The St. Petersburg Times is running a local follow-up story to the New York Times article that set forth the proposition that Social Security is overburdened with disability claims because Long Term Disability (LTD) insurance carriers are forcing their insureds to file disability claims when they have no chance of being approved.
I have a low regard for the LTD carriers, but this story is preposterous. Blaming the LTD carriers for Social Security's backlogs is about as pathetic as saying the dog ate the homework. The few excess claims that may be attributable to LTD carriers is a drop in the bucket compared to the flood of disability claims caused by the aging of the baby boom population.
If the Social Security Administration wants to cut down on excessive claims, it needs to look at its own conduct. Field offices are routinely taking Supplemental Security Income (SSI) claims for many individuals whose income is far too high for them to qualify. Part of the reason for this is a genuine desire to avoid missing SSI claims, but a good part of this is that Social Security field offices are alloted staff based upon the number of claims they take, giving field office managers an incentive to try to increase the number of claims taken. I would daresay that the number of unnecessary SSI claims taken by Social Security field offices vastly exceeds the number of unnecessary disability claims taken as a result of LTD carrier pressure.
I also have to question how unnecessary these claims taken at the behest of LTD carriers really are. Let me set forth an example. The claimant has been in an automobile accident and has been seriously injured. The expected return to work date is eight to ten months after the accident. Is it abusive to tell this person to file a Social Security disability claim -- since the definition of disability requires that the claimant have been or be projected to be disabled for at least a year? I would say not. Projections on when an individual will return to work after serious trauma are inherently uncertain. There is a real chance that a person in this situation will take more than a year to recover. So why not just wait and see how long it takes them to recover? You do not want to wait in this situation because it takes Social Security so long to adjudicate claims! The best thing to do is to get the claim filed as quickly as possible. The claimant can drop the case if he or she can get back to work in less than a year, but if not, the claimant will be much further along with the case if he or she files the claim shortly after the accident. This is just common sense.
If the Social Security Administration wants to cut down on excessive claims, it needs to look at its own conduct. Field offices are routinely taking Supplemental Security Income (SSI) claims for many individuals whose income is far too high for them to qualify. Part of the reason for this is a genuine desire to avoid missing SSI claims, but a good part of this is that Social Security field offices are alloted staff based upon the number of claims they take, giving field office managers an incentive to try to increase the number of claims taken. I would daresay that the number of unnecessary SSI claims taken by Social Security field offices vastly exceeds the number of unnecessary disability claims taken as a result of LTD carrier pressure.
I also have to question how unnecessary these claims taken at the behest of LTD carriers really are. Let me set forth an example. The claimant has been in an automobile accident and has been seriously injured. The expected return to work date is eight to ten months after the accident. Is it abusive to tell this person to file a Social Security disability claim -- since the definition of disability requires that the claimant have been or be projected to be disabled for at least a year? I would say not. Projections on when an individual will return to work after serious trauma are inherently uncertain. There is a real chance that a person in this situation will take more than a year to recover. So why not just wait and see how long it takes them to recover? You do not want to wait in this situation because it takes Social Security so long to adjudicate claims! The best thing to do is to get the claim filed as quickly as possible. The claimant can drop the case if he or she can get back to work in less than a year, but if not, the claimant will be much further along with the case if he or she files the claim shortly after the accident. This is just common sense.
5 comments:
The SSI technical denials do take up time in the field offices but not at the state Disability Determination Services (DDS) or at the Office of Disability and Adjudication and Review (ODAR). While there is a great deal of work at all levels the big backlogs which are generating the headlines are at ODAR.
I tend to agree, however..the bigger problem is the so called "SDW" issue where a claimant was insured for Title 2(DIB, DWB or CDB), but the Field Office missed it. This has created a mes since SSA must address these if there is SSI entitlement.
The SSI technical denials we take in the filed have a negligible effect on other workloads. The real problem is people being referred to file again and again by the local Public Assistance offices-they have minor disabilities, but are forced to file and refile, and to appeal denials
It all adds up to time spent on not working on valid claims. LTD referrals, technical SSI denials, welfare referrals. Every component of the agency thinks their workload is the worst. Taking a technical denial takes maybe about 5-10 minutes, a few sheets of paper and some ink, a few minutes of explanation (if the CR tells the claimant what they are doing). Then there is the printing of the denial notice, the cost of the envelope, the postage. Then there is the 5-10 minute phone call to the TSC or the CR when the notice arrives and the claimant thinks the T2 claim was denied. Then, in some instances, the T16 claim 'windfalls' the retroactive T2 benefit and causes it not to be sent out until actions are taken by the FO and the PC, with numerous phone calls, reviewing of diary lists, electronic referrals to the PC, phone calls. TIME THAT COULD BE SPEND ADJUDICATING VALID CLAIMS.
FO employees have to choose between a formal technical denial and an informal denial. Since they take about the same amount of time for the FO employee most managers would prefer the formal denial because the office receives "work credit" for it. No credit is received for an informal denial which also causes a notice to be printed and mailed so no savings there. The biggest difference is that if the FO employee was wrong the informal denial only protects the applicant for 60 days. A formal denial can be reopened for up to a year for any reason and up to two years for new and material evidence; therefore, the formal denial offers more protection to the applicant in case of error or wrong information.
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