By Diane Stafford, Kansas City Star, February 15, 2010
The nation’s disability insurance system is in rehab.
But it’s far from well, and problems in Kansas City are particularly acute.
An aging baby boom population and high unemployment rates are combining to flood the Social Security Administration with applications for disability insurance benefits.
The result: a backlogged system that can take years to pay out benefits.
Blame the agency’s staff cuts in previous years.
Blame people who try to fake disabilities.
Blame a labyrinthine claims system that volleys legitimate applicants between federal and state offices.
And, in Social Security offices such as Kansas City’s, blame a sluggish productivity rate for disability hearings.
In Kansas City, applicants for Social Security Disability Income at the end of 2009 were waiting an average of 604 days for a decision from an administrative law judge.
That processing time ranked 135th out of 143 Social Security Office of Disability Adjudication and Review offices around the country, according to an agency report.
Hearings are granted after prior benefits denials. Among those who finally appear before an administrative law judge in Kansas City, about four in 10 continue to be denied, according to agency records covering the end of last year.
"There are disability guidelines, but it’s very difficult to interpret them, though," said Sue Alt, spokeswoman for the Kansas City office. "How sore is your foot? Or is it sore at all? It’s not easy to know."
State detour
Each year, about 2.5 million Americans file claims for Social Security disability benefits. Two-thirds of them are turned down in the first round of consideration.
More than a million applicants each year give up without pursuing appeals.
After applicants file disability applications with Social Security, their files are sent to a Disability Determination Office staffed by state employees — not federal Social Security employees — in each state.
Unfortunately, notes Dana Duggins, vice president of the union that represents federal Social Security workers, budget problems in many states are causing layoffs and furloughs of those state employees, exacerbating the backlog problem.
And that system is riddled with “poor pay, poor training, high turnover and a lot of arbitrary decisions that differ broadly among the states,” said Larry Denny, a Kansas City lawyer who has represented disability claimants for decades.
"It’s a federal problem that they passed off to the states, and they need to fix that. The whole system ought to be seamless with federal employees."
But as the system stands, screeners in the state offices probe applicants’ work histories and doctors’ reports and refer to voluminous Social Security guidelines about what conditions constitute qualifying disabilities.
Just last Thursday, Social Security added 38 disorders or diseases to a list of "compassionate allowances" — conditions including early onset Alzheimer’s, Tay-Sachs disease and mixed dementia — that are among fast-ticket diagnoses for disability benefits.
Applicants whose maladies don’t appear on the fast-track list face a long haul, peppered by the agency’s need to ferret out malingerers and fraud artists.
In limbo
Legitimate applicants who persist are seeking rightful benefits due them from a program introduced during the Eisenhower administration in the 1950s.
It’s a program designed to provide income for people who become too ill or injured to work.
Funded by part of the Social Security taxes taken out of workers’ paychecks, benefits are paid out based on individuals’ earnings and thus
vary broadly among recipients.
The program managed to keep fair pace with applications through the 1990s, but the double whammy of more applicants and slashed Social Security staffing by the Bush administration — down to 1970s-era levels — caused the claims backlog to surge.
But in September, for the first time since 1999, the agency ended its fiscal year with fewer disability hearings pending than in the prior year.
That still was a big number: 722,822 people awaited a decision about whether they were entitled to disability benefits.
"Even in the face of a significant increase in our workloads as a result of the worst recession since the Great Depression, we have reduced the hearings backlog for nine consecutive months," Social Security Commissioner Michael Astrue said in announcing the reduction.
The Obama administration has allocated funds to hire more administrative law judges and more support staff for the Social Security field and hearing offices.
Those additions last year helped reach decisions on 166,838 cases that had been in the application process for 850 days or more. The agency’s goal for this year is to clear all cases that are 825 days or older.
The omnibus appropriations bill for fiscal 2010, passed by Congress and signed by the president on Dec. 16, will allow the agency to hire 226 new administrative law judges, 950 support staff and 60 hearing-office managers, among other positions.
By the end of this fiscal year, in September, the agency expects to have 1,450 hearing judges. But, an agency spokeswoman noted, it takes time to hire and train new workers.
And Denny pointed out another problem that simply adding hearing judges won’t help:
Despite stated productivity goals from Social Security officials in Washington, there are no repercussions for judges who hear few cases.
The Kansas City office is particularly notable for its share of judges who hear far fewer cases than average. Kansas City judges dispose of an average of only 1.9 cases a day, according to the most recent published data.
To help handle the backlog, hundreds of Kansas City-based cases are being heard by administrative law judges based in Albuquerque, N.M.
