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Unveiling the Crisis: The Truth Behind SSA’s 1 Million Case Backlog
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In the maze of government bureaucracy, the Social Security Administration (SSA) stands as a critical juncture for many Americans—a gateway to much-needed support through Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Yet, a daunting challenge overshadows this provider of hope: a staggering backlog of 1 million claims awaiting processing. This delay not only measures in months and years but also in the untold hardships and injustices faced by Americans on the brink of despair.
On October 26, 2023, Congress convened a pivotal hearing to shine a light on these systemic delays and the inherent flaws of the SSA that have led to this crisis. As a law firm deeply entrenched in the fight for disability rights, we are poised to dissect the complexities of this hearing, elucidate the SSA's shortcomings, and amplify the voices of those who spoke truth to power. This blog aims to navigate through the intricate discussions, provide a digest of the most impactful moments, and offer a beacon of guidance for those whose lives hang in the balance, waiting for the benefits they rightfully deserve.
The Human Toll: How SSA Delays Disrupt American Lives
The repercussions of the SSA's backlog extend far beyond mere inconvenience; they represent a critical failure in a system designed to provide a safety net for the most vulnerable. For the countless American citizens caught in this snarl of red tape, the consequences are dire. Delays in processing disability claims mean that many are left without the financial support necessary for basic living expenses, medical care, and the stability that comes with knowing they can meet their needs.
The backlog not only strains the financial resources of individuals and families but also places immense emotional and psychological stress on applicants who are already facing significant life challenges due to their disabilities. The human cost of this backlog is immeasurable, with stories of despair and hardship becoming all too common. As the wait times increase, so does the risk of these individuals falling into poverty, losing their homes, or being forced to make impossible choices between healthcare and daily sustenance. This crisis is not just a bureaucratic delay; it is a profound societal issue that calls for immediate and decisive action.
Congressional Hearing Overview: A Critical Examination of SSA’s Operational Challenges
The Congressional hearing, held on October 26, 2023, was a focused examination of the SSA’s current operational challenges. This important session was called to confront the critical issue of the SSA's one million pending claims, a situation that significantly delays the distribution of disability benefits. The primary objective of this session was to understand the root causes of these delays and to determine what changes are necessary to improve the system's efficiency and responsiveness.
Flaws in the SSA System
The SSA is tasked with a monumental responsibility: to administer benefits that millions of Americans rely on for their well-being. However, the Congressional hearing brought to light several key flaws within the SSA that are contributing to the backlog and affecting the quality of service.
These shortcomings are multifaceted and have created a domino effect of inefficiency and frustration for claimants and representatives alike. Here we outline the key issues identified during the hearing:
Processing Inefficiencies
Despite a decrease in the number of claims filed, the time taken to process these claims has lengthened. On average, it takes the SSA 220 days to process initial applications and longer than that to process appeals. This is far above the 60 days the SSA defines as its minimum level of performance.
The mySocialSecurity portal is designed to provide immediate claim status updates but has instead caused confusion and anxiety due to its vague status indicators. Furthermore, applicants must have a home address to set up an account which prevents some groups of people from creating an account altogether.
The SSA still references the Dictionary of Occupational Titles (DOT) from 1991 to determine a claimant’s ability to work, despite it being outdated and many jobs on the list are now obsolete. For example, the DOT lists “tube operator” and “addresser” as possible occupations - both occupations that have now been replaced with technology to automate the process for businesses. Furthermore, the Department of Labor’s offices do not use the DOT anymore and have since replaced it with the Occupational Information System (OIS).
Challenges in Evidence Collection and Disability Verification
The SSA's requirement for "all evidence" rather than "relevant evidence" has led to an overflow of unnecessary documentation, adding hundreds of pages per applicant to the processing workload.
The SSA's criteria for establishing disabilities have become less inclusive of findings from other agencies or treating physicians due to a significant policy shift. Prior to 2017, adjudicators were permitted to give significant consideration to the opinions of a claimant's treating physician, acknowledging their specialized knowledge and the comprehensive understanding gained from ongoing patient interactions. However, this approach has changed, and now, even if the Department of Veterans Affairs (VA) deems a veteran 100% disabled and that veteran is receiving monthly compensation for their disabilities, the SSA may still deny their benefits.
