Senate Finds Flaws in Disability Claims

Washington Times

September 13, 2012

More than one out of every 20 Americans of working age was collecting Social Security disability payments as of March, but the system designed to judge claims is overloaded and bungles more than a quarter of the cases, according to a new report by a Senate investigative subcommittee.

Investigators looked at 300 cases in which disability was approved and found adjudicators regularly ignoring red flags in applications, such as incomplete or inconsistent information. That finding is consistent with the Social Security Administration’s own internal reviews and signals a system in need of an overhaul, said Sen. Tom Coburn, the ranking Republican on the subcommittee.

Coburn led the study and said some of the decisions coming from administrative law judges (ALJs)—one level of the process—are so bad they make the final judgments seem almost arbitrary. “I think you could flip a coin for anybody who came before the Social Security Commission and get it right just as often as the ALJs do,” he said.

Disability is one of the two major parts of the Social Security system and is designed to provide support for Americans who are unable to work because of physical or mental impairments. Benefits start months after a claim is approved, and two years later, beneficiaries also can begin to collect Medicare.

The panel looked at 300 cases in which claims were approved, selecting applications from Virginia, Oklahoma and Alabama. Coburn said he’ll next take a look at cases in which claims were denied and said he expects to find applicants who should have qualified but were denied. “My worry is we’re going to find a lot of people this system was designed for that didn’t get disability,” he said.

Not alone

Social Security spokesman Mark Hinkle said the agency shares investigators’ concerns. He said “a small number of judges” have failed to conduct proper hearings or require proper documentation.

“We have undertaken a vigorous set of quality initiatives since the time most of these cases were decided about five years ago, and data indicates that we have made substantial progress,” Hinkle said in an emailed statement. “We have substantially reduced the number of ‘outlier’ decisions (i.e., decisions that applied the law too harshly or too generously), and our affirmance rate in the federal courts is better today than it has been in decades.”

The report was issued Wednesday night by the Republican staff, ahead of a Thursday hearing. The investigation itself was bipartisan and conducted in cooperation with Sen. Carl Levin (D-Mich.), who is chairman of the investigative subcommittee.

The 132-page report highlights one ALJ in Oklahoma, Coburn’s home state, who has issued more than 1,000 decisions each year since 2006. Judge W. Howard O’Bryan Jr. peaked in 2008 with 1,846 decisions and regularly approved 90% or more of the claims. The average approval rate is about 60%.

The committee investigation said his decisions “were most notable for their decidedly poor quality” and that O’Bryan regularly used the same boilerplate language in approving cases. He decided cases so quickly, the agency began shipping him ones from around the country. “I may have taken a few shortcuts,” he told investigators, though he stood by his decisions. “You do whatever you can to make them go. You try to get through them the best you can.”

Coburn said he first got interested in the issue after he hired a man to clear trees from his Oklahoma property several years ago. The man asked Coburn to make the payment check payable to his mother, and when Coburn asked why, it became clear the man was still collecting disability but was working on the side. That man went down to the Social Security office and canceled his disability claim, Coburn said.

Off the web

The Washington Times reported earlier this year that the Social Security Administration told ALJs they aren’t allowed to use information gleaned from the web when they make their decisions.

Agency officials said they don’t want frontline adjudicators going out to look for information on their own. They said that’s a job for fraud investigators later in the process. But some adjudicators said the more tools they have to make good decisions, the better.

Last year, Coburn highlighted the case of a man living as an adult baby, which meant sleeping in an adult-sized crib and wearing diapers, who was collecting disability even though he displayed carpentry skills on a reality-television program and maintains a website for other adult “babies.”

The man said he was investigated after Coburn brought attention to his case and was cleared of wrongdoing. His case, though, raises other questions. The investigative staff on the subcommittee said the list of jobs ALJs use hasn’t been updated since the 1970s, meaning it excludes many computer jobs that those who have some disabilities might be able to perform.

Hearings before an ALJ are conducted entirely based on the record compiled and on the applicant’s own say-so. Coburn said he would like to see an adversarial system in which someone from Social Security is there to raise questions.