Article: Social Security judges rubber-stamp claims

[counsel]

From www.wtop.com/308/3638756/Report-Social-Security-judges-rubber-stamp-claims

Tuesday - 6/10/2014, 8:28am ET

STEPHEN OHLEMACHER
Associated Press

WASHINGTON (AP) -- Four Social Security judges are headed to Capitol Hill to face accusations they rubber-stamped claims for disability benefits, approving billions of dollars in payments from the cash-strapped program.

Each of the judges approved more than 90 percent of the cases they heard from 2005 to 2013, according to a new report by the Republican staff of the House Oversight Committee. The report says the high approval rates indicate the judges didn't follow proper procedures or conduct meaningful hearings.

"In essence, these judges rubber stamped nearly every claimant before them for a lifetime of benefits at taxpayer expense," the report said.

The administrative law judges were scheduled to testify Tuesday before the Oversight Committee.

In written testimony, Judge Gerald I. Krafsur of Kingsport, Tennessee, said he had heard thousands of cases and never had one overturned because the applicant was not disabled.

Judge Harry C. Taylor of Charleston, West Virginia, said he makes it a point to keep an open mind about each case while conducting a balanced, thorough review.

From 2005 to 2013, Krafsur approved 99 percent of the cases he decided, the report said. Lifetime benefits average about $300,000, according to the report, so Krafsur's cases will lead to nearly $1.8 billion in benefits.

During the same time period, Taylor approved 94 percent of the cases he decided, for nearly $2.5 billion in total benefits, the report said.

Also scheduled to testify were Judge Charles Bridges of Harrisburg, Pennsylvania, and Judge James A. Burke of Albuquerque, New Mexico.

The report said some judges approved claims at alarmingly high rates as part of an agency effort to reduce case backlogs and processing times. It is often easier for a judge to approve a claim than to deny it, the report said. Denials can be appealed, so judges must meticulously document their reasons, the report said. Approvals are generally accepted, ending the judge's role in the case.

In 2007, the average processing time for a hearing was 512 days. It is now about 411 days.

A report by the committee's Democratic staff said the judges at Tuesday's hearing don't reflect the vast majority of administrative law judges. The Democratic report says oversight and training for the agency's 1,400 judges has improved over the past decade.

Both reports note that, overall, judges are approving claims at the lowest rate in years. In 2013, judges approved 56 percent of the cases they decided, down from 72 percent in 2005.

Tuesday's hearing comes as Social Security's disability program edges toward the brink of insolvency. The trust fund that supports the disability program is projected to run out of money in 2016. At that point, the system will collect only enough money in payroll taxes to pay 80 percent of benefits, triggering an automatic 20 percent cut in benefits.

Congress could redirect money from Social Security's much bigger retirement program to shore up the disability program, as it did in 1994. But that would worsen the finances of the retirement program, which is facing its own long-term financial problems.

Nearly 11 million disabled workers, spouses and children get Social Security disability benefits. That's a 45 percent increase from a decade ago. The average monthly benefit for a disabled worker is $1,146.

An additional 8.4 million people get Supplemental Security Income, a separately funded disability program for low-income people.

In order to qualify, people are supposed to have disabilities that prevent them from working and are expected to last at least a year or result in death.

Social Security disability claims are first processed through a network of local Social Security Administration field offices and state agencies called Disability Determination Services. About two-thirds of initial claims are rejected, according to agency statistics.

If your claim is rejected, you can ask the field office or state agency to reconsider. If your claim is rejected again, you can appeal to an administrative law judge, who is employed by Social Security.

The Republican report notes that most cases have been rejected twice by the time they reach an administrative law judge, raising questions about high approval rates.

[almostheaven]

See related article below. Although I recognize that these assertions represent the exception and not the rule, it makes it worse when it wasn't so long ago that allegations were made against a Huntington, WV SSA ALJ regarding his decision-making. Not the image I would want to have representing SSA or ALJs -- or my home state. The only way to go from here is up??

