Wait Time For Federal Disability Benefits Appeal Reaches Record High

This article was originally posted in the San Francisco Chronicle

People who have applied for Social Security Disability Insurance and been turned down twice are having to wait a record number of days to get a hearing in front of a judge and receive a decision.

The average wait time is 596 days or 19½ months, up from 545 days in September and only 353 days in 2012. The backlog of cases pending a hearing stands at about 1.1 million, up from 700,000 in 2010.

Those who ultimately win their case can get federal disability benefits, known as SSDI, dating back to five months after the date of their original claim. (Some can get benefits retroactive to their original claim, if they can prove they were disabled before they filed it.)

People who can’t work and have no other source of income while awaiting a hearing can face extreme financial hardship, even bankruptcy. Even if you are not disabled now, “this could happen to you one day,” said Mary Dale Walters, a senior vice president with Allsup, a company that helps people get these benefits. If you have been paying Social Security taxes and become disabled, you are entitled to the benefits.

The Social Security Administration blames the backlog on Baby Boomers moving into their prime disability years, an increase in claims filed during the recession and staffing shortages.

News reports about disability insurance fraud — such as a 2013 episode of “60 Minutes” — make it seem like benefits are easy to get. President Trump’s budget director, Mick Mulvaney, has suggested that some recipients aren’t really disabled and the government could save billions by pushing them back into the workforce.

In reality, getting disability benefits can be arduous, and only about 37 percent of former workers who apply end up getting them.

To qualify, you generally must have worked and paid Social Security taxes for at least five of the past 10 years, or four of the past eight years if you are younger than 30, Walters said. More than a third of applicants are denied for this and other technical reasons separate from medical conditions.

If you are working and earning more than $1,170 per month (or $1,950 if blind), you generally won’t qualify.

Finally, you must be “unable to engage in substantial gainful activity due to a medically determinable physical or mental impairment that has lasted or is expected to last at least one year or to result in death,” Social Security spokeswoman Patricia Raymond said in an email.

In 1960, the most common reason people were awarded federal disability payments was for problems of the circulatory system, such as heart disease and strokes. In 2015, the most common impairment (suffered by 36.3 percent of those awarded benefits) was for diseases of the musculoskeletal system and connective tissue, such as muscular dystrophy, arthritis, bursitis, carpal tunnel syndrome and tendinitis. The next biggest group (15.1 percent) got benefits for mental disorders.

Your monthly benefit amount depends on your earnings history. The maximum this year is $2,687, but the average is $1,170. If you are getting workers’ compensation benefits, they will be deducted from your disability payment. Once you reach your full retirement age (66 to 67), you will move from disability to Social Security retirement benefits.

Most people who apply for federal disability have already exhausted unemployment and short-term state disability benefits, Walters said.

The process starts with an initial application. It takes about four months on average to get a decision unless you have one of about 250 “compassionate allowance” conditions — such as Lou Gehrig’s disease and stage four cancers — in which case you could get an answer very quickly. Only about a third of applicants get their initial application approved.

If you are rejected, you have 60 days to ask for a “reconsideration,” then wait another four months on average for a decision. Only 12 percent of people who ask for a reconsideration get approved.

If you are turned down again, you have 60 days to request a hearing in front of an administrative law judge. The average wait time — between applying for a hearing and getting a judge’s decision — ranges from 11 to 26 months, depending on location, but averages 19½ months nationwide (and in the Bay Area).

The percentage of people who apply for a hearing and win has fallen to 46 percent from 64 percent six years ago, Walters said. One reason: Since March, judges can now give equal weight to the applicant’s doctor and to a second opinion from a doctor appointed by Social Security. Previously, they gave more weight to the applicant’s doctor.

Many people who were denied benefits on the first and second go-rounds win at the hearing phase, because the hearing process “uncovers detailed and complete medical evidence, and sometimes individuals’ medical conditions deteriorate,” Raymond said.

From the the date of their initial application, many people end up waiting for 2½ years or longer for a judge’s decision.

George “Chris” Parker of San Francisco was diagnosed with Klippel-Feil syndrome, which involves the abnormal joining of spinal bones in the neck, as a child. “I was totally normal through my 20s, I had a career (in real estate) and everything,” he said.

About four years ago, he started having numbness in his arms and now has spinal stenosis. “It doesn’t just affect your spine. It’s a debilitating chronic pain disease,” Parker said. “I have to take medication through the day. I have trouble sitting and standing. I have doctor’s appointments all the time.”

Parker lost his job as a part-time real estate assistant in 2014 but did not qualify for short-term disability from the state. He filed for Social Security disability in October and was rejected in February. The reason, he said, is that he’s only 36.

“It’s harder to get approved if you’re under 50 than over 50,” said Walters, whose firm is representing Parker.

He was rejected a second time in June and filed for an appeals hearing in July. He could be waiting more than a year and a half for a decision.

Meanwhile, Parker is living in a 250-square foot subsidized apartment. He gets food stamps, and his boyfriend helps with cooking, cleaning and grocery shopping. His parents are helping out financially, “but it has been getting to be a bit of a burden on them,” he said.

Parker, who filed for bankruptcy during the recession when the homes he owned fell in value, said he might have to file again.

In January 2015, Social Security developed a plan to reduce the hearing backlog. It included expanding the use of video hearings and hiring at least 250 additional administrative law judges (plus support staff) each year in fiscal 2016, 2017 and 2018. Its goal was to reduce the waiting time to 270 days by the end of 2020.

It hired 264 judges in 2016, but added only 30 in fiscal 2017 (which ends next month) because of hiring freezes in the agency and throughout the federal government, Raymond said.

People can pursue disability claims on their own or hire an attorney or company like Allsup or Myler Disability to help. Their fee is limited to 25 percent of the past-due benefits you are awarded, up to a maximum of $6,000. If you don’t win, they don’t get paid.