Opening Statement at PSI Hearing on Social Security Disability Programs
Improving the Quality of Benefit Award Decisions
Thursday, September 13, 2012
The Social Security Disability Insurance program provides financial support to Americans who, due to a disability, are incapable of working at a full-time job. The number of individuals applying for disability insurance aid has been increasing in recent years, made worse by the 2008 financial crisis when millions of workers lost their jobs and their employer-sponsored health insurance. Without health insurance, many of those individuals couldn’t afford to pay for health care. Without health care, chronic conditions held in check by medicine and treatment worsened and sometimes became disabling. Those workers then turned to federal disability insurance.
More individuals receiving disability insurance payments has, in turn, increased the stress on the Social Security Disability Trust Fund. Recent estimates predict that trust fund may be unable to pay full benefits by 2016, a problem this country has a moral obligation to address.
Another problem is how long the disability application process takes. Applicants can wait two years to get a hearing and even longer for their case to be decided. During that years-long wait, claimants often have less access to medical care or medicines. Although the Social Security Administration has recently reduced the backlog, large numbers of our most vulnerable citizens are still waiting in long lines.
While there are many concerns about Social Security disability programs, including exhaustion of the trust fund and the backlog, today’s hearing focuses on another set of concerns: what happens when an individual finally gets to the front of the line and gets their case heard. At the request of Dr. Coburn, the Ranking Republican on our Subcommittee, we launched a bipartisan investigation into how decisions are made to award disability benefits. After receiving actual case files from three counties in three different states, with all personal information removed, the files were reviewed to see how they were being decided, at both the initial and appellate levels. The review examined only cases in which benefits were awarded, and not any cases in which benefits were denied.
A number of troubling problems appeared. One judge who churned out over 1,500 cases per year took inappropriate shortcuts in his opinions, cutting and pasting medical evidence from the case file into his opinions without explaining or analyzing what it meant, and writing the phrase “etc., etc., etc.” rather than describing the relevant evidence. His chief judge confronted him in person and by letter, but for years he turned out the same poor quality work.
In other cases that were reviewed, judges held perfunctory hearings that lasted less than five minutes, failed to elicit any testimony from the person applying for benefits, and failed to examine medical evidence raising questions about whether that person was entitled to disability benefits. In still other cases, poorly written opinions awarding benefits failed to identify medical evidence showing how the requirements for establishing a disability were met, did not acknowledge or address evidence that impairments were not disabling or evidence that the claimant had been working, and at times even misreported medical findings or hearing testimony.
The report’s findings of a large number of poor quality decisions in the 300 case files reviewed are consistent with the Social Security Administration’s own internal research. An SSA quality review process found that, in 2011, 22% or over 1 in 5 disability cases decided by an Administrative Law Judge had contained errors or were inadequately justified. Those errors went in both directions, awarding and denying benefits. Those errors and inadequacies did not mean that the 1 in 5 disability decisions were all wrongly decided; what they meant was that the opinions being produced in those cases did not contain the type of analysis needed to be confident that the cases were correctly decided and disability benefits go only to the truly disabled.
Senator Coburn is releasing a report that describes the results of the investigation into the disability decision making process. That report, in a unique way, provides detailed, relevant information about a process that is necessarily closed to the public, since disability hearings discuss an individual’s personal medical records. The report not only confirms the Social Security Administration’s own findings, it demonstrates what is at stake, identifies important issues illustrating how the quality of disability benefit award decisions needs to be improved, and why oversight by the SSA and Congress is so important.
The report also contains many recommendations with which I agree, including expanding the Social Security Administration’s quality review process; closing the evidentiary record at a reasonable time before a hearing to ensure adequate time to review materials; updating the decades-old job list; and increasing training for the judges.
I do have a significant concern about a key recommendation to mandate a government representative at all disability hearings, because of the likelihood that it would lead to an adversarial process. The Supreme Court has said that the Social Security Act calls for the agency to operate “as an adjudicator, and not as an advocate or adversary.” That is a central principle of the disability system, and if the proposed government representative is not to advocate for a particular position before the Administrative Law Judge, it would seem to be an expensive and time consuming duplication or confusion of roles.
The men and women who administer the Social Security disability programs don’t have it easy. The plight of the disabled demands that they do their jobs quickly, given the backlog. The law requires them to navigate complex rules and make difficult judgments. The threat to the program’s solvency hovers over everything. I hope that the Subcommittee’s work will contribute to the ongoing efforts to improve the disability award process, and I look forward to the testimony of our witnesses today. First, I turn to my friend, the Ranking Republican Senator Coburn, for his opening statement, and thank him for the extensive work he and his hardworking staff put into this important effort.