Posts Tagged With: SSA

Social Security Administration Moves To Abolish Treating Physician’s Rule. Backlog Of Hearing Requests Sure To Worsen.

New Rule May Worsen Backlog For Social Security Disability Claimants

By the time Stephenie Hashmi of Lenexa, Kansas, was in her mid-20s, she had achieved a lifelong dream: She was the charge nurse at one of Kansas City’s largest intensive care units. But even as she cared for patients, she realized something was off with her own health.

“I remember just feeling tired and feeling sick and hurting, and not knowing why my joints and body was hurting,” Hashmi says.

Hashmi was diagnosed with systemic lupus, a disease in which the body’s immune system attacks its own tissues and organs.

She’s had surgeries and treatments, but now, at age 41, Hashmi is often bedridden. She finally had to leave her job about 6 years ago, but when she applied for Social Security disability benefits, she was denied.

                                                                                            

“I just started bawling. Because I felt like, if they looked at my records or read these notes, surely they would understand my situation,” Hashmi says.

Lisa Ekman, director of government affairs for the National Organization of Social Security Claimants Representatives, says Hashmi’s struggle with the application process is not unusual.

“It is not easy to get disability benefits. It’s a very complicated and difficult process,” Ekman says.

Right now, just about 45 percent of people who apply for Social Security disability benefits are accepted, and getting a hearing takes an average of nearly 600 days.

The Kansas City office’s average hearing time is closer to 500 days, but its approval rate is slight lower at 40 percent.

The Backlog started snowballing about 10 years ago, around the time Jason Fichtner became acting Deputy Commissioner of the Social Security Administration (SSA).

He says that during the Great Recession, a lot of people who had disabilities applied but weren’t necessarily unable to work.

“But they’re on the margin,” Fichtner says. “They can work, but when the recession happens, those are the first people who tend to lose their jobs, and then they apply for disability insurance.”

There are now more than a million people across the country waiting for hearings. Adding to the strain, the Social Security Administration’s core operating budget has shrunk by 10 percent since 2010.

This spring, the SSA introduced changes to fight fraud and streamline the application process, including a new fraud-fighting measure that removes the special consideration given to a person’s long-time doctor.  (This is known as The Treating Physician’s Rule)

Lisa Ekman says this is a mistake.

“Those changes would now put the evidence from a treating physician on the same weight as evidence from a medical consultant employed to do a one-time brief examination or a medical consultant they had do a review of the paper file and may have never examined the individual,” Ekman says.

She says this could lead to more denials for disabled people with complex conditions like lupus, multiple sclerosis or schizophrenia. These illnesses can affect patients in very different ways and may be hard for an outside doctor or nurse to assess.

She says more denials will lead to more appeals, which will only increase the backlog.

She is correct. The Treating Physician’s Opinion is controlling.

https://judgelondonsteverson.me/2016/06/24/the-treating-physician-rule-is-controlling/

But former administrator Fichtner, now a senior research fellow at George Mason University’s Mercatus Center, says the SSA is obligated to weed out any fraud it can, including the admittedly rare cases of treating physicians tipping the scale in favor of their patients.

He says the SSA can still prioritize applicants.

“For patients that are really in dire condition and really have major disabilities, I don’t think they have to worry about this rule change,” Fichtner says.

He acknowledges, however, that the backlog needs attention and says the agency has safeguards to monitor whether the rule is working.

Back in her kitchen in Lenexa, Stephenie Hashmi’s husband Shawn prepares a family dinner she won’t be able to eat because she’s having problems with her esophagus.

Stephenie puts on a brave smile, but the progression of her illness and the ordeal with Social Security have made her increasingly pessimistic.

After several rejections, she’s now on her final appeal. Her hearing is scheduled for November – of   2018.

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Categories: Social Security Benefits | Tags: , , | 2 Comments

Culture of Corruption At Social Security Administration, Starts At The Top

                                                                                              

The “so-called” scandal in the Madison, Wisconsin Social Security Office of Disability Adjudication and Review, SSA/ODAR, is disturbing. I believe that Judge John H. Pleuss’ is getting a raw deal.

I have some thoughts on the matter. At the end of this Blog post I have posted the article written by M. D. Kittle. Please read the article after I offer my comments. I have considerable experience in these matters.

This is an invasion of Judge John H. Pleuss’ privacy. I express no opinion concerning the Judge’s remarks in his personal notes. Some may find them inappropriate, and some may not. However, the Judge has an “expectation of privacy” in his personal notes and observations.

The Social Security Administration encourages the Judges to keep a “Private File” of notes to refer to when deciding a disability case. The notes help the Judge to refresh his recollection of the claimant and of the Hearing when he goes back to make a decision on the case. The File is separate from the Claimant’s Disability File. They should not be discoverable under the Freedom Of Information Act (FOIA).

The Disability Hearings are private, unless the claimant consents to strangers sitting in on the Hearing. The Judges’ personal notes from the Hearing should also be private.

The disability evaluation process is a “high volume’ business. A Judge must hear 50 to 75 cases a month in order to produce an average of 50 to 60 decisions a month. There are no pictures of the claimant in the case files. All judges scribble notes and memory joggers in order to try to remember the claimant later when they review the file. Credibility weighs heavy in the decision making process. A Judge must conjure up a recollection of the claimant to properly dispose of the case. One Judge’s characterization of the person who appeared before them may be different from another. His job is not to flatter the claimant, but to remember who he or she was. There is nothing in Judge Pleuss’ notes that is grounds for adverse action against him.

