated with that representation.
In fact, an attorney or representative cannot charge a fee without written approval from the SSA. In many cases, the lawyer only gets paid if the appeal is successful and even then the fee comes from the past-due benefits, according to the SSA’s website.
The SSA determines how much the representation was worth, which is usually 25 percent of the past-due benefits. A claimant never owes an attorney more than this except if there were fees associated with medical record acquisition. If a claimant comes to an agreement with the attorney about a fee structure before the appeal, the SSA will consider that agreement as long as the total is not more that 25 percent of the past-due benefits.
Hiring an attorney for a SSDI appeal could be considered a steal at this price since in most other types of cases attorney’s fees would be greater than that. If the appeal is won, then the lawyer is paid directly by the SSA and the claimant receives a check for the remainder of the past-due benefits.
There are clear benefits of having legal representation when filing a SSDI appeal. An attorney will be able to access a claimant’s file and act on his or her behalf before the SSA. An attorney also will be able to help a claimant access medical records or other information that supports the appeal of the claim. Accessing medical records can be a challenge and attorneys with Social Security appeal experience will know how to get that information in a timely manner.
A claimant can bring an attorney to any interviews, conferences or hearings with the SSA. An attorney also will be experienced at preparing witnesses for a hearing, which can be critical to the appeal.
The Social Security Administration will need to approve the fee structure even if a second party like an insurance company is paying the attorney’s fees, according to the SSA website.
Claims for Social Security Disability Insurance take a long time to be processed and decided these days. An increase in the number of claims in recent years has caused wait times for some applicants to stretch into the hundreds of days. It is in everyone’s best interest for this backlog to be eliminated so that every new application can be decided in a timely manner.
To that end, the Social Security Administration (SSA) encourages its administrative law judges (ALJs) to hear between 500 and 700 claims each year – they call the numbers a “goal.” But some judges claim that the numbers constitute an unlawful “quota.” And now the judges are taking the SSA to court.
The Association of Administrative Law Judges (AALJ) recently filed suit on behalf of 1400 of its members, claiming that the SSA’s expectations cause them to have to improperly rush evaluations. It also creates an incentive to approve cases because approvals are faster than denials. This leads to the potential approval of claims that should be denied, which results in greater fraud, abuse, waste, and expense to taxpayers, the judges say. Their specific legal allegation is that the agency’s directive violates the Administrative Procedure Act and the Social Security Act. They also claim, contrary to the agency’s statements, that judges who do not hear enough cases are subject to reprimands, “counseling,” and “threats and intimidation,” according to the lawsuit.
SSA Commissioner Michael J. Astrue, who was appointed by President Bush, stepped down in February, 2013. President Obama has not yet named a successor – the agency is currently headed by acting commissioner Carolyn Colvin, a former secretary of the Maryland Department of Human Resources. Judge Randall Frye, president of the AALJ, says a lack of permanent leadership may be contributing to the problem.
“One way to protect the treasury and help deserving claimants is to end the quota system,” Frye said. “However, an acting commissioner may not feel that she has the authority to make the necessary changes and correct problems.”
Meanwhile, the Disability Insurance Trust Fund, from which disability benefits are paid, is currently paying out more than it is taking in. It is projected to reach zero in 2016. If that were to happen, it would result in an immediate 21 percent cut in benefits to nearly 11 million Americans with disabilities.
Disability insurance, like most government programs these days, faces intense budgetary pressures. Even in good economic times, ALJs will scrutinize disability claims to make sure taxpayer money is not wasted. If you are disabled, it pays to have an experienced Social Security Disability attorney on your side to get you the benefits you deserve in a timely manner.
A story recently aired on National Public Radio (NPR) has sparked a national conversation on a federal government benefit program, including passionate defenses and calls for its overhaul.
The program is Social Security Disability Insurance (SSDI), and as the NPR series “Unfit For Work” described, its payroll, after sharp growth in recent years, now numbers over 14 million. This growth is in spite of medical advances and laws banning employment discrimination based on disability.
NPR reporter Chana Joffe-Walt found that declining real wages, a stagnant economy, and limited employment opportunities create powerful incentives for disabled workers to seek SSDI. She visited Hale County, Alabama, where nearly a quarter of working-age adults are SSDI beneficiaries. There, openings for jobs not requiring physical labor are almost completely unattainable for many due to a lack of education. The states with the highest percentages of disability beneficiaries are also the states with the lowest percentages of college-educated population, including West Virginia, Alabama, and Mississippi.
Joffey-Walt also visited the family of a 10-year-old boy with a learning disability in the Bronx. That disability makes him eligible for $700 per month in Social Security, the family’s primary source of income. If Jahleel were to completely overcome his disability and excel in his education, it would threaten his family’s livelihood. The story illustrated the conflicting motivations some families with benefit income struggle with.
