Disability Approval Rates Decline in the US

New data has revealed that administrative law judges hearing cases for the Social Security Administration’s Office of Disability Adjudication and Review (ODAR) are applying far stricter criteria in approving disability applications. In ODAR’s Wilkes-Barre office in Pennsylvania, a trend mirrored by the rest of the nation reveals significantly increased rates of rejection. In the year 2010, 64 per cent of cases were approved; in 2011, that number dropped to 54 per cent, in 2012 to 48 per cent and in 2013 to 42 per cent. The result is a noticeable upsurge in the number of appeals filed before federal courts and an immense backlog of cases which federal courts cannot keep up with. New legal measures are already being considered to reduce the size of this backlog, with lawyers representing claimants providing crucial commentary and advice on the matter.

What is the Cause of the Higher Denial Rate?

There are many reasons being posed for the stricter stance adopted by agencies when it comes to approving disability applications. On the one hand, the economic crisis has led more people with marginal disabilities to claim benefits. An additional reason is the surge in the number of baby boomers who are too young to obtain retirement benefits yet who are more prone to disability as they grow older. There is no doubt that the Social Security is swamped with work – agencies received applications from some 3.2 million persons in 2012 alone. This trend is on the rise, despite promising developments in medicine and technology, which have led, for instance, to falling rates of dementia, mainly owing to two factors: people are completing more years of schooling and there is a generally improved awareness of factors that can contribute to dementia, including high blood pressure and high cholesterol levels. The growing number of elderly adults in the US undoubtedly means that claims for disability owing to dementia will increase. However, the fact that more people are growing older without experiencing this devastating disease is undoubtedly a relief both on their families, since living with dementia can be as taxing on carers as it is on the healthcare system. So far this year, the Social Security has doled out an average monthly amount of approximately $1130 to some 8.9 million workers, representing a cost of $10 billion. Mental disorders are some of the most oft claimed disabilities.

Attorneys representing claimants agree that economic factors may have been influential in the rising numbers of rejections, but also note that the agency tends to hire judges who previously worked for the Social Security. They have expressed concern about judges possibly feeling pressured to decline cases which have previously been rejected.

What are the Most Often Claimed Disabilities?

The greatest percentage of disability claims is taken up by bone and muscle pain cases, closely followed by mental disorders (including dementia).

How are Disability Claims Normally Processed?

Most disability claims are initially presented through a local field offices and state agencies (such as Disability Determination Services). Between 25 and 35 per cent of applications being approved at this level. If a case is rejected, the claimant can request reconsideration y the field office or state agency.

What is the Normal Course of Appeal Against a Rejected Claim?

When a claim is rejected twice, the next step is to make a formal appeal before an administrative law judge. The latter is an employee of the Social Security system. The typical appellant will need to wait a little over a year for a decision. Currently, there are over 800,000 appeals pending.

Coping with the Backlog

The pressure to reduce the backlog is intense for judges, so much so that some lawyers are concerned that the pressure may lead judges to make quick decisions which may need further research and consideration. It is not just the appeals courts that are overburdened – once applicants receive their benefits, they must be reviewed periodically to ensure they are still disabled. Yet by the end of 1996, there were over 4 million overdue reviews. In 2002, the backlog was eradicated following a $4 billion injection of funds, authorized by Congress. Despite the success of the effort, the backlog has consistently piled up to its present level. President Obama’s proposed budget allocates $1.5 million to deal with this problem. This amount of funds will enable the agency to carry out over 1 million reviews, which is a significant improvement on last year’s figures (443,000). The current backlog of continuing disability reviews stands at 1.3 million.

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