If you notice all of the cited comments refer to women; and women, only. Normally that would cause one to think that the ALJ is obsessed with women or female claimants. But, I have a better explanation, and it has nothing to do with the ALJ.

I contend that this incident raises serious questions about the fitness of the Decision Writers in Judge Pleuss’ Hearing Office. Judges do not write their own decisions. There are professional Decision writers in each Hearing Office. Lawyers and Para-legal writers draft a proposed decision based on the ALJ’s Hearing Notes. The ALJ modifies, amends, and approves a final draft.

First, if a Decision Writer has passed on to the Civilian Managers in the Hearing Office Judge Pleuss’ personal notes, that would be unethical and disloyal. We need look no further than the Decision Writers and Management to see what is happening here.

There has always been tension and friction between between the ALJ Corps and civilian managers, all the way up to the Commissioner in Baltimore, Maryland.

On several occasions the AALJ, the Judges’ Union, has lobbied Congress to remove the ALJ Corps from under the authority, supervision, and management of the SSA civilian managers.

( https://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757?ie=UTF8&ref_=asap_bc)

Yes, there is a Culture of Corruption here; but, it starts in Baltimore, Maryland at the Office of the Commissioner and the Office of the Chief Administrative Law Judge; and it reaches down to the lowest level. And it is most malignant at the Hearing Office Director (HOD) and Decision Writers level.

Many of the Decision Writers suffer from mild mental disorders. They tend towards Melancholia. They are frustrated, and they bicker and complain. Some tend to be trouble makers.

Many, I have noticed, appear to be envious of the Judges. They resent that the ALJ hears the cases, but they, the writers, have to do the leg work of writing the decision. They work in the dark, behind closed doors, and get little or no credit. This tends to generate friction and resentment.

The worst of the lot are the male homosexual writers. And there are many. There were two in my office for almost 20 years. We had only six writers and the two males were homosexuals.

They are prone to hysterics. They are easily agitated, often for no discernible reason. I was discussing a draft decision with one once and, out of the blue, he became agitated and screamed at me. I was shocked. I did not know what I should do. Do I discipline him, or what? I did nothing, because there are so many of them and they are well placed. Also, the Hearing Office Chief Judges tends to protect them. So, I just let it go.

All of which brings me back to my original point. This is just the type of hanky-panky that male homosexual writers would start. This is how they operate. I know from experience. I spent about 20 years in a Hearing Office and I saw just about every kind of dirty office shenanigans that one could imagine.

The tip-off is that they only mentioned remarks about women. Anyone who has ever had to work with male homosexuals in a legal office or other closed community would notice that. It is a dead give-away.

All of this will probably turn out to be nothing more than a tempest in a tea pot.

Here is the article.

Social Security judge suspended in wake of Madison scandal.

Wisconsin Watchdog has learned that Administrative Law Judge John Pleuss’ hearings in recent days have been canceled amid a looming Social Security Administration Office of the Inspector General investigation into the Madison Office of Disability and Adjudication Review, or ODAR.

Asked whether Pleuss had been suspended, an office employee who answered the phone Thursday June 16would say only that Pleuss was out of the office. So, too, was Office Director Laura Hodorowicz. Asked whether Hodorowicz had been suspended, the employee said, “I can’t answer that,” but that the director is “out today, too.”

Neither Pleuss nor Hodorowicz returned calls from Wisconsin Watchdog seeking comment.

Sources close to the situation say Administrative Law Judge John Pleuss appears to have been suspended as an investigation looms into allegations of misconduct at the Madison Office of Disability Adjudication and Review. Doug Nguyen, spokesman for the Social Security Administration’s Chicago Region, did not return an email seeking comment. ‘Culture of corruption and cover-up’

Wisconsin Watchdog first reported last week about new charges of “pervasive” sexual harassment, bribery and nepotism coming to light at the Madison ODAR facility. These accusations came on top of previous allegations of misconduct, harassment, and whistleblower retaliation at both the Madison and Milwaukee disability claims review offices.

“There is a culture of corruption and cover-up, and that goes all the way to the top,” said an ODAR employee with knowledge of the situation. The staff member spoke on condition of anonymity for fear of reprisal.

Wisconsin Watchdog obtained internal documents showing what employees have described as “highly inappropriate” comments Pleuss has made about claimants appearing before him.

“Young, white (female); attractive brunette,” Pleuss wrote under “Initial Observations” in official hand-written hearing notes. The claimants’ names and other personal information have been redacted.

“Young, white (female); long brown hair; attractive; looks innocent,” the ALJ wrote.

He described another claimant as “buxom,” and noted that a “young, white (woman) looks like a man.”

“Obese, young, white (female) skimpy black top,” he wrote of another claimant.

“Very black, African looking (female),” the ALJ wrote, and parenthetically he added,“(actually a gorilla-like appearance).”

In one document, Pleuss wrote, “I’ll pay this lady when hell freezes over!

RELATED: ‘Culture of corruption and cover-up’ alleged in Madison Social Security office

Pleuss is one of six administrative law judges at the Madison office. He has been the subject of an internal investigation into sexual harassment allegations, according to multiple sources.

The employee who spoke to Wisconsin Watchdog on condition of anonymity said Pleuss has acquired a reputation as “being sexually inappropriate.”

“It truly has become a national running joke,” the staff member said.