Under HIPAA, healthcare providers can take up to 30 days to deliver records or even longer with extensions. However, SSA regulations may only wait 20 days for the records without verifying the requests were received. When medical records are not received within the 20 days, the SSA will often send the claimant to a paid consultant for examination.
Phone Issues
For claimants or representatives of claimants who have questions, calling the SSA could lead to more frustration. On average, callers had to wait on hold for 33 minutes before a SSA agent could answer the phone.
From January 1st to September 30th, the SSA received over 42 million phone calls and maintained an average on hold time of a little over 36 minutes.
To further add to this wait time, the current SSA process requires SSA staff to call and verify electronic signatures even though all documents submitted online go through an electronic signature platform for verification. This not only adds to call lag times but also creates potential delays if claimants miss these verification calls.
High Denial Rates
A significant proportion of initial claims are denied, compelling many claimants to enter the appeals process, which further burdens the system and prolongs the waiting period for applicants. In 2022, the SSA denied 62% of the 1,765,032 claims received - which meant over a million Americans were denied their disability benefits. That same year, 459,925 claimants submitted appeals for reconsideration and 85% were still denied their benefits.
Of the 235,462 claims that were pushed on for a hearing, the SSA only has 1,250 judges to review them. This creates immense stress as judges are expected to complete 500-600 cases each year and can lead to unfair denials. Approval rates amongst judges can vary as well - a recent government study revealed that one judge approved 97% of disability claims yet another approved only 10%.
The SSA maintains the authority to reassess claims and withdraw benefits if they determine that the claimant was not eligible for them initially. This policy can be particularly disheartening in situations like that of Kelly Page, who, after years of struggle to have her benefits approved, faces the prospect of having them abruptly revoked. Such a decision by the SSA not only negates her hard-won approval but also forces her to begin the entire disability claims process again.
Operational Constraints for Representatives
At Wettermark Keith, a personal injury firm specializing in disability cases, attorneys face operational challenges in navigating the SSA's appeal process for multiple clients. Just like claimants, attorneys and representatives must call the same 1-800 number and go through the tedious process of waiting on hold. Even worse, representatives can only inquire about one claim at a time – leaving them with no choice but to repeat the phone call process over again for each of their clients. This inefficient one-case-at-a-time system contributes to the backlog of callers waiting on hold and slows the appeals process.
Representatives also encounter technical issues with their representative accounts, such as being penalized for checking on unprocessed claims. If a representative checks too many unprocessed claims within a 24-hour period, their account will be locked and they will have to call the SSA Help Desk to regain access to their account.
Unfortunately, representatives cannot see the same claim status information as claimants, which leads to confusion when the claimant calls their representative for an explanation on what their mySocialSecurity portal status shows.
Proposed Solutions and Recommendations
Lawmakers are frustrated with the SSA’s backlog of claims and in disagreement on how best to resolve the issue. Following the insightful remarks of David Camp, Interim CEO of the National Organization of Social Security Claimants’ Representatives (NOSSCR), on the inefficiencies within the SSA, he proposed several immediate, cost-effective solutions. These solutions are designed to streamline processes and enhance the accuracy of disability assessments. They include:
Remove the reconsideration step - By removing the optional reconsideration step in the initial claims process, the SSA could substantially shorten the processing time. This stage, which currently takes up nearly half of the total processing duration, not only extends the timeline by months but also leads to identical outcomes in more than 90% of cases, underscoring a significant redundancy in the system.
Restore the treating physician rule - If the SSA were to restore the rule allowing adjudicators to give significant consideration to the opinions of a claimant's treating physician, it could lead to a more holistic and accurate assessment of disability claims. This change would acknowledge the depth of understanding that treating physicians have about their patients' conditions, potentially resulting in a higher rate of approved claims for those genuinely in need. Additionally, it could foster greater alignment between SSA disability determinations and the findings of other agencies like the Department of Veterans Affairs, thereby reducing inconsistencies and improving the overall efficiency of the claims process.
Prioritize obtaining medical evidence - By investing additional effort to acquire existing medical records and evidence, the SSA could ensure a more comprehensive and accurate evaluation of each claimant's condition, potentially reducing the need for additional consultations. This approach would not only streamline the process but also minimize the physical and emotional strain on claimants, who often face significant challenges in attending extra medical appointments.
