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Investigation faults judges in disability cases

Wednesday - 9/12/2012, 10:01pm  ET

By STEPHEN OHLEMACHER
Associated Press

WASHINGTON (AP) - Overworked Social Security officials often award disability benefits without adequately reviewing claims, potentially adding to the financial problems of the cash-strapped system, congressional investigators said in a report released Wednesday.

Investigators reviewed 300 randomly selected cases from Virginia, Alabama and Oklahoma in which people were awarded disability benefits. In more than a quarter of the cases, decisions to award benefits "failed to properly address insufficient, contradictory, or incomplete evidence."

In many cases, officials approved disability benefits without citing adequate medical evidence to support the finding or without explaining the medical basis for the decision, according to the report by the Republican staff of the Senate Permanent Subcommittee on Investigations.

In some cases, it appeared that administrative law judges struggling to reduce backlogs didn't take the time to review all the evidence, the report said.

"The administrative law judges are not looking at the cases because the pressure from Social Security is to get the cases out," said Sen. Tom Coburn of Oklahoma, the top Republican on the subcommittee. "I think you could flip a coin for anybody that came before the Social Security commission for disability and get it right just as often as the (judges) do."

The subcommittee released the report ahead of a hearing on the issue scheduled for Thursday morning. The investigation was done by both Republican and Democratic staff members. However, subcommittee Chairman Sen. Carl Levin, D-Mich., did not sign off on the final report because he disagreed with some of its recommendations.

Social Security has been working for years to reduce a huge backlog of disability claims.

"We share the subcommittee's concern that a small number of judges have failed our expectations with regard to a balanced application of the law, proper documentation, proper hearings and proper judicial conduct," said Social Security spokesman Mark Hinkle. "We have undertaken a vigorous set of quality initiatives since the time most of these cases were filed about five years ago and data indicates that we have made substantial progress."

Hinkle added, "We recognize the need for further improvement and are working hard toward that goal."

Laid-off workers and aging baby boomers have been flooding Social Security's disability program with benefit claims since the economy tanked in 2008, straining the agency's resources while pushing the disability system toward the brink of insolvency.

Without congressional action, Social Security's disability trust fund will run out of money in 2016, leaving the program unable to pay full benefits, according to the trustees who oversee the program. The trustees have urged Congress to shore up the disability system by reallocating money from the retirement program, just as lawmakers did in 1994. That fix, however, would further weaken the retirement system, which has its own long-term financial problems.

About 11 million people receive disability benefits from Social Security, an increase of more than 23 percent over the past five years. Benefits average a little less than $1,000 a month.

About 8.2 million people receive Supplemental Security Income, a disability program for poor people who don't have substantial work histories. SSI benefits average a little more than $500 a month.

As part of their investigation, the subcommittee's staff asked the Social Security Administration to randomly select 100 cases apiece from counties in three states _ Virginia, Alabama and Oklahoma. The cases were limited to those in which benefits were awarded.

Investigators spent 18-months reviewing the case files, including transcripts of hearings. They did not, however, talk to any of the people who were awarded benefits or make any determinations about whether people got benefits they did not deserve.

Instead, they reviewed the cases to see if officials used proper procedures in making their decisions.

The report acknowledged that the findings may not be representative of the entire country. However, it said, "The same types of issues affected decisions across all three counties, suggesting they may be a factor elsewhere in the nation."

Disability claims typically increase in a bad economy because many people who worked despite their disabilities get laid off and apply for benefits. Navigating the system, however, can difficult.

Applicants start by filing claims with state agencies that are overseen by Social Security. Most initial claims are denied, but applicants in most states can appeal the decision to the same state agency. If they are denied again, applicants can appeal to an administrative law judge.

As a group, the judges decide about 700,000 cases a year, the report said, with each judge expected to process at least 500 cases a year. One judge in Oklahoma City, Okla., decided 5,401 cases in three years, from 2007 to 2009, according to the report.

"Since most cases contain several hundred pages of documents _ many over 1,000 pages, including complex medical documents _ making a proper decision and producing a high quality written description of that decision on more than one case per day is difficult," the report said.

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Follow Stephen Ohlemacher on Twitter: http://twitter.com/stephenatap


(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)