But there is nothing funny about the charge by those familiar with the administrative law judge and the “toxic environment” of the Madison office that Pleuss has approved or rejected disability claims based on “how sexy he thought the claimant was,” the employee said.

The insider claims “sexual harassment of staff is pervasive and ongoing” in the Madison office. Other sources have told Wisconsin Watchdog as much.

A disability claims attorney told Wisconsin Watchdog this week that there has been concern for some time about Pleuss’ conduct. The attorney said cases that seemed strong were denied, while weaker cases were approved.

“This issue may explain a lot about that inconsistency,” the attorney said. “Given your reports, I will now be able to raise issues involving females. It should be interesting since I will be asking for copies of his notes on every denial.  I’m sure that request will be denied and I may end up asking federal district court to issue orders for the release of the documents.”

The ODAR employee who spoke to Wisconsin Watchdog said the SSA offices in Milwaukee and Madison are “extremely hostile work environments for whistleblowers.” They also are closely connected by the same administrative players in the Chicago ODAR Region.

Reward and punishment

ODAR whistleblowers have told Wisconsin Watchdog that they have repeatedly been subject to retaliation and intimidation for reporting waste, abusive behavior and other misconduct in their government offices.

Less than a month after Ron Klym was featured in a Watchdog.org special investigation, the senior case technician at the Milwaukee Office of Disability Adjudication and Review was told the agency that has employed him for 16 years is proposing to fire him.

Klym detailed the Milwaukee office’s growing backlog of cases. Wisconsin Watchdog obtained records of some of the more lengthy delays.

More problematic is what Klym calls the administrative “shell game.” He said the Milwaukee office’s case disposition numbers have at times drastically improved because managers in the chain have dumped off scores of cases to other regional offices.

(NOTE: This is not new. This was happening before 1990. Shell Games. Paying Down The Backlog. See https://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757?ie=UTF8&ref_=asap_bc )

Multiple sources have told Wisconsin Watchdog that, Hodorowicz, director of the Madison office, protects Pleuss and others in her inner circle.

The employee who spoke on condition of anonymity said Hodorowicz is fond of making “dirty backroom deals,” offering  “cooperative” employees perks in the form of financial benefits and special privileges to maintain their loyalty and above all –silence — about misconduct in the office.

Eventually, the office director runs out of sweeteners, the employee said.

“When that happens , the threats begin. … She will threaten people’s jobs, tell them she won’t promote them, lower their performance reviews, say that she will give them a bad reference,” the insider said. “She will give them the worst work assignments in the office.”

Wisconsin Watchdog has obtained emails sent by Hodorowicz that appear to be threatening in nature.

Multiple employees say the office director has been the subject of several investigations into her conduct, in Madison and when she held the same position in Milwaukee. Each time, they say, her cadre of loyalists testify on her behalf. And, sources say, they are rewarded for their loyalty.

And a Madison office staff member said Hodorowicz has taken nepotism to a new level.


Wisconsin Watchdog reported Monday that Office of Inspector General agents are opening an investigation into the Madison office, particularly focusing on Pleuss,  Hodorowicz, and Wayne Gentz, a group supervisor considered to be a Hodorowicz ally.

Also this week, U.S. Sen. Ron Johnson, R-Wis., sent a formal letter to the Social Security Administration requesting the agency’s “unfettered cooperation” in turning over information related to allegations of misconduct and retaliation in SSA’s disability claims review offices.

“I write to you concerning reports of whistleblower retaliation within the Milwaukee and Madison hearing offices of the Social Security Administration’s Office of Disability Adjudication and Review,” Johnson wrote in the letter to Carolyn Colvin, SSA’s acting commissioner.

Johnson, chairman of the Senate Homeland Security and Governmental Affairs Committee, has been trying to get answers from the SSA since a staff-level briefing on May 9.

By

Categories: Social Security Judges | Tags: , , , , , , | 2 Comments

Honorably Discharged Navy Veteran Defrauded VA and SSA of $1.5 Million

‘Wheelchair-Bound’ Man Caught in Disability Fraud After Seen Jet Skiing, Riding Motorcycle. He conned the VA and the SSA out of millions of dollars.

/ AP

/ AP

A South Carolina man was convicted of “one of the largest” disability fraud cases in Veterans Affairs history after he was caught riding a motorcycle and going jet skiing while pretending to be wheelchair-bound.

Dennis Paulsen faces up to 20 years in prison for conning the VA and Social Security Administration (SSA) out of millions of dollars, taking nearly $10,000 a month for more than a decade.

Mr. Paulsen obtained the benefits by pretending he was unable to use his feet or hands due to a multiple sclerosis diagnosis (MS). Meanwhile, he regularly hit the gym, joined a club baseball team, played golf, and drove around in his Escalade.

“In conducting one of the largest fraudulent single disability compensation claims in VA history, Paulsen substantially feigned and exaggerated the impairment resulting from his multiple sclerosis (MS) diagnosis,” the Social Security Administration’s(SSA) Inspector General(IG) said. “After being diagnosed and discharged from the Navy in the early 1990s, Paulsen began receiving a monthly VA benefit as a result of his diagnosis. Unsatisfied with the amount he was receiving, Paulsen began a pattern of malingering by claiming his MS rendered him unable to use his hands or feet in any respect.”

“Still unhappy with the money he was awarded, Paulsen ramped up his claims, lying to his doctors, presenting himself as house- and wheelchair-bound, and making false claims that he required daily professional medical care to live until his benefits were increased to the maximum disability payments available to a Veteran,” the inspector general said.