Revise the “All Evidence” rule - This change would reduce the overwhelming volume of unnecessary documentation currently required, thereby alleviating the administrative burden, and speeding up claim processing times. A more targeted approach to evidence collection would also enhance the accuracy and efficiency of disability determinations, ultimately benefiting both claimants and the SSA.
Accept Electronic Signatures without a verification call - This approach would significantly reduce call wait times and administrative overhead, as it leverages the security and efficiency of established electronic signature technologies. By doing so, the SSA can streamline document processing, enhance user convenience, and focus its resources more effectively on other critical aspects of service delivery.
Utilize the existing Occupational Information System - The SSA should transition from using the outdated Dictionary of Occupational Titles (DOT) to the more current Occupational Information System (OIS) to ensure that disability evaluations are based on accurate and relevant job market data. The OIS offers a contemporary and dynamic overview of occupations, reflecting the current labor market and technological advancements, which is crucial for making fair and realistic determinations about a claimant's ability to work. This shift would align the SSA's practices with current labor trends and improve the accuracy of disability assessments.
As lawmakers grapple with the challenge of addressing the SSA's backlog of claims, the solutions proposed by David Camp offer a pragmatic and efficient path forward. These recommendations, if implemented, could significantly reduce delays, enhance the fairness of disability assessments, and improve the overall experience for claimants. It is now incumbent upon the SSA and policymakers to consider these thoughtful proposals and take decisive action to reform a system that impacts the lives of millions of Americans.
Embracing Change: A Call to Action for the SSA
The path to reforming the Social Security Administration is complex but essential. The insights and recommendations provided by experts like David Camp illuminate a way forward that balances efficiency with fairness. As the SSA confronts its backlog and operational challenges, the adoption of these proposed solutions could mark a significant turning point in how disability claims are processed and managed. It is a critical moment for the SSA to embrace change, not just in its operational tactics but in its overarching approach to serving the American public. The time for action is now, with the goal of creating a more responsive, equitable, and effective system that upholds the promise of support and security for all who depend on it.
Frequently Asked Questions
The SSA's backlog is attributed to several factors, including processing inefficiencies, reliance on outdated systems like the Dictionary of Occupational Titles, and policy changes that have made disability determinations more stringent. Additionally, challenges in evidence collection, high denial rates, and operational constraints for representatives contribute to the delay. The combination of these factors has led to a system that struggles to keep pace with the volume of claims.
As of June 2023, roughly $1.4 trillion will be paid out in Social Security benefits to 67 million Americans each month. Below, is a snapshot of the number of beneficiaries by category:
- Retired Workers 49.4 million recipients
- Dependents of Retired Workers total 2.6 million recipients
- Disabled Workers 7.5 million
- Dependents of Disabled Workers total 1.2 million
- Survivors 5.8 million
The Congressional hearing highlighted critical issues within the SSA, including outdated and inefficient processes, high denial rates of claims, and the lengthy time taken to process appeals. The hearing also brought attention to the need for modernizing the SSA's systems and policies, such as transitioning from the DOT to the OIS for more accurate job market data. Experts like David Camp proposed several solutions to streamline processes and improve the accuracy of disability assessments.
Navigating the current SSA system requires patience and persistence. Claimants and their representatives should ensure that all documentation and evidence submitted are thorough and relevant to expedite the review process. Maintaining consistent communication with SSA representatives can also be beneficial in staying informed about the status of their claims. Additionally, it is crucial for claimants to seek support from experienced disability attorneys or advocates who are well-versed in the complexities of the SSA system. These professionals can offer valuable guidance and assistance throughout the claims process, helping you navigate the bureaucratic challenges more effectively.
In 2023, recipients of Social Security Disability Insurance (SSDI) receive an average monthly payment of $1,484.26 if they are disabled former workers, $406.31 for spouses of disabled workers, and $473.14 for children of disabled workers. Meanwhile, for those eligible for Supplemental Security Income (SSI), the average monthly benefit stands at $914 for individuals, $1,371 for couples, and $458 for essential persons.
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