Some gains made on Social Security backlog

Three years ago, the Social Security Administration’s Atlanta offices had the nation’s worst backlog of pending disability cases. Some very sick people, who initially had been turned down for Social Security benefits and were awaiting appeals, were losing their homes, or even dying, before getting a cent.

The situation wasn’t a whole lot better in other parts of the country.

But these days, the average wait time to get an appeal hearing has been cut by more than half. The Social Security Administration has hired more staff; opened its third hearing office in the Atlanta area, in Covington; and overhauled its operations here and around the country.

“It’s been the most remarkable improvement in the country,” said Social Security Commissioner Michael Astrue.

Lawyers and people applying for disability benefits say the process still often takes years and is fraught with frustration, but the agency has made big improvements overall by shortening the time to get an appeal heard.

Astrue said the improvements have had a dramatic effect locally.

Social Security’s downtown Atlanta office now takes 366 days on average to resolve a claim, down from 900 days — almost 2 1/2 years — in 2007, when it often had the worst turnaround time in the nation. It’s now in the middle of the pack among Social Security’s hearing offices.

Likewise, average processing times dropped from 885 days to 363 days during the same period at its Atlanta North office on Clairmont Road.

The agency’s goal, he said, is 270 days. “I think Atlanta will be there in about a year,” said Astrue.

But such numbers only count the time people spend waiting for a hearing, and don’t count several months that most cases spend in the initial phases.

Most applicants face a complicated, multistep process that begins with an initial review and a second review by state officials (working under contract for Social Security) before their cases ever go before the federal agency’s hearing officers. That initial stage has grown longer because more people are applying than expected due to the weak economy, said Astrue. Applications tend to rise during recessions as people who worked despite disabilities lose their jobs.

Wait increases in state

In Georgia, the average time at the initial stages jumped from about 86 days in 2007 to 141 days this year — now a month longer than the national average.

The Social Security Administration is shifting case

s to other states to catch up.

The Georgia Department of Labor, which does the initial reviews, also denies a higher percentage of applicants — 70 percent versus 65 percent nationally.

Less than half then appeal to the state agency, and about 85 percent of those are denied again. Those that take the next step — appealing to a Social Security Administrative law judge — face another long wait of roughly a year. But, of those that persist, more than 60 percent typically win their claims.

“A lot of the people who don’t appeal are not less disabled than the people who do,” said Ethel Zelenske, with the National Organization of Social Security Claimants’ Representatives, which is why she wants “the right decision as early as possible.”

Agency officials, lawyers and others give varying explanations for the differing outcomes at the initial and final stages of the process. Many people get sicker over time, and those with strong cases are more likely to keep going. Many also hire lawyers to help with appeals and have more time to gather medical records and other evidence.

If past trends hold, the Social Security Administration will eventually approve roughly half of the 3.3 million disability claims expected to be filed this year. Recipients, who must prove they are unable to work for at least a year, account for about 15 percent of the 53 million-plus people nationally and 1.4 million Georgians receiving money from Social Security.

Even with quicker turnaround times to get a hearing, the wait can be a year-and-a-half or more for applicants who are jobless and often have mounting medical problems — and bills. A wait of a year or two is too long, and many cases take much longer, said Ron Lowry, an Atlanta lawyer who often handles disability cases.

“How are you supposed to live three years without income?” he asked.

System seems ‘random’

He said six of his clients have died over the years while their cases were pending.

Meanwhile, critics continue to complain that the agency is either heartless or too lenient when deciding whether to grant disability benefits.

“The system, it seems so random. I just don’t see how some people get approved [and I don’t],” said William “Billy” Caswell, who started work at 17 and has held jobs as a factory worker, plumber’s helper and bartender.

The 33-year-old Acworth man applied for disability benefits in January after he became too ill to work because of a congenital heart defect. His wife, a nurse in a cardiac unit, said the condition could kill him by age 40 if he doesn’t get a heart transplant.

But Caswell was among the roughly 70 percent of applicants in Georgia whose claims are initially denied. Caswell has appealed the decision.

Meanwhile, critics say there’s too much fraud and overpayment. Critics such as Sens. Thomas Carper (D-Del.) and John McCain (R-Ariz.) in hearings earlier this year said the agency made $10.7 billion in overpayments from 2004 to 2008, according to The Washington Post.

Astrue, the Social Security commissioner, said the agency is being unfairly “clobbered” by critics.

“We do an exceptional job. Are we perfect? No,” said Astrue.

On the one hand, some fraudulent claims are sure to slip through “when you’re dealing with 3.3 million cases a year and the system is this complicated,” he said. But the vast majority of people who receive disability benefits truly need them, even if they appear to neighbors and acquaintances to be able to work, he added.

“You don’t know what your neighbor’s medical records look like,” he said.

On the other hand, he added, the agency has made great strides to speed up its decisions on disability applications and to make the process more humane.

Trying to catch up

The agency’s backlog of cases peaked at almost 770,000 cases nationally in 2008 as it struggled to recover from years of budget cuts and swelling applications from aging baby boomers. The hearing backlog is now about 700,000.

To catch up, the Social Security Administration hired more administrative law judges and other staff to handle its rapidly growing case load, and set up national hearing centers to hear cases remotely through live video-conferences. About half of Atlanta’s cases are now handled remotely, the agency’s data shows.

Astrue said the agency worked overtime to shift its cases from paper records to computer. It also began using computers to give automatic approvals — usually within two weeks — for a shortlist of 88 especially severe conditions, such as aggressive brain cancers where the applicant isn’t expected to live long.

“We moved very quickly on this because I think it was a legitimate weakness of the system,” said Astrue.

Meanwhile, Kelly Caswell is wondering how long she will be able to keep her family afloat since her husband became too ill to work.

“I have all the responsibility on me. I’m just overwhelmed,” said Caswell, who has a 2-year-old son, Will. A nurse in Kennestone Hospital’s cardiac unit, she has been working at least 48 hours a week to keep her family afloat. “We’re good people. We try to do what we’re supposed to do,” she said.

Billy Caswell had been sidelined before by his condition. The major arteries to his heart are reversed, reducing the blood flow and oxygen levels to his organs. But Caswell had managed to work most years — until two years ago.

He’s undergone two surgeries to implant a stent, pacemaker and defibrillator to boost his weakening heart.

Still, the trim man’s lips looked blue recently after a short play session at home with his son. A grocery shopping trip or a short flight of steps is an ordeal for him, said his wife.

Kelly Caswell assumed her husband would easily qualify for monthly benefits of roughly $1,200 from the Social Security Administration. His doctor told the agency he is totally disabled.

But in the April letter rejecting his application, the Social Security Administration said he is still able to work and do his “usual activities.”

Kelly Caswell said she was devastated and insulted when the agency rejected her husband’s application. She said she has known patients who were clearly in better shape than her husband who received monthly disability payments.