Thursday, April 19, 2018

A longer wait: Some now try nearly 3 years to get disability insurance

By the time Teralyn Fleming could finally plead her case to get federal disability insurance, she had been waiting two years and three months.

The wait was not a peaceful one — a blood clotting disorder pushed her out of the workforce in 2015 so she couldn’t continue her paralegal work. Multiple expensive surgeries and three children stretched her budget. She was threatened with eviction. She considered filing for bankruptcy, but it was too expensive.

Relief was supposed to come at her Nov. 30 hearing. But the day before, she found out that her side job working with children, which brought in just over $1,000 per month, pushed her over the limit allowed to qualify for the benefits.

"Who can live on that?" the former paralegal and Tampa resident said.

Rather than be denied and jeopardize her benefits entirely, her lawyer advised her to withdraw. Now she has to start the entire process over again from square one.

Fleming, 48, is one of a growing backlog of about 21,000 off-the-job workers in Tampa Bay and 1 million nationally seeking a hearing to get Social Security disability insurance.

The statewide backlog of 70,413 cases as of late October is among the worst in the country — with Florida accounting for four out of the five biggest backlogs.

And in some cases, it’s only getting worse thanks in part to a shortage of administrative judges and a tight federal budget.

In Tampa alone, the average wait time has grown from 673 days to 705 days over the past few months. At the same time, Tampa’s backlog has built up to become the nation’s second-highest, with 12,304 pending cases as of October, up from 11,695 in September 2014.

Social Security disability insurance is a government program that provides coverage for people whose health issues make it impossible for them to work. It is separate from worker’s compensation, which covers on-the-job injuries and occupational diseases.

"In general, this is the only public program available to help individuals with injuries or chronic illnesses get income support when they can no longer work as a result," said Lisa Ekman, director of government affairs at the National Organization of Social Security Claimants’ Representatives.

But the process to secure those benefits is mired in bureaucracy and can span years. To get a case before a judge, where the highest number of cases are approved, now takes an average of 593 days nationally. And that clock doesn’t start ticking until many applicants have already spent six months or more going through the initial application phases and getting rejected.

In Florida, the average time to see a judge is 619 days, with the longest stretches in Miami (725 days) and Tampa (705 days).

After all the waiting, worker advocates contend, the payout is meager. The average benefit nationally is $1,173 per month and coverage through Medicare after a two-year waiting period.

The long list of applicants is made up of people with injuries and illnesses that prevent them from working the way they have for most of their adult life. Most are older than 50, and many have diseases such as multiple sclerosis. Baby Boomers feature heavily here, and are likely to begin applying in droves.

"The ones who do end up getting approved generally are lower skilled workers and they generally have lower education attainment," Ekman said.

The many stages for relief

The saga to get benefits begins locally at a state-level agency. A person hoping to receive benefits submits their application and medical records, and a federal Social Security Administration employee makes a decision on whether to approve benefits. The average wait time for this portion is 113 days, Ekman said. About 33 percent of people are approved here.

Those who are rejected move on to the second stage, known as "reconsideration." At the same agency that denied them the first time, a new person takes a look at the application. A little over a decade ago, 10 states did away with this to try to speed up the process. Florida still has this stage.

In 2016, just 12 percent were approved in this phase nationally. This portion of the process averages 103 days, Ekman said.

Here’s where things take a turn. If someone is denied in both the first and second stage, their next hope is to secure a hearing with an administrative law judge. About 46 percent of people who request a hearing are granted benefits, but it is time-intensive — the average wait time for this period nationally is 593 days.

That means that the average benefits seeker will wait more than two years to get benefits by the time a judge sees them.

As of the end of October — the most recent figures available — six of Florida’s eight hearing offices have wait times that exceed the national average.

The wait times largely come down to the number of available judges in a jurisdiction, said Jason Fichtner, senior research fellow at George Mason University’s Mercatus Center. Fichtner previously served as deputy commissioner of Social Security.

Should a judge rule in favor of the person seeking disability, they will immediately get benefits.

If they are denied, however, they move into the fourth stage — filing an appeal. Benefits are only awarded in 1 percent of cases in this portion, but about 13 percent of cases are sent back to a judge. If the appeals court denies someone Social Security disability benefits, the only course of action is to appeal it in federal court.

Many times, the wait can feel especially long because applicants cannot make more than the amount they would receive in benefits to qualify. That means two years of not working, even if their illness or injury allows them to do some work.

"When you put it in the context that about half the country doesn’t have enough in savings to pay for a $1,000 emergency," Ekman said, "you can imagine what kind of financial straits people are getting in while they’re waiting to access the benefits they are entitled."

Often, that means selling assets and trying to make ends meet with savings.

"People who are trapped in that backlog are losing their homes and they’re losing the savings they’ve accumulated," said Steve Perrigo, vice president of Allsup, an Illinois-based company people attempting to get benefits can hire to guide them through the process.

Why so long?

Long wait times are largely attributable to budget constraints and a lack of available administrative judges.

A major contributing factor is the Social Security Administration’s budget. In fiscal year 2016, the agency’s budget was $12.4 billion, slightly less than its 2011 budget — $12.5 billion.

Administrative law judges, who move a significant number of cases along, are in short supply. While the agency has worked to solve this by hiring more than 300 judges over the past two fiscal years, Ekman said, the same has not been true for the judges’ support staff. Hiring freezes previously prevented law clerks, senior attorneys, paralegals and other support staff from being hired. Even when new employees are hired, it can take up to two years for them to be fully adjusted to the process.

"When you add to that a perfectly-expected increase in applications, those things have compounded one another," Ekman said.

Seeking solutions

A multi-pronged approach is needed to diminish the backlog, experts say, but it begins by spending more on the problem.

"They need more money and it needs money over a long period of time," Ekman said.

The backlog must be made a priority, Fichtner said, and the priority must extend further than lowering the average wait time.

"If you measure the average wait time, you might be sending the message that you can clear out (easier) cases," leaving more complicated cases to sit for longer but ultimately bringing the average down, Fichtner said.

A targeted effort to clear out cases that have sat for 600 days or more, he said, is one way to help the backlog.

Resources for districts could be better distributed, too, he said. If a city such as Boston, which has a relatively low wait time, is able to handle a heavier load, it could potentially take some cases from more inundated cities, such as Miami, to help speed them along. This could be accomplished, Fichtner said, with methods such as video hearings.

But all of this requires leadership, Fichtner said. The agency hasn’t had a confirmed leader since 2013. The two following then-commissioner Michael Astrue’s departure have been acting commissioners.

"Without that kind of confirmed Senate-backed leadership, it’s hard to reallocate resources and take command," he said.

Contact Malena Carollo at [email protected] or (727) 892-2249. Follow @malenacarollo on Twitter.

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