In all, Paulsen was able to steal $1.5 million from the government, collecting $9,400 each month.

The case is reminiscent of the case of a “blind” Wisconsin man whose Social Security disability fraud scheme ended when federal agents caught him driving a speedboat. Paulsen was caught driving a motorcycle.

“Despite his feigned claims of impairments and presenting himself in a wheelchair to his doctors, Paulsen lived in a non-handicap-accessible residence and was able to ride his motorcycle and jet skis plus play baseball and golf on a regular basis,” the inspector general said. “In 1999, Paulsen met his ex-wife at the gym where he exercised and worked training others.”

Paulsen was also “active in several gyms, joined a baseball league from 2006 until 2014,” and seen “playing pool, swimming in his backyard pool, playing on the beach, and driving his Escalade and manual shift Mini Cooper.” He even participated in a Marine Mud Run.

Investigators used surveillance footage and family photographs to reveal Paulsen’s very active lifestyle, contradicting his claim of suffering from a severe disability.

Paulsen continues to exaggerate his condition, appearing at his trial in federal court, which concluded last week, in a wheelchair.

Paulsen testified, in a wheelchair, for four hours and called three doctors as expert witnesses in an attempt to support his claim that he was and had been totally disabled,” the inspector general said. “The guilty verdict reflects that the jury did not find this testimony credible.”

 

(BY:
January 27, 2016)

Categories: Social Security Benefits | Tags: , , | Leave a comment

Mentally Impaired Social Security Claimants Commit Suicide After Being Told That Benefits Will End

Lawsuit blames two suicides on notice of imminent cut in disability benefits.

 A move by the Social Security Administration (SSA) to end disability checks for thousands of people in Kentucky played a substantial role in two people killing themselves, a federal lawsuit alleges.

 

The two dead claimants committed suicide by gunshot. They blew out their brains. Melissa Jude and Leroy Burchett, were despondent after getting notice that they would lose benefits, the lawsuit alleges.

Burchett shot himself in the chin on June 1. Jude shot herself in the head the next day, according to the lawsuit.

The lawsuit further alleges that two Social Security recipients were distraught over the notice from SSA that they would lose their livelihood and might have to repay pass benefits received.

Social Security has notified thousands of benefit recipients of the impending loss of checks.

This case is linked to allegations of fraud in disability cases of Kentucky lawyer Eric Conn.

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If The Social Security Administration Says That You Are Dead, You May Wish That You Were

The first thing I do every morning when I get my newspaper is to read the Obituaries. I want to make sure I am not dead. If The Social Security Administration reports you as dead, you may wish you were. Your life can become a living hell. They will stop paying you and begin to confiscate your bank accounts.

From May 2007 through April 2010, SSA’s publication of the “Death Master File” resulted in the breach of  Personally Identifiable Information for as many as 36,657 additional living individuals erroneously listed as deceased on the DMF. SSA made these individuals’ SSNs; first, middle, and last names; date of birth; and State and ZIP codes of last known residences available to users of the DMF before learning they were not actually deceased.

Holiday Hills man is among 9,000 falsely reported dead by Social Security each year.

McHenry County family felt chain reaction affecting health benefits, income and more.

(Sarah Nader – snader@shawmedia.com
By EMILY K. COLEMAN – ecoleman@shawmedia.com

Linda Grether read the letter four times.

 The letter from their Medicare Part D insurance provider was addressed to the estate of her husband, John Grether, and it expressed condolences for her loss.

The thing was, John Grether wasn’t dead.

The Holiday Hills man wasn’t dead six months later, either, when a second letter arrived, or this December when a third letter arrived, but for some reason, John Grether kept getting reported as deceased to the Social Security Death Master File, resulting in a chain reaction that affected their health benefits, their Social Security income and his pension from his job as a construction company shop foreman.

Social Security receives death information from a variety of sources, primarily from family members, funeral homes, financial institutions and state governments, regional spokesman Doug Nguyen said in an email. Of the 2.8 million death reports Social Security posts each year, about 9,000 are found to be false.

That number is down from the average of more than 12,000 a year found to have been erroneously added to the Master Death File from May 2007 through April 2010 by the Social Security Administration’s Office of the Inspector General, according to a 2011 report.

Nguyen credits the increased use of electronic death registration, which automates Social Security’s receipt of death information. Illinois is among the 42 states using the system.

“Universal implementation of [the system] has the potential to virtually eliminate death reporting errors and would ensure that our death records – whether pertaining to current beneficiaries or other persons – include the most accurate and most current information,” Nguyen said in an email.

The Grethers have their suspicions for why the death reports keep happening, but they don’t understand why Social Security hasn’t been able to flag the account or otherwise prevent it from happening again.

“I just keep dying,” John Grether said. “Isn’t that something?”

Despite the wry humor, the experience has been anything but funny.

“We find out by accident [that he’s been reported deceased],” Linda Grether said. “Like all of a sudden, we’ll go fill a prescription and it’s not covered. Or the bank will call and [we] saw our accounts are over-drafted because they’ll just take the money away.”

The Grethers have had to go into the Woodstock office to prove John’s alive. They’ve spent two-plus hours on the phone each day for a week trying to get their benefits restored and to figure out how to prevent it from happening again.

When John Grether’s breathing got worse, a result of his chronic obstructive pulmonary disease, he couldn’t go to an immediate care center. They had to use his nebulizer at home.

