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Lack of planning
The number of backlogged claims now stands at 755,000. Congressional audit shows that federal disability claims process needs overhaul
Saturday, Jan. 12, 2008 | 2 a.m.
Federal auditors say the Social Security Administration lacks a sufficient plan to address its backlog of hundreds of thousands of disability claims.
The claims are those submitted to the federal Disability Insurance or Supplemental Security Income programs by people who no longer can work because of severe physical or mental disabilities.
The report by the Government Accountability Office, the investigative arm of Congress, says 1.5 million claims remained unresolved at the end of 2006 and 576,000 of those were backlogged meaning they had exceeded the amount of time generally needed for resolution of claims.
As we noted in an editorial in December, the number of backlogged claims has continued to climb since the 2006 figure cited by the GAO, and the backlog now stands at 755,000.
Backlogs “have occurred at most stages of the claims process,” the GAO reports. Appeals of claims that were initially denied can result in some of the longest delays, with the average wait now about 500 days. Some people have waited three years for their claims to be resolved. Others have died before their cases were decided.
Social Security Administration officials have said that in order to hire enough staff to adequately process the backlog, the agency needs $100 million beyond the $275 million increase that Congress approved in December. Both amounts are more than President Bush has proposed in his 2008 budget, which calls for funding at the existing level.
The GAO, however, said that regardless of whether funding is increased, the agency needs to improve the poor communication that exists among the agency’s state offices, where initial claims are handled.
Social Security Administration officials also must improve the monitoring of claims as they enter the appeals process, the GAO says, and must adequately plan and execute programs to address the backlog something the agency has failed to do.
It is sad to think that Americans who are unable to work because of injury or illness are helplessly watching bills pile up and mortgages go into arrears while waiting years for the federal government to decide whether assistance will be granted. Congress must see to it that the GAO’s recommendations are carried out.
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The press nationwide recognizes the SS disability mess, but their analysis--too little funding--is too superficial.
But the biggest problem lies in the decisionmaking process and the schizophrenic nature of the program. Ideally, unbiased medical experts should guide the assessment of what a claimant can and cannot do. (Such an assessment is necessary in 66% of all claims.) The problem for the States began with the Nixon Administration; without going into detail for lack of space, the NA policies took the decisionmaking guidance from unbiased physicians. The Reagan Administration took it further by making physicians conform to a fiscal policy, which destroyed good decisionmaking at the State level. Added to that, every Legislature since 1980 (PL 96-265) has added to the problem by focusing Federal reviews on the States' allowances, which creates an institutional bias to deny claims.
The Administrative Law Judges, on the other hand, have horribly inadequate medical training. Most of their decisions, therefore, rest on personal bias and the subjective impressions of the claimant gained at an evidentiary hearing. The ALJs are so subjective that 10% of them uphold States in 90% of their decisions and 10% of them reverse the States 90% of the time.
What this means: Despite the fact that the Statute, Regulations, and Rulings that guide the program apply equally to the States and the ALJs (de jure), markedly differing judgments of what a claimant can or cannot do apply at both levels. SSA is in essence running two separate programs (de facto).
I have, of course, left out many details, but this is the root problem in a nutshell and no amount of funding can fix it.
Bob Burgess
OK, one more comment: Folowing the Reagan OMB/SSA fiasco in the early 80s which made States cease or deny benefits to those who should have received them, Congress and the courts inundated the States with a massive amount of red tape that only raised costs and slowed processing time.
The second thing that happened was that the public discovered the ALJs. Because ALJs know little about medicine, which leads them to reverse huge numbers of claims that should not be reversed, appeals to ALJs have climbed from 72,000 in 1974 to 750,000 currently. Of course, this clogs the system and slows processing time at all levels. (Studies show that at least 50% of ALJs' favorable decisions are unwarranted.)
Bob Burgess