Location, Location, Location
Published02/14/2013 by Tim Carney
At all levels of the process, location plays a major role in the Social Security Disability application and appeals process. From local Social Security field offices to State Disability Determination Services (“DDS”) to the Office of Disability Adjudication and Review (“ODAR”), the process suffers from wide state-to-state disparities in all areas, including claims receipts, processing times and allowance rates.
There has been no shortage of publicity around the two distinct backlogs that have been impacting the processing of SSDI claims for the past few years. As more and more people applied for benefits in 2009 and 2010, more and more strain was placed on the limited resources available to process the applications at the field offices and DDS. Meanwhile, periodic furloughs of state employees, including DDS, and a reduced overall employment level at SSA (down from just over 70,000 in December 2010 to about 65,000 at the end of 2012) have only exacerbated the delays at the initial level.
At the hearing level, the impact of increased initial application receipts over the past few years was clearly felt at ODAR, where the national hearing backlog skyrocketed to a high of about 700,000 cases with a corresponding processing time of over 500 days for a claimant at the hearing level to attend a scheduled hearing. Fortunately, the processing time has been drastically improved to about 360 days as of the first quarter of 2013. While some ODARs have successfully kept up with the increased levels of claims, others have struggled, leading to undue delays and notable variations in allowance rates. Analyzing the data, which is available through SSA’s Public Use Files, it is apparent that the single factor of where an SSDI applicant lives not only has an incredible impact on whether he or she will be approved for SSDI benefits, but also on how long it will take for the claim to work its way through the system. This trend is most evident at the hearing level, where inconsistency in hearing office processing times and ALJ disposition rates (Exhibit A – Queens, NY) results in a lack of uniformity, predictability and fairness.
Hearing Office Processing Times
From 2008 to 2010, SSA experienced an incredible 42% growth in the number of initial applications filed for SSDI benefits. While claims receipts have finally leveled off over the past two years, the sudden increase put tremendous pressure on DDS offices that evaluate initial claims and reconsiderations for medical eligibility. As the influx of claims then made its way through the system to ODAR, the strain shifted to the ALJs and hearing office staff that adjudicate claims at the third level of the process. With that shift, ODAR experienced a 46% increase in the number of requests for a hearing from 2008 to 2012 (from 589,449 in 2008 to 849,869 in 2012).
As the tsunami of initial applications began to flood ODARs across the U.S., the data revealed (and continues to reveal) remarkable inconsistency from one hearing office to the next. Consider the following:
- A claimant that requests a hearing in Shreveport, Louisiana will wait 6 months for a hearing date; In St. Louis, Missouri or Portland, Oregon (as well as five other offices) the wait is over twice as long (15 months).
- In Shreveport, Louisiana, it takes just under 8 months (233 days) for final disposition of a hearing request (processing time from request for hearing to hearing decision); In St. Louis, a claimant will wait over twice as long.
- In Rio Grande Valley, Texas, ALJs average 3.11 dispositions per day; In Queens, NY, ALJs are producing less than two per day (1.32).
While there is no doubt that some regions have been hit harder by the economic recession and high unemployment rates than others (theoretically leading to increased application rates), the data shows that claims receipts do not necessarily result in higher processing times or increased backlogs. For instance, based on the processing times above, you would assume that Shreveport has a low volume of claims, when in fact the Shreveport ODAR has received over four times as many requests as St. Louis. The lagging turnaround time in St. Louis means that over 6,000 applicants there are waiting for hearings, while only about 3,000 wait in Shreveport. Meanwhile, ALJs in both cities are producing roughly the same number of dispositions per day (2.46 vs. 2.14).
ALJ Approval Rates
When the Social Security Act was passed by Congress in 1935, there was no provision for a hearings process for claimants who felt that their cases were not treated properly under the law at the initial level. In 1939, however, amendments to the Act created a requirement that the agency provide hearings to dissatisfied claimants. As it stands today, these hearings are conducted by Administrative Law Judges who play key roles in determining the future economic security of each claimant who comes before them. There has been much scrutiny over the past few years relative to the disparities in allowance rates across different U.S. cities (coming to a head with the recent lawsuit against the Queens ODAR), and for good cause. The following samples of annual ALJ dispositions for the first quarter of FY 2013 demonstrate the inequality:
- ALJ 1 (Harrisburg, PA): 192 Fully Favorable, 27 Denials (88% Approval Rate)
- ALJ 2 (Queens, NY): 4 Fully Favorable, 16 Denials (20% Approval Rate)
- ALJ 3 (Dallas, TX): 138 Fully Favorable, 8 Denials (95% Approval Rate)
- ALJ 4 (Seattle, WA): 2 Fully Favorable, 48 Denials (4% Approval Rate)
- ALJ 5 (Norfolk, VA): 66 Fully Favorable, 69 Denials (49% Approval Rate)
Likelihood of approval is slim to none for the unfortunate applicant who comes up against ALJ 4 in Seattle. On the flip side, however, the vast majority of claimants are successful when they have the good fortune of getting a hearing with ALJ 3 in Dallas. The inconsistency exists not only in the allowance rates from one ALJ to the next, but also in the number of claims they decide on a daily basis. While the majority of ALJs have been able to meet the agency’s aggressive mandate of producing 500 to 700 legally defensible dispositions per year, others have struggled mightily. Again, the data provides evidence that even ALJ production suffers from a lack of parity from one region to another, with a high of 3.11 in Rio Grande Valley to a low of 1.32 in Queens.
So What Does It All Mean?
The data clearly demonstrates a lack of geographic uniformity in the SSDI claim adjudication process and this lack of uniformity means that regardless of eligibility, a disabled claimant applying for benefits in Boston will have a very different experience than a similarly situated claimant applying for benefits in Birmingham. Additionally, it underscores the importance of professional representation and advocacy to ensure that no matter where an individual’s application is filed, it is processed accurately, it is processed quickly, and it is subject to a fair and timely hearing when necessary.
Location, location, location… While the somewhat overused expression certainly has its place in the real estate industry (where location remains the most important factor in a home’s present and future value), there is simply no place for it when it comes to processing and deciding disability benefit claims for working Americans.