Social Security’s clogged pipeline

Mired in a Nixon-era process and underfunded for more than a decade, the system for deciding whether Americans qualify for disability benefits under Social Security needs to be fixed, and fixed quickly.

With the first wave of 80 million baby boomers beginning to fall into the Social Security safety net, Congress and the White House can’t put off a major reform of the disability claims process any longer.

Nationwide, the system has a backlog of 761,000 claims in the pipeline, with about 22,000 in the Atlanta region alone. On average, applicants in the Atlanta region now wait more than two years to find out whether they qualify for disability benefits, one of the worst service records for any region in the country.

That level is service is simply unacceptable. Besides providing income for those unable to work, Social Security disability opens the door for medical coverage under Medicare and Medicaid for people who have no jobs and are uninsured. The bureaucratic wait is so long that some applicants die while waiting for the disability claims to be adjudicated, while others are merely impoverished by the process.

Of course, taxpayers fund the Social Security system, and they do need protection against fraudulent disability claims. However, data indicate that the process seems stacked against even those who are obviously disabled. More than 2.6 million Americans will file disability claims this year, fueled by the baby boom generation reaching an age where chronic illness and injury can make it difficult, if not impossible, to hold a job. Applicants must show that they cannot work for at least a year.

Using state workers, the Social Security Administration screens all applicants, rejecting about 75 percent. Those who are turned down have the right to appeal. An administrative law judge, paid by Social Security, is assigned to hear each case. Most who appeal are eventually approved for disability income through the program.

The reason for the backlog is not in dispute —- not enough workers to process the claims, and not enough administrative law judges to hear appeals of denials.

Last year, Congress increased the Social Security budget submitted by the White House by $148 million, the first increase in the agency’s funding in more than a decade. The money is being used to hire about 189 new administrative judges and to set up a system in northern Virginia that allows judges to hear cases via streaming video from Atlanta and other backlogged regions.

However, that won’t be enough to unclog the system. Without a major infusion of funds to hire more judges, along with fundamental changes in how disability claims are reviewed, the system is destined to backlog again. Many of the rules governing the process were adopted more than 35 years ago and have changed very little since then.

Among other things, the process for people who are severely impaired must be streamlined. If physicians treating the applicant agree that the person’s disability renders them unable to work a 40-hour week, then the claim —- absent indication of fraud —- should be handled promptly. (If fraud is later proved, the physicians would be liable.) These claims need not even proceed to a hearing.

Another change would require more thorough monitoring of how privately insured disability claims are being handled. Some private disability insurers require that applicants also apply for Social Security benefits. If the employee refuses, the private company can stop paying the benefit.

Moreover, when applicants are turned down by Social Security, private firms often insist the employee appeal the denial, understanding that a large percentage of appeals will eventually be approved. If the appeal is granted, some private insurers then take that person off their rolls and shift the cost to taxpayers. Congress should investigate how often this happens and take action against firms that are shirking their responsibility and clogging the system.

Other fundamental issues involving the funding of the Social Security system have so far defied bipartisan consensus. But surely leaders on both sides of the aisle in Washington can create a disability claims process that works.

—- Mike King, for the editorial board (mking@ajc.com)