“Until you even get a little bit, you don’t understand just how devastating the whole thing is,” Linda Grether said. “I mean, we just sat here nights and just cried because we have no way to do anything. We’re at their mercy.”

Social Security reached out to Grether after the Northwest Herald contacted them about the Grethers’ situation and is looking into what can be done.

http://oig.ssa.gov/sites/default/files/audit/full/pdf/A-06-10-20173_7.pdf

 

(NOTE: Summary Report from the Social Security Administration’s Office Of The Inspector General)

Follow-up: Personally Identifiable Information Made Available to the Public Via the Death Master File (Limited Distribution)

Our objective was to determine the status of corrective actions taken by the Social Security Administration (SSA) to address recommendations in our June 2008 report, Personally Identifiable Information Made Available to the General Public Via the Death Master File SSA implemented procedures to report erroneous death entry-related personally identifiable information (PII) breaches to the United States Computer Emergency Readiness Team each week. SSA also hired a contractor to provide ongoing reviews of Death Master File (DMF) exposure related to 26,930 individuals whose  Personally Identifiable Information, SSA inadvertently exposed from July 2006 through January 2009. The contractor evaluated available data for anomalous patterns that could identify organized misuse. SSA stated that, to date, the contractor has identified no organized misuse. However, SSA did not implement a risk- based approach for distributing DMF information, attempt to limit the amount of information included on the DMF version sold to the public, or explore alternatives to inclusion of individuals’ full Social Security number (SSN). SSA continued to publish the DMF with the knowledge its contents included the  Personally Identifiable Information of living number holders.

From May 2007 through April 2010, SSA’s publication of the “Death Master File” resulted in the breach of  Personally Identifiable Information for as many as 36,657 additional living individuals erroneously listed as deceased on the DMF. SSA made these individuals’ SSNs; first, middle, and last names; date of birth; and State and ZIP codes of last known residences available to users of the DMF before learning they were not actually deceased. As such, we believe SSA should take additional precautions to limit the number of reporting errors and the amount of personal information published in the DMF —
particularly the version sold to the public. We made two recommendations for corrective action.
The (SSA) Agency disagreed with both recommendations.
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More Bad News From Social Security

The Biggest Change to Social Security You’ve Never Heard About

 

2014-06-13-ssaofficeclosed.jpg

There’s been lots of debate and discussion lately about how to shore up Social Security for future generations. But already there are dramatic changes underway that threaten to end Social Security as we know it — yet almost no one has even heard of it.

The plan is called Vision 2025, and every working American has a stake in it.

To explain the significance of what’s going on, let me paint a picture. Say you’re the CEO of a major corporation doing $850 billion in business annually out of 1,200 locations across the country. More than 43 million clients walked through your doors in the past year, seeking one-on-one appointments with your experienced customer service representatives on matters affecting their financial security.

But there’s a storm brewing. You’ve lost 12 percent of your employees in just the past three years, and another third of the workforce is projected to retire in the next decade. Customer demand is breaking records, yet failure to fill vacancies means longer waits for appointments. Customers are waiting three times longer than last year for assistance on your 1-800 phone line, while the website that was set up to take pressure off your field offices can’t meet demand either.

So what do you do? If you’re the head of the Social Security Administration, you lay out a plan to close most of your 1,200 field offices, not replace the 30,000 employees about to walk out the door, and force your customers to conduct nearly all of their business using a phone line and website that already are overwhelmed.

This is the real-life scenario playing out at SSA right now, and the ramifications of decisions made today will affect every working man and woman in this country for generations.

This fall, SSA will unveil its long-range strategic plan for the next 10 years, the so-called Vision 2025 plan. A draft of the plan, being developed for SSA by the National Academy of Public Administration, is frightening:

  • The bulk of SSA’s field offices would be shut down, leaving the agency with a “significantly smaller and more virtual workforce.”
  • Many of the employees left behind would be “generalists” who lack the technical skills and expertise to address benefits questions.
  • Customers could reach an actual claims representative only in “very limited circumstances,” either through in-person visits, phone calls, online chats or video conferences. In the vast majority of cases, the only way to interact with SSA would be through “online self-service delivery.”

Self-service checkout may work at grocery stores, but it’s not the right model for an agency tasked with determining complex retirement and disability benefits for tens of millions of Americans each year. Do they really expect grandpa to hop on his iPad Mini to apply for benefits and get all his questions answered?

Most of the individuals contacting SSA for help are elderly, disabled or indigent. Many others are active seniors who simply are overwhelmed by the complicated maze of laws, regulations and policies pertaining to retirement benefits. They deserve and expect face-to-face interaction with skilled employees who can ensure they receive all the benefits they are owed.

Unfortunately, SSA seems determined to cannibalize itself. In addition to leaving thousands of positions vacant, management already has shuttered 80 field offices and dramatically reduced hours at remaining offices — even before its strategic plan is finalized.

As the representative for the bulk of SSA’s workforce, our union is working hard to save Social Security for current and future generations. This week, we plan to submit testimony at a congressional hearing on SSA’s plan to dismantle the program. AFGE will not let it die without a fight.

I urge you to join the discussion about a program that all of us will ultimately depend on. Your retirement security is at stake.

( By J. David Cox Sr., National President of the American Federation of Government Employees, which represents more than 670,000 federal and D.C. government employees nationwide, including more than 28,000 SSA field office employees across the country

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Social Security’s 79 th Birthday Celebration Marred By Massive Problems

Social Security Has No reason To Celebrate Its 79th Birthday, Massive Problems Are Rampant

SSA Service Cuts, Computer

Problems Plague

Social Security’s 79th Birthday.