A group of eight former Social Security Administration (SSA) commissioners wrote an open letter to the public responding to the NPR story. The commissioners pointed out that analysts at the SSA had predicted the current uptrend in SSDI’s growth for decades. Two demographic swells combine to account for the majority of the growth in SSDI: the baby boom and the influx of women into the American workforce in the 1970s and 1980s. These groups are now entering their high-disability years.
The letter added that the growth in children receiving Supplemental Security Income (SSI) benefits is due to the nationwide growth in poverty. Less than four percent of low-income children receive SSI benefits – a figure that has held steady, according to the commissioners.
Advocacy group the Consortium for Citizens with Disabilities (CDC) also published an open letter shortly after the story aired. They called attention to the strictness of the eligibility requirements, saying only about 40 percent of adult applicants are approved.
SSDI ensures the livelihood of millions of Americans, but has swelled at an eyebrow-raising rate in recent years. Congress may reform the program in the coming years to help those on the margin remain gainfully employed. But they must take care to ensure the economic security of the most vulnerable Americans.
Software developers at the Wright State Research Institute have developed a system that may dramatically streamline Social Security disability claims.
The U.S. Social Security Administration (SSA) evaluates an individual’s claim for disability benefits; the system will soon use electronic medical records to reduce the decision time from 100 days or more to as little as 48 hours. Researchers at Wright State have dubbed their health information exchange “HealthLink.” They developed it under a $750,000 contract with the SSA. The agency awarded a total of $17.4 million in contracts to 15 health care companies for electronic medical records as part of the American Recovery and Reinvestment Act.
“The use of Health IT will dramatically improve the speed, accuracy and efficiency of this process, reducing the cost of making a disability decision for both the medical community and the American taxpayer,” said SSA commissioner Michael J. Astrue.
HealthLink launched as a pilot program in December, 2011, with 500 doctors. During the trial, which lasted nine months, HealthLink averaged one Social Security eligibility determination per doctor per month without incident.
The SSA’s Health IT program is an effort to bring greater speed and power to the agency’s disability eligibility determination process by harnessing the potential of electronic medical records. The records are sent through the Nationwide Health Information Network.
Each year, the SSA receives over 3 million disability claims. To determine eligibility, it requests over 15 million medical records from about one half million health care providers. Currently, the vast majority of those records are transmitted by mail or fax. Electronic records provide huge savings not just in time, but also in the labor and supplies associated with the tasks of printing, copying and mailing records.
Just as with paper medical records, the release of electronic medical records requires patient authorization. HealthLink developers said that they have implemented comprehensive security protocols regarding worker access, physical security, and data transmission. The computer hardware that runs HealthLink is located in HIPAA-certified facilities on campus at Wright State.
HealthLink developers say that the system generates revenue and is commercially viable. They have seen interest in creating an independent commercial entity based on the system. HealthLink is available to doctors who use the Internet-based medical records system known as athenaClinicals, and Wright State is seeking additional users of the system to expand HealthLink’s network. The research institute also plans to support competing records system EpicCare.
The creators of Health Link say they hope to be a leader in the nascent industry of electronic medical records.
The Social Security Administration is calling on private insurers that pay workers’ compensation as well as state and local agencies to report payments to the agency to help cut down on fraud and overpayments.
In a recent speech to the U.S. House Ways and Means Subcommittee on Social Security, Carolyn Colvin, deputy administrator for the SSA, explained that funding shortages are forcing tough decisions to be made. The administration is trying to streamline income reporting to cut back on how long it takes to catch overpayments for Social Security Disability Insurance and the Supplemental Security Income programs.
When the Social Security Administration waits for beneficiaries to report changes in their income, it can take too long and invites problems, Colvin said.
“By requiring plan administrators to provide payment information to us promptly, this proposal would improve the integrity of the [workers’ compensation] and [public disability benefit] reporting process, improve the accuracy of SSDI benefits and SSI payments, and lessen our reliance on the beneficiary to report this information,” she said.
The agency considers the goal of curbing improper payments to be key in the Social Security Administration’s strategic plan to “Preserve the Public’s Trust in Our Programs,” she told the subcommittee.
Funding issues are forcing the administration to do fewer continuing disability reviews and significantly fewer SSI redeterminations. The agency does SSI redeterminations on the nonmedical factors that make a beneficiary eligible for SSI. Since the agency has cut back on the number of reviews and redeterminations, it has needed to rely more on the strategic use of the processes and staff, she told the lawmakers.
