Difficult disability claims in rural areas; data show low approval rates | New
ATLANTA – Getting approval for disability benefits from the Social Security Administration isn’t easy, but depending on where you live it could be even more difficult.
In northern Alabama, for example, three of the judges hearing disability claims have the lowest approval records of any administrative law judge in the state; two of them also have one of the lowest approval ratings among the country’s 12,000 judges.
In 2020, 39% of initial disability claims were approved nationwide, according to data from the SSA. Data from August 2021 shows Alabama has the fourth-lowest approval rate for disability claims – 32.3% – while national data shows an approval rate of 41.7%.
Receiving disability benefits is not easy at first and it is by design. Over the past decade, the Social Security Administration has changed regulations to make it more difficult to approve disability claims.
Social security has a strict definition of disability: “the inability to engage in substantial gainful activity (work) due to a medically determinable physical or mental impairment that has lasted or is expected to last at least one year or result in death said Patti Patterson, regional communications director for the Atlanta-area Social Security office, which represents Alabama and seven other southern states.
The Social Security Disability website lists a range of impairments and disorders that could be considered a disability, including the mental, respiratory, immune and cardiovascular system if found by medical records severe enough to prevent someone. ‘one to work.
Many disability claimants think they will only need a letter from their doctor stating that they must be disabled. Not only has it never been easier, but in 2017 the Social Security Administration made it even easier to reject the physician’s referral by allowing the denial on the basis of physician specialty, duration, and type of. treatment, among other factors.
Rachael Henderson of the Georgia Legal Services Program, which represents clients with disabilities in 155 counties outside of the Atlanta metro area, said access to transportation has been a long-standing barrier in rural counties where her clients have tried to get a handicap.
“In rural areas you often won’t have doctors. In recent years, in some of our rural areas, in one or two counties, they have lost hospitals, ”she explained. “You have to go to a large city to be able to see a doctor. “
While current income, past denials, and failure to adhere to treatment plans are among the top reasons disability claims are denied, the lack of adequate medical evidence also plays a significant role in the claimant’s denial.
“It is very important that you have good and reliable health care (because SSA) requires sufficient visits for the doctor to give them and provide an adequate diagnosis supported by laboratory tests and symptoms,” said Henderson. “It becomes a vicious cycle.… If you don’t get the treatment then you get disparate treatment and then you don’t get adequate treatment. Then if I (represent a) disability (claim), it is very difficult as I have to redo all these steps to make sure you have everything to meet the requirements.
The claim goes through multiple levels, and at each level, according to federal disability decision data, more claims are denied than approved. At the level where administrative law judges are called upon to rule, a little more than half, or 53%, are accredited.
But if a person files a disability claim with the Florence, Alabama office, which covers the northern part of Alabama, including Cullman and Limestone counties, the odds of getting a claim approved drop dramatically, according to the judge in charge of the case.
Overall, the district has a claims approval rate of 42%; and three of the judges are the only ones in the state to approve less than 30% of the applications submitted to them.
Judge Cynthia Weaver only approves 12% of claims, giving her the lowest claim approval rate of any disability judge in Alabama. Among nearly 50 judges nationwide with similar workloads, between 250 and 260 decisions, Weaver had the lowest approval score for claims based on data reported in recent months.
A claimant’s chances are only slightly better if they appear before Judge Patrick Digsby, who approves about 13.6% of the claims that come before him. Justice Mallette Richey has third lowest claims approval rate at 26%
While the Florence office had an average wait time of 288 days, which was quite low nationally – ranked 41st out of 170 offices – the office, along with the Mobile and Birmingham offices, had one of the most low numbers of cases per judge per day, all ranked in the bottom of 16% with an average of 1.9 cases per judge.
If an application is denied at the ALJ hearing stage, applicants may choose to appeal to the Appeals Board or dismiss their applications and start all over again, in the hope of securing a judge and a judge. different result next time. In 30% of the cases assigned to Weaver, this is what the candidates did.
Patterson declined to arrange an interview with Weaver or a representative of the SSA, but said the Appeals Council is essentially the ALJ’s accountability body.
“The Appeals Board uses several methods to ensure the quality of ALJ decisions,” Weaver said in an email. “In addition to handling the last level of the agency’s appeals process and referring cases with gaps to the ALJ, it performs pre-implementation reviews on a random sample of allocations from the ALJ. ALJ and post-implementation reviews that examine specific issues to help inform our training needs and potential policy changes. “
If applicants choose to appeal, their chances are not good. The Appeal Board rejects 82% of the requests and refers an additional 14% to the judge who heard the case. There is no data on the final outcome of cases referred to judges. Only 1% of requests are approved by the Appeal Board.
A claimant whose claim is rejected by the Appeals Board may choose to appeal to a federal court, which examines whether or not the ALJ followed federal rules in denying the claims. Although ALJs are subject to federal rules and regulations, many lawyers and disability groups have asserted that judges’ decisions can often be made with hidden biases.
“The ALJ is going to have some subjectivity and internal biases,” Henderson said. “It’s the way the ALJ looks at the person and some of them have written some interesting decisions.”
Tom Jedlowski of the Tennessee Disability Coalition referred to a case in which an ALJ rejected the claim of a claimant with heart disease, who he said appeared biased towards a history of alcohol and drug use. of the applicant.
“Anything big is going to have bad actors. … I think what ends up happening to these people in the disability community is that these stories end up dominating the narrative and making it seem like everyone who receives these benefits is guilty of the same crimes, ”he said. said Jedlowki. “I think it’s an unfortunate narrative because it’s really people’s lives that is at stake. These decisions disproportionately affect marginalized communities for sure. “
Patterson said the ALJs are bound by rules of impartiality. Coupled with at least seven years of legal experience, judges are also required to undergo training throughout their careers.
“A quality decision is both timely and accurate. We use tools to provide individualized feedback to our referees. This gives ALJs information about their (Appeals Board), including the reason for detention. , but also information on their performance against other ALJs in their office, region and nation, ”she said.
Tennessee currently has a 37.9% disability approval application rate, comparable to Georgia and Mississippi, which approve at just over 36.5%. These states join Alabama in the top 16 states with the lowest approval rates for disability compensation claims in the country.
“We have a rural health crisis in the state of Tennessee,” Jedlowski explained. “Because we chose not to expand Medicaid, many rural hospitals closed because they relied on these payments to stay open. If these communities have broadband, which is also a crisis in Tennessee, perhaps they could have a telemedicine visit with a specialist in one of our major markets. “
A January 2019 report in the Tennessean found that more than half of all contract physicians reviewing disability claims exceeded the federal standard of 1.5 cases per hour, and one in five physicians were doubling that rate; they get a certain amount for each case they review.
“The more complaints are processed, the more they get paid,” Jedlowski said. “And that doesn’t always lend itself to the most scrupulous scrutiny of every application.”
Four of six Tennessee hearing offices ranked in the top 36% with the fastest hearing times; the state average is 297.5 days.
Here are the states with the lowest percentage disability claim approval rates through August 2021:
West Virginia: 31.9
North Carolina: 33.5
New Mexico: 34.4