Recent reports slam the Social Security Administration (SSA) for (1) reduction in staff, (2) cutting operating hours and (3) computer systems that do not work.
The SSA should have reason to celebrate. After all, August 14, 2014, marked its 79th Birthday, the day when President Franklin Roosevelt signed the Social Security Act, which ushered in the landmark entitlement program.
However, the SSA’s birthday was less than cheerful, coming on the heels of an audit that criticized the SSA for deciding to cut staffing and reduce its service hours. At the same time, the SSA learned that its new multimillion-dollar computer system may very well have turned out to be an expensive failure.
According to the audit produced by the SSA’s own Inspector General’s (IG)  Office, “overall service has suffered” because of the agency’s 2011 decision to trim its staff by nearly 11,000 employees and reduce its weekly field office hours from 35 to 27. The audit found that the end results of the agency’s cutbacks were felt as soon as fiscal year 2013, when “the public waited longer for a decision on their disability claim, to talk to a representative on the National 800-Number and to schedule an appointment” at a field office.
The process of applying for Social Security disability benefits takes a significant amount of time and is very complex. The Inspector General’s findings represent unwelcome news for disabled Americans who need a speedy resolution of their claims.
Compounding the critical assessment from the Inspector General’s Office, an internal report has concluded that the SSA’s new $300 million computer system, which was designed to handle its disability claims, does not work.
The agency laid the groundwork for the new system in 2008 when its aging computers were swamped by disability claims. But the recent report found that delays and mismanagement still plague the new system. And SSA officials have not been able to answer queries on when the new system will be up and running.
The Social Security Administration may have thought that its new computer system could make up for its decision to cut back service, but that assumption was dependent on the system actually working. Instead, already long wait times for the processing of disability claims are getting even longer.

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Social Security Judges Must Follow Treating Physician Rule

Judge Revives Claim For Disability Benefits

 

Eastern District Judge Arthur Spatt (See Profile) has ordered the Social Security Administration (SSA) to reconsider its decision to deny disability benefits to a 55-year-old union carpenter with a knee injury, finding that an administrative law judge rejected the opinions of the man’s treating physician without justification.

The plaintiff, William Box, slipped and fell on the job in January 2009. He was later diagnosed with multiple injuries in his right knee, including a torn anterior cruciate ligament and torn meniscus. He eventually underwent two surgeries. In November 2009, Box applied for disability benefits. In August 2010, an administrative law judge denied the application. An Appeals Council (A/C) denied Box’s petition for review, and in March 2012, he sued the Social Security Administration seeking to overturn the decision.

Box’s treating physician, Benizon Benatar, submitted an opinion that Box was completely disabled because he could not stand or walk for more than two hours a day.

Another doctor, Erlinda Austria, also examined Box at the request of the New York State Division of Disability Determination. Austria opined that Box was capable of light work. A person capable of light work is presumed to be able to stand and/or work for six of eight hours in a day.

District Judge Spatt found that the ALJ had improperly credited Austria’s testimony over Benatar’s without justification, going against the “treating physician rule,” which requires deference to an applicant’s treating physician.

While an ALJ can choose not to credit a treating physician, Spatt said, that choice must be justified by an analysis of the record, which the ALJ did not do.

Spatt therefore remanded the case for further proceedings consistent with the opinion.

The Claimant, William Box is represented by Sharmine Persaud.

The SSA is represented by Eastern District Assistant U.S. Attorney Vincent Lipari.

The case is Box v. Colvin, 12-cv-1317.

(Brendan Pierson, New York Law Journal,March 19, 2014  )
Read more: http://www.newyorklawjournal.com/id=1202647472089/Judge-Revives-Claim-For-Disability-Benefits#ixzz2wRwdyspq

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It Is Getting Harder To Get Social Security Benefits. The Hearing Backlog Is Growing again.

Social Security Disability Hearing Backlog Growing Again

 Number of people waiting in the hearing backlog approaches 1 million.

If your application was denied and you must appeal your SSDI benefits claim, it’s important to avoid waiting to file and get help.  The Back Log of people waiting to attend a hearing for Social Security Disability Insurance (SSDI) benefits is growing closer to 1 million.

As of December 2013, there were 903,720 people who had filed an appeal and were waiting for a hearing before an administrative law judge (ALJ). , according to  data released by the Social Security Administration (SSA).

This is a nearly 7 percent increase from 847,984 hearings pending at the end of fiscal year 2013, and a 17 percent increase from 771,318 hearings pending in FY 2011.

As the waiting time grows longer, more and more people are enduring significant financial hardship to receive SSDI benefits through a program they paid into through FICA taxes while they were working.

The first-quarter FY 2014 data also shows that the time it takes to get a Hearing has increased to 393 days from 382 days in FY 2013.

Click here to see a state-by-state ranking of pending hearings, based on an analysis of SSA data.

 

The growing Social Security disability Backlog illustrates the challenges of meeting the SSA’s goals outlined in its FY 2008-13 Agency Strategic Plan.

Social Security had planned to reduce the hearing Backlog to 466,000 claims and the average processing time to 270 days, but a number of factors have worked against this.