Report: Charleston judge “rubber stamped” disability claims
by Dave Boucher, Capitol Bureau Chief
A Charleston Social Security judge is accused of rubber stamping more than $2.5 billion in lifetime Social Security benefits since 2005, according to a congressional report released today.
Administrative law Judge Harry Taylor reportedly approved 94 percent of the cases presented to him between 2005 and 2013, according to an investigation by Republican members of the House Committee on Oversight and Government Reform.
“He had an overall allowance rate of nearly 94 percent and awarded benefits to nearly 6,000 people without a hearing,” the report states.
The report also accuses Taylor of inappropriate conduct toward female employees and sleeping on the job.
“When ALJ Taylor held hearings, the review found that he never elicited testimony from medical experts,” states the report, citing a formal review from 2011
“The report found that an ‘overreaching problem’ with the reviewed decisions ‘was a lack of rationale. ... There would be little evaluation of the evidence and no function by function assessment of the claimant’[sic] abilities.’”
Taylor is one of four administrative law judges specifically noted in the report who appeared before the committee Tuesday. While Republicans on the committee argued the cases were emblematic of systemic problems, Democrats said several examples don’t mean an entirely new system is needed.
. . .
Of the 8,770 people with claims before Taylor between 2005 and 2013, Taylor approved 8,277 cases for benefits, the report states.
Taylor acknowledged approving many cases and receiving at least one administrative letter appreciative his speedy turnover of cases. After asking Taylor about the letter, Issa asked Taylor if his high reversal rate meant the administrator who reviewed the case was wrong almost all the time.
“That’s a hard question to answer, sir,” Taylor responded.
Taylor, a Wheeling native who’s served as an administrative law judge in Charleston since 1988, said he followed a multi-step judgment process in deciding whether a case needs a hearing or whether benefits should be awarded.
“I have always been a person driven to work. With very few hobbies except those of my children, my dedication and attention has always been on my work days, nights, and even weekends,” Taylor said at the end of the four-page statement.
Taylor is also accused of leaving an inappropriate message on a female employee’s voice mail, conducting “sloppy work” and routinely falling asleep during hearings and in his office.
“(An administrative inspector) also recounted numerous other sleeping incidents witnessed by other SSA employees and court officials,” the report states.
“He recounted one employee’s statement that ‘Judge Taylor’s snoring was the subject of discussion/humor among the writers whose offices are nearby’ and that he could ‘be heard snoring just about every other day.’”
Taylor was eventually suspended for 14 days.
Since the suspension Taylor is accused of more inappropriate conduct toward female employees and more sleeping in court, in addition to questionable rulings, the report states. There is an open investigation by the Social Security Administration, according to the report.
A spokeswoman from the administration’s regional office said all requests for comment needed to be submitted via email. No one responded to a Daily Mail emailed request for more information about Taylor.
During the hearing, Taylor denied any inappropriate conduct toward any women. He acknowledged falling asleep at work, but said it was due to a sleep medication that was making him drowsy in the morning.
“ALJ Taylor’s high decision total, high number of decisions without hearings, and excessive allowance rate, combined with his personal misconduct, demonstrate that ALJ Taylor should not be deciding disability cases,” the report states.
“However, ALJ Taylor continues to decide a full caseload, and awards benefits to nearlyand awards benefits to nearly every claimant before him .”


- See more at: www.charlestondailymail.com/article/20140610/DM01/140619970#sthash.3cYFAPCT.dpuf

[JudgeRatty]

So frustrating to see all of this when the vast majority of us are ethical hard working honest employees of the agency. Crud. Sigh.

[moopigsdad]

The just as interesting fact is that I do not see any Congressional review of those ALJs who only approve 15% or less of the disability claims before them. I think the extreme norms on either side are just as bad. The reality of the situation is most ALJs are in the middle norm of decision-making and do their job correctly. There are bad apples in every profession, including politics and Congress. So, is the only concern for Congress the assets of the Trust Fund? Why is there not an equal concern for the claimant's arbitrarily turned down by ALJs whose approval ratings for claimants are in the single digits? I guess it is just more political showmanship and soapbox oratory.