By asking private insurers and state and local agencies to report income to the SSA, the reporting can trigger some reviews and increase the agency’s efficiency. In the past two years, the agency’s work to continue disability reviews has paid off. In about a third of the work, CDRs found that a disability had ceased and suspended benefits.
SSI redeterminations are up since 2007 after falling the five years before that. The numbers are up because funding increased for program integrity, she said. The increased funding has enabled the agency to improve SSI overpayment accuracy rates by almost four percent in three years.
Colvin asked members of the subcommittee to push for provisions in the President’s budget that would require employers to report wages quarterly. The more frequent the reporting, the easier it is for the agency to accurately distribute benefits, she said.
The Social Security Administration is working on new initiatives that could cut down on wasteful overpayments, disincentives to work and costly labor time to investigate payments.
The Work Incentives Simplification Pilot is a legislative proposal being considered by Congress that could replace well-intentioned but complicated laws meant to incentivize disability beneficiaries to return to work. The work incentives proved too burdensome for an agency already fighting funding cuts.
Carolyn Colvin, deputy administrator for the Social Security Administration spoke to the U.S. House Ways and Means’ Subcommittee on Social Security in late January.
She explained that the new legislation could kill regulations like trial work periods and the extended period of eligibility that are overcomplicating the work of the administration.
The law now says people on Supplemental Security Income, or SSI, are on a sliding scale as they return to work. So, for every $2 an SSI beneficiary earns, $1 is removed from their SSI benefit, she said. Improper SSI payments happen when beneficiaries fail to notify the administration of new work, new assets or a raise or reduction in salary.
Each beneficiary is a different case with a different employer and a different income. Each case has to be individually handled, which often means contact with the employer. Most cases are complicated and require small bits of work and starting and stopping until enough information is gathered to make a decision, she said.
This type of work takes considerable expertise and training and the administration simply does not have the resources to do it well, she said.
There also are plenty of crossover beneficiaries who qualify for SSI and Social Security Disability Insurance C as many as 30 percent of SSI recipients also get SSDI between 18- and 64-years-old. Because the two programs are guided by two sets of rules, the labor for the Social Security Administration is overly burdensome, she said.
Officials hope the new WISP plan will address a disincentive to work by eliminating a beneficiary’s fear that if they get a job, they will lose their benefits.
The work incentive policies are difficult for beneficiaries to understand and for the administration to oversee, Colvin told the subcommittee.
The goal of WISP is to test some simplified work rules that would still be subject to tight evaluation. Officials hope the WISP will encourage people to work while reducing administrative costs, she said.
WISP also would count beneficiaries’ earnings when they are paid instead of when they are earned so that SSDI and SSI rules would be better aligned.
A qualified attorney can represent clients in Social Security cases to help make sure they fully explain their case.
Federal administrative law judges who hear Social Security Disability appeals have widely ranging records that may indicate unfairness in the appeals process.
The Social Security Administration is commissioning a review of the entire disability system to make sure it is not awarding benefits to those who do not deserve it and to make sure the agency is not denying benefits to those who do deserve them.
The SSA will review the work of about 1,500 disability appeals judges across the country whose rates vary significantly from the norm. Some judges award benefits less than 20 percent of the time while others award benefits almost 100 percent of the time, according to a story in the Wall Street Journal.
The Administration has already decided to stop notifying applicants who their judge will be in their appeal to discourage shopping an appeal to a more lenient judge.
The Administrative Conference of the United States will take on the review. The independent government study organization hopes to make recommendations for updating the appeals process in 2012.
The Social Security Disability Insurance program provides financial assistance to Americans who cannot work. The Wall Street Journal reported that the program paid $130 billion in 2011 to 10.6 million people.
If a case comes before a federal Social Security judge, it has already been denied twice at the state level. There is a tremendous backlog of cases at the federal level.
In September of 2011, there were more than 771,000 people waiting for their appeal to be heard. The SSA has been working to address the backlog issues and it has cut down on the number of people who die while they wait for their appeal to be judged, according to the WSJ.
The hearings usually last about an hour. Some critics have said judges pushing cases through much more quickly than that are cutting corners and not doing thorough reviews. The conference plans to factor how much time judges look at cases into its review.
The SSA’s commissioner told Congress in the summer of 2011 that judges awarding disability benefits more than 85 percent of the time cost the agency another $1 billion a year. The Wall Street Journal reports that there are more than 100 judges whose award percentages are that high.
Overall, the federal court system is finding errors or overturning about half of the decisions made by Social Security judges. The independent study will review how the federal courts are looking at the cases to make sure it is interpreting the SSA’s rules consistently, according to the WSJ. A qualified Social Security Disability attorney can help clients file appeals with the agency.