Restricted funding has led Social Security to cut the hours its Hearing Offices are open to the public. In addition, the average wait time for calls going to the SSA’s national 800-number have increased. Since September 2010, the SSA has lost more than 7,400 employees from its workforce, according to the U.S. Office of Personnel Management (OPM).

At the same time that waiting times are growing to get a Hearing, it’s becoming much more difficult to receive SSDI benefits.

For example, the SSA reported that 89,332 people were granted benefits in December 2012. A year later, that number was reduced to 61,983 in December 2013, a 30 percent decline.

SSDI is a federally mandated insurance program that provides monthly benefits to individuals who are under full retirement age (65-67) and who can no longer work because of a severe, long-term or terminal disability. FICA payroll taxes paid by workers and their employers fund the program, which is administered by the SSA.

You Need Help When Filing An SSDI Appeal

Things To Consider When Applying for SSDI benefits.

1.    Consult An Attorney. Those who applied for Social Security Disability Insurance benefits without a representative have the opportunity to get help with a disability appeal. At the hearing level of the SSDI program, nearly eight in 10 applicants have a representative.

2.    Appeal Every Thing. When people apply for SSDI and are denied benefits, they may decide to give up on their application. It’s important to pursue a disability appeal because delaying or missing important dates can hurt someone’s claim. For instance, those who decide to wait and apply later may wait too long and become uninsured. The SSA requires individuals to be fully and currently insured in order to receive SSDI benefits. Generally, this means having a work history of five out of the last 10 years—and waiting too long could mean missing this window.

3.    Provide documentation and details. It may take the SSA two years or longer to review an SSDI claim through the appeals process, which points to the importance of good documentation. Continue to work closely with your doctors to document updates, new tests and test result. It’s also important to correct any errors, explain changes and provide more detail with your SSDI appeal.

More than 168,000 people applied for SSDI benefits in December 2013 and entered the growing line for review of their disability insurance claims.

It is important for new SSDI applicants to realize they need expert help with their application. That expertise and attention to your claim can result in benefits as early as your initial application. That means avoiding disability appeals altogether.

 

Find more information about SSDI disability appeal see http://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757

 

(Statistics Source: ALLSUP) ABOUT ALLSUP :

Allsup is a nationwide provider of Social Security disability, veterans disability appeal, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Allsup professionals deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. Founded in 1984, the company is based in Belleville, Ill., near St. Louis. For more information, go to Allsup.com or visit Allsup on Facebook at http://www.facebook.com/Allsupinc.

 

Categories: Social Security Benefits | Tags: , , , , , , , , | Leave a comment

More Disability Claimants Forced To File In Federal Court

Social Security Disability Approvals Decline

Attorney John Bednarz thought he had a clear-cut case to win Social Security disability benefits (SSID) for his client.

The 39-year-old man had Huntington’s disease, a debilitating and often fatal disorder that caused tremors in his hands, left him off-balance and suffering from frequent bouts of confusion.

An employee at the Social Security Administration (SSA), State Disability Determination Service (DDS) didn’t see it that way, however, and denied the initial claim twice. Mr. Bednarz appealed the case to an administrative law judge (ALJ), who upheld the Agency’s decision.

 

Ultimately his client prevailed after Mr. Bednarz filed an appeal in Federal District Court. It was a long struggle that took far more time than it should have, he said.

“This case is one that really got me,” Mr. Bednarz said. “He had a degenerative neurological impairment. He had involuntary movement in his right hand and symptoms of dementia. … A diagnosis like this is essentially a death sentence.”

His client is not alone in his struggle.

Administrative law judges (ALJ) who hear cases for the Social Security Administration’s Office of Disability Adjudication and Review (ODAR) have become more selective in the cases they approve, data show, forcing an increasing number of claimants to file suit in federal court.

(Read more at http://www.amazon.com/socialNsecurity-Confessions-Social-Security-Judge/dp/1449569757 )

In the Wilkes-Barre ODAR, the percentage of cases approved has steadily declined the past three years, mirroring a nationwide trend.

Appeals spike.

In fiscal 2010, the office granted 64 percent of the cases. That dropped to 54 percent in 2011, 48 percent in 2012 and 47 percent in 2013, according to data compiled by Social Security. Statewide, 42 percent of cases were approved at the administrative law judge level in 2013.

The increase in denials has led to a huge spike in appeals filed in federal court for the Middle District of Pennsylvania, a review of the court docket shows. As of Nov. 22, 204 appeals were filed, compared to 117 in all of 2012, a 74 percent increase. That compares to 90 appeals in 2011 and 113 in 2010.

 

Officials with SSA say the higher denial rate is partly attributable to an increase in filings due to the poor economy, which historically leads more people with marginal disabilities to seek benefits.

Several attorneys who represent claimants agree economic factors may have played a role. But they’re concerned the system has become increasingly stacked against claimants due, in part, to the SSA’s propensity to hire judges who formerly worked for Social Security. There is also concern judges are being subjected to outside pressure that may make them more prone to deny cases.

“I’m not saying everyone is perfectly honest and that there is not fraud, but we see a lot of cases being denied that appear legitimate,” said Steven Rollins, a Harrisburg attorney who specializes in disability claims. “You have more of a shift of judges who have become more in tune to affirm a denial and are less willing to grant cases.”

Unable to engage.

In 2013, the Social Security Disability system paid 8.9 million workers an average monthly benefit of $1,129 at a total cost of $10 billion, according to the agency. To qualify, claimants must prove they are unable to engage “any substantial gainful activity” due to a mental or physical impairment which has lasted 12 months, is expected last 12 months or will result in death.