[maquereau]

Moopig, the low payers get reviewed and often reversed/remanded at the AC and District Court. The high payers don't get the same appellate scrutiny for obvious reasons. So, in effect, there is already a check on the low payers that the high payers do not face.

[spousemouse]

It's also worth noting the disparities by state. Approval averages range from roughly 30% - 50%, which reflects, in part, the differences in quailty/staffing of the initial review. Being a 15% pay judge in a 30% state would be less of a red flag than in a 50% state, and, as already noted, both are subject to review.

[moopigsdad]

Jun 11, 2014 7:28:18 GMT -5 maquereau said:

Moopig, the low payers get reviewed and often reversed/remanded at the AC and District Court. The high payers don't get the same appellate scrutiny for obvious reasons. So, in effect, there is already a check on the low payers that the high payers do not face.

Maq you make the assumption that all people denied at the ALJ level appeal that decision. This is not the case a lot of the time. Furthermore, the AC has the ability for own motion review and does use it. Don't get me wrong I am not supporting the high payers, not the low payers, but I am supporting a fair and impartial Congressional review of the system. The majority of ALJs do their jobs correctly and fairly. This Congressional witch hunt is out to give all ALJs a black-eye, not just high payers. These majority committee members are "damning" the whole system and the entire ALJ corp and I take issue with that condemnation.

[bartleby]

I take this as more of a condemnation of management and their blind eye to quality with emphasis on pay down the back log and allowing these ALJ high payers to continue for years on end. Regional management and Chief Judge's office have known for years what was going on. At the ongoing Congressional investigation, Commissioner Colvin stated that "ALJ's have never been required to do 500-700 cases a year". This is pretty bald face in view of the facts. I don't think any of this will hurt the everyday average Joe/Jane ALJ in the field. I think it may shake up management for a while as it should.

[Gaidin]

Judge Taylor's pay rate is not the only thing out of whack. Assuming the numbers are accurate he was issuing well over a thousand decisions a year.
I honestly believe if a judge is an extreme outlier (top/bottom 10%)in number of dispositions, pay rate, or reversal rate their practices should be examined. I am not necessarily saying they are doing something wrong. They may be getting an abnormal amount of very small or large files or some other reason that may require a reassessment of the work flow. They may have figured out a better system which could be passed onto other judges or they may need additional training in some aspect of their job. I don't think anybody that is an outlier should feel insulted by such a review.
The easiest way to identify problems or potential innovation in a process as large and diverse as the ODAR process is to analyze your outliers.

[sandiferhands (old)]

Doubly frustrating because there are so many qualified and conscientious candidates waiting in the wings who would take the job seriously.

[grassgreener]

Jun 11, 2014 7:37:21 GMT -5 spousemouse said:

It's also worth noting the disparities by state. Approval averages range from roughly 30% - 50%, which reflects, in part, the differences in quailty/staffing of the initial review. Being a 15% pay judge in a 30% state would be less of a red flag than in a 50% state, and, as already noted, both are subject to review.

While I agree that there are regional and state differences, the vast differences within an ODAR office or with ODARs in the same state are puzzling. In my ODAR, for example, the pay rate is between 30% - 85%.

[privateatty]

Jun 11, 2014 7:28:18 GMT -5 maquereau said:

Moopig, the low payers get reviewed and often reversed/remanded at the AC and District Court. The high payers don't get the same appellate scrutiny for obvious reasons. So, in effect, there is already a check on the low payers that the high payers do not face.

Simple fix. Appropriate the funds to hire more OGC to appeal and make sure they have the same office write the necessary CFRs to appeal the high payers. Hire more AJs at the AC. Save millions with thousands.