25% of Social Security disability benefits may be paid out improperly

And the hits keep coming for the Obama administration! OK … it’s not just the Obama administration, it’s the culture of federal government dependency that has been growing for decades. A Senate panel reviewed 300 disability case files and found 25 percent “failed to properly address insufficient, contradictory, or incomplete evidence.”

The full report (PDF) is available online. Here are the findings of fact in the report.

Based upon its review of the 300 disability case files, the Report makes the following findings of fact.

1. Low Quality Decisions. The investigation’s review of 300 disability case files found that more than a quarter of agency decisions failed to properly address insufficient, contradictory, or incomplete evidence. The report’s findings corroborate a 2011 internal quality review conducted by SSA itself, which found that on average nationwide, disability decisions made at the ALJ level had errors or were insufficient 22 percent of the time. The three counties examined by the Subcommittee are in regions with even higher individual error rates, according to SSA, of between 23-26 percent. It is likely that the three counties had error rates in excess of their regional averages, raising serious questions about the quality of their decisions. ALJs also failed in some cases to adequately analyze the effect of factors such as obesity and drug and alcohol abuse on a claimant’s impairment.
2. Insufficient and Contradictory Medical Evidence. In many cases, at both the initial and appellate levels of review, the state-based Disability Determination Services (DDS) examiners and SSA Administrative Law Judges (ALJs) issued decisions approving disability benefits without citing adequate, objective medical evidence to support the finding; without explaining the medical basis for the decision; without showing how the claimant met basic listing elements; or at times without taking into account or explaining contradictory evidence.
3. Poor Hearing Practices. Some SSA ALJs held perfunctory hearings lasting less than 10 minutes, misused testimony provided by vocational or medical experts, and failed to elicit hearing testimony needed to resolve conflicting information in a claimant’s case file.
4. Late Evidence. Some case files showed that disability applicants, usually through their representatives, submitted medical evidence immediately before or on the day of an ALJ hearing or after the hearing’s conclusion, a practice leading to confusion about the supporting evidence and inefficiencies in case analysis.
5. Inconsistent Use of Consultative Examinations by ALJs. In many cases before ALJs, consultative examinations (CEs) submitted on behalf of either SSA or a claimant were either summarily dismissed or heavily relied upon, with little to no explanation. In addition, the CEs themselves often consisted of little more than conclusory statements with insufficient reference to objective medical evidence or how the CE’s findings related to other evidence in the case file.
6. Misuse of Medical Listings. In many case files, ALJ opinions failed to demonstrate how a claimant met each of the required criteria in the SSA’s Medical Listing of Impairments to qualify under “Step Three” in the application process. Awards at Step Three are reserved for those who have medical conditions SSA has determined to be severe enough to qualify an applicant for benefits.
7. Reliance on Medical-Vocational Guidelines. The majority of disability awards reviewed by the Subcommittee at the ALJ level utilized SSA medical-vocational grid rules. A recent SSA analysis found that benefit awards were made under these grid rules at a rate of 4 to 1, compared to awards made due to a claimant’s meeting a medical listing. At times, these decisions were the result of a claimant’s representative and the ALJ negotiating an award of benefits by changing the disability onset date to the claimant’s 50th or 55th birthday.
8. Outdated Job List. Some case files showed DDS examiners and ALJs relied on the Department of Labor’s outdated Dictionary of Occupational Titles (DOT), which SSA is in the process of replacing with a new Occupational Information System, to identify jobs open to claimants with limited disabilities. The last major revision to the DOT occurred in 1977, yet the new database is not expected to be ready until 2016. In the meantime, SSA disability decision-makers will continue to rely on the DOT which does not reflect current labor market trends or jobs available in the national economy.

Looking for one more outlandish figure to ensure your eyes roll back from the screen? Between 2006 and 2011 – in just five years – the total number of Social Security disability insurance beneficiaries increased 23 percent, and the total benefits paid increased 40 percent. Think that 23 percent increase matches up with the population change between 2006 and 2011? Oh heck no!

The population change between 2006 and 2010 per the US Census Bureau (yeah, I know I’m using 2010 data instead of 2011 which I can not find right now) for the two age groups most likely to need Social Security disability benefits was about plus 8 percent. The population change for the 45 – 64 age group went up 8.8 percent from 2006 to 2010 and the change for the 65 and over crowd went up 8 percent. (The estimated total US population went up 4 percent between 2006 and 2011.)

You would think the percentage of those needing disability benefits would go down with the United States becoming a safer place, but that’s not the case at all. It’s clear more people are asking for benefits and the SSA is giving it to them. Certainly, the rough economy has to be a factor. More people unemployed and without health insurance could increase the need for benefits, but 8 percent versus 23 percent? Oh heck no!

In 2006 about 2.9 percent of Americans received SSDI. Remember, we’re talking about disability benefits, not Social Security. In 2011, that percentage rose to 3.4 percent, an increase of 17 percent in just five years. There is little chance we can reverse this trend, but we must try. Democrats will fight to ensure that 3.4 percent (or higher) will become the new normal. Once we get out of this economic downturn – and I hope we eventually do – let’s go back to this post and revisit the numbers to see if “we’re better than we were 10 years ago.”

Driving. Off. Cliff. Soon.