The initial determination is made by the State DDS based solely on a review of medical records, attorneys said. Roughly 25 to 35 percent of claimants are approved at that level, Mr. Rollins said. If denied, the case goes before an ALJ – an attorney hired through Social Security to conduct an independent review. The judge can hold a hearing that includes testimony from the claimant and physicians.

 

The are currently 1,500 ALJs in the nation. In Pennsylvania, judges preside in Wilkes-Barre, Harrisburg and Philadelphia.

If the ALJ denies the claim, it goes to the Appeals Council within Social Security. The final step is federal court. A judge will review the entire record and has the power to award benefits or return the case to the ALJ for further review.

Few data.

There are no national statics on the percentage of cases remanded. A review of the federal court docket in the Middle District of Pennsylvania shows that of the 90 appeals filed in 2011, the last year for which full data are available, 56 were either affirmed, dismissed or withdrawn by the plaintiffs. Most of the cases filed in 2012 and 2013 remain pending.

Mark Hinkle, a spokesman for SSA, said there is always a debate over whether the agency approves or disapproves too many cases. The agency does not seek to influence ALJs, who have complete independence.

“Our judges have qualified decisional independence to enhance public confidence in the fairness of our process, to protect people applying for disability, and to ensure that they issue decisions free from pressure to reach a particular result,” he said in an email.

As for the overall decline in approval rates, Mr. Hinkle said the agency believes several factors have played a role.

“We have seen an increase in the number of disability cases based on the aging of the baby boom generation and the economy, and when this occurs it is expected that the approval rate will decrease when the number of applications increase,” Mr. Hinkle said.

Jonathan Stein, an attorney with Community Legal Services in Philadelphia, said he believes the decrease in ALJ approvals is partly tied to a change in the make up of judges hired to review the cases.

Under pressure to speed up review of cases, the SSA hired an additional 500 ALJs within the past three years. Mr. Stein said. A large percentage of those attorneys previously worked for SSA, Mr. Stein said.

ALJs are supposed to issue rulings based solely on the evidence. Mr. Stein said he can’t help but question whether their experience with the agency may influence how they view cases.

“When you are a judge you must be independent. You follow SSA rules and have to make independent decisions,” he said. “The reality is, when you spent most of your life in the system, it will shape your views.”

Charles Hall, an attorney from North Carolina who writes a blog about Social Security issues, said there is also concern that the changing political climate toward entitlement programs and media stories that have focused on judges who have high approval ratings may be unduly influencing judges.

Sick or bums?

“There is a great deal of public sympathy for people who are sick or disabled.  On the other side here are people who say (recipients) are lazy bums who ought to get back to work,” Mr. Hall said. “Judges are human beings. The same things that affect the rest of us affects them.”

Mr. Hall said SSAy may have unintentionally influencedALJs by publicly posting data on the percentage of cases they approve. If a judge’s rulings are out of whack with others within his or her region, that could play on their minds, he said.

The data, which are available on SSA’s website, show approval rates vary significantly among judges. In Pennsylvania, Judge Craig De Bernardis in Wilkes-Barre and Judge Christopher Bridges in Harrisburg had some of the highest approval rates between 2010 and 2013, data show. Judge De Bernardis approved 97 percent of his cases in 2010 and 96 percent in 2011, the two years he served. Judge Bridges’ approval rating varied from 90 to 96 percent between 2010 and 2013.

Highest rate

The highest approval rating in the Wilkes-Barre office in 2013 belonged to Judge Eugene Brady, who approved 56 percent of cases. On the other end of the spectrum are Judge Michelle Wolfe, who approved 34 percent of the cases, and Judge Therese Hardiman, who approved 38 percent of her cases.

Several judges in Wilkes-Barre also saw significant drops in their approval percentages since 2010. The most notable change is Judge Hardiman. In 2010, she approved 73 percent of the cases she heard. That dropped to just 38 percent in 2013.

Mr. Rollins said he’s also concerned news media stories that focused on abuses within the system and judges who award a high percentage of cases may influence decisions.

He noted coverage of a recent Senate investigation that raised questions of whether a West Virginia judge had colluded with an attorney to approve an inordinate number of the attorney’s cases.

The investigation, led by Sen. Tom Coburn of Oklahoma, revealed Judge David Daugherty, who no longer hears cases, approved 1,375 of cases filed by attorney Eric Conn, denying only four.

Judges are not immune to publicity,” Mr. Rollins said. “I suspect if I’m in their position, I’m looking over my shoulder if others are being investigated and I’m seeing stories about too many allowances.”

While they have concerns about the system, Mr. Rollins stressed he believes the majority of judges try to be fair. The cases they review are rarely clear cut, he said, and require analysis of hundreds of pages of medical records.

“I think, by and large, they do the right thing,” Mr. Rollins said.

Mr. Bednarz, the attorney for the Wilkes-Barre man with Huntington’s disease, said he also feels most judges do the best they can. He fears legitimate cases are being lost, however, because many claimants don’t have attorneys to represent them.

Attorneys are only paid in disability cases if they obtain benefits for their client. Because the cases are so difficult, attorneys have become increasingly selective about which cases they will take, he said. That means some marginal cases that may have merit fall by the wayside.

“It is much more difficult than it has ever been being a social security practitioner,” he said.

(Morgan-Besecker, T.; Times Tribune, Scranton,PA, Dec 1, 2013)

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