"There are a couple of good judges," Denny said of the Kansas City office, “but it’s mind-boggling how inefficient some are. We need something to actually make the judges hear cases, but we can’t force them to do anything. How could someone use our tax money that way?”
The nation’s most productive hearing office reaches disposition on an average of 3.92 cases per judge per day.
Alt, the spokeswoman for the Kansas City office, said there are reasons, such as illness or vacations, that some of the hearing judges show an extremely light case load. Also, she said, hearings aren’t simple.
"The average size of a claim that gets to the hearing level is over 600 pages," agreed Dan Allsup, communications director for the Allsup company, which, like Denny, represents individuals with their disability claims.
"The process is complex," Allsup said. "It’s stressful. By the time claims reach this level, we’re not talking about scofflaws. We’re talking about many people who are at the end of their emotional and financial ropes."
Indeed, Denny said, in 2008 he had eight clients who died before they obtained benefits.
Denied again
Cheryl Hainkel, a Social Security field office worker in Kansas City, Kan., says the disability application process is difficult from the get-go.
Speaking as regional vice president of the union that represents Social Security workers, Hainkel said she sees many applicants who are "very poor and have poor educational levels, and the quality of the documents they fill out is poor, so we have to send them back to work on the documents some more."
The field office worker who first deals with the applicant is likely to never see the person again, she said.
"Until the hearing, face-to-face is missing from the system," Hainkel said.
The state reviewer look only at files - information that the claimant filled out plus reports from Social Security-approved doctors and the applicant’s doctors - and denies about three out of four applications.
The next step is an appeal for a hearing.
To help deal with the hearing backlog and better serve applicants who don’t live near district hearing offices, the Social Security agency is setting up video hearing rooms around the country.
One such facility has been installed in Social Security regional offices in the City Center Square building in Kansas City and has thus far handled a handful of cases.
After a claimant finally receives a decision from a hearing judge, the government cuts a check if benefits are approved, including payment for claimant’s lawyers or other professional representation.
If benefits are denied, the applicant can appeal to a national appeals council - and wait perhaps two years for a response from a massive facility on the East Coast.
Denied again? The national appeals council may send the applicant back to the same hearing judge for reconsideration.
Denied again? Some claimants - who have the time and have a lawyer to take the case - can appeal in lawsuits filed in U.S. District Court.
Denied again? The case can go to a federal appellate court. Whether in Missouri’s 8th District or Kansas’ 10th, benefits denials routinely are upheld.
"As cruel as it may sound, if someone has a car accident and loses a leg, she could be denied disability benefits because, within a year, she could have a prosthetic and be working somewhere else," Allsup said. "There’s a very tight definition of what constitutes a qualified disability, and then there’s individual interpretation involved."
In the pipeline
Kansas City Office of Disability Adjudication and Review Pending cases: 5,727 (as of Dec. 31)
Average wait for office hearing: 19 months
Dispositions per day per administrative law judge: 1.91
Number of administrative law judges: 11
Ranked by processing time compared to 143 offices nationally: 135th
Average percent of claims denied at hearing: 42 percent (October through December 2009)
Hearings handled in Kansas City
For October through December 2009 (part of fiscal year 2010):
Administrative law judge (ALJ) Debra Bice, Total dispositions * = 213, Total decisions = 109, Total awards = 52, Total denials = 57
ALJ Susan Blaney, dispositions * = 5, decisions = 4, awards = 1, denials = 3
ALJ George Bock, dispositions * = 119, decisions = 101, awards = 52, denials = 49
ALJ Christine Cooke, dispositions * = 103, decisions = 77, awards = 45, denials = 32
ALJ Evelyn Gunn, dispositions * = 53, decisions = 33, awards = 21, denials = 12
ALJ William Horne, dispositions * = 155, decisions = 124, awards = 89, denials = 35
ALJ Jack McCarthy, dispositions * = 37, decisions = 28, awards = 14, denials = 14
ALJ Jack Reed, dispositions * = 63, decisions = 51, awards = 30, denials = 21
ALJ James Stubbs, dispositions * = 129, decisions = 102, awards = 74, denials = 28
ALJ Linda Sybrant, dispositions * = 105, decisions = 88, awards = 44, denials = 44
ALJ Guy Taylor, dispositions * = 89, decisions = 79, awards = 42, denials = 37
TOTAL ALJs , dispositions * = , decisions = , awards = , denials =
Filing a claim
Applications for Social Security Disability Insurance benefits may be filed in one of three ways in Kansas City:
The area’s field offices are located at:
For people who reach the disability hearing level, the Kansas City Office of Disability Adjudication and Review is at 2301 McGee (816-283-8024).
Source: Social Security Administration
To reach Diane Stafford, call 816-234-4359 or send e-mail to stafford@kcstar.com.