Quotas On Disability Claims Approval Alleged

From the Press-Register (a newpaper which is based somewhere in Alabama, but try finding which city using their online edition!):

Some former medical consultants at the Alabama agency deciding thousands of Social Security disability claims each year say they were pressured to approve more applications, an assertion backed by e-mails obtained by the Press-Register. ...

The Social Security Administration's inspector general, a kind of an internal watchdog, is now conducting a review of how claims are handled, a spokesman said last week. Citing that review, Tommy Warren, director of Alabama's Disability Determination Service, declined comment on the e-mails. He said that for comparison purposes, the agency lets employees know what the allowance rates are in other Southern states, but added that it does not have goals.

The e-mails, sent by supervisors at the Birmingham-based agency between 2006 and last year, urged consultants to shoot for a 30 percent "allowance rate." ...

Among eight Southern states, the agency had the highest allowance rate (44.3 percent) statewide for applications for disability insurance. It ranked 5th for SSI claims at 29.5 percent allowance and, at 23.2 percent, was third in approving "concurrent claims" for both disability insurance and SSI.

That showing came some two years after a supervisor voiced concern about how Alabama stacked up in the region.

"If you have consistently had allowance rates below 30 percent, you need to look at your decisions very closely," she told dozens of consultants in a January 2006 e-mail. Similar exhortations followed in 2007 and last year.

"If your allowance rate is below 30 percent, refer back to your plans of action and continue to work on bringing your allowance rates up," another supervisor wrote in a May 2008 e-mail. ..

At a meeting last year, consultants were told "that our (office) had one of the lowest allowance rates in the country," said Samuel Popkin, a clinical psychologist hired to evaluate claims of mental impairment. "The tone and implication . . . was that that was not a good thing."

"I certainly felt the pressure, let's put it that way," said Gordon Rankart, also a psychologist.

Rankart, who worked for the Birmingham disability office for some 6½ years, said he was repeatedly "hammered" over his allowance rate. Both his and Popkin's contracts were not renewed. Popkin said he was not told the reason. Rankart said he was informed that his work had problems. "This has nothing to do with my work performance and I'm not going to pretend that it does," he said.

Again citing the inspector general's review, Warren declined to say whether allowance rates are a factor in renewing consultant contracts, but noted that the agreements can be ended by either side with 30 days' notice.

Begun in May and prompted in part by an anonymous complaint, the inspector general's review is aimed at ensuring that the Alabama agency's claims-handling process is fair and that applications are "being adjudicated the way they should be," said Wade Walters, the agency's assistant inspector general for external affairs in Baltimore.

The review is expected to be completed by year's end.

Let me throw out an explanation why Alabama should not have a low rate of allowance of disability claims. On the whole, Alabama's workforce is poorly educated, has weak job skills and has lousy access to medical care. This combination leads to a high rate of disability claims and should lead to a high rate of approval of those claims since the definition of disability that Social Security must use makes education and work experience relevant in determining disability and poor access to medical care leads inevitably to poor public health. Poor education, weak work skills and poor access to medical care are the case across most of the South.

The South is where I practice, so I have some knowledge of this. Indeed, I see this in a particularly vivid way since my office is in Raleigh, which has a well-educated population with high work skills and good access to medical care, but many of my clients live in poor communities 50 to 100 miles away. Compare the populations and the number of disability claims and disability benefits recipients in Robeson County and Wake County, NC sometime. The difference is stunning. It would be even more stunning to compare Cary, NC and Red Springs, NC. I can recall having a day of hearings in Robeson County some years age with a visiting Administrative Judge (ALJ) who had just came in from Boston. I had three clients in a row who were illiterate. The ALJ asked me pointedly if all my clients were illiterate. I told him that until the early 1960s Robeson County had had three separate school systems. The school system for whites was lousy, the school system for blacks was much worse and the school system for Lumbee Indians was much worse still. Most older Lumbees at that time were illiterate. (The passage of time since the integration of school systems has made this situation better, thank goodness.) I had happened to have had three hearings in a row with older Lumbees. In context, there was nothing remarkable about their illiteracy. The hearing assistant who was a local was nodding her head in strong agreement with what I was saying. The ALJ seemed stunned. (By the way, the story of the Lumbees is fascinating. They are one of the largest of native American tribes but remain unrecognized by the federal government largely because of the opposition of other Indian tribes and an extraordinary amount of simple discrimination which was aided and abetted for many years by Jesse Helms. Before I finish digressing, read about the 1958 battle -- and I do mean a battle -- between the Lumbees and the Ku Klux Klan, a truly great story.)

Poor education, weak job skills and lousy access to medical care are not spread evenly across the population. One very large group in Alabama, African Americans, is much more affected than others. I won't go any farther along this line since you can see where it leads.

The real story here is that Social Security may have quotas or goals for approval of disability claims. You can criticize this because you think the quotas or goals are too high or you can criticize this because you think the quotas or goals are too low or you can criticize the whole idea of quotas or goals. The way in which you criticize quotas or goals may suggest something about your political or social views.