The Washington Post is reporting on an 80 year old woman who has been living on the D.C. streets for 16 years complaining that she couldn't get Social Security to straighten out her benefits. It turns out she was right. Social Security did owe her money. They've just paid her $99,999 and probably owe her more. Yes, if you know much about Social Security, it's obvious that she should have done things differently but people make dumb Social Security mistakes all the time and this woman has a better excuse than most. Despite the lady's protestations to the contrary, it's obvious that she has serious psychiatric problems. The bigger issue is that Social Security field offices often fail people like this who need extra help. That would happen some even with good staffing but it becomes more frequent when staffing is as tight as it is now. The consequences of failing to adequately serve people who have special needs can be terrible.
26 comments:
Interesting story. It's remarkable to see how little it takes for someone to fall into homelessness. The unfortunate thing she got wrong was her belief that cashing the Social Security checks would have prevented her from pursuing an underpayment. Perhaps that's understandable for a lay person because some insurance company settlement checks have settlement language on them, even if SSA checks do not.
They never did state exactly why she was owed that much money.
The unfortunate consequence of being in a bureaucracy that measures and values the wrong things, is that good employees who take the time to go above and beyond, to listen, be kind and compassionate, to spend more than the minimum time allotted on a real person (not a number) may face "performance" consequences for doing the right thing, while there are rarely consequences for those who cause real damage by playing the numbers game, cutting corners to meet goals, or making mistakes because they are working too fast under the pressure of meeting "goals" (e.g., FO employee "pressed the wrong button" and a deceased person was erroneously designated a felon, leaving a surviving, grieving widow to sort out the mess. To SSA's credit, the FO employee and manager fixed the mistake immediately and personally apologized to the widow, but this was in a small town where personal appointment could be made versus large urban office with long waits). Imagine these "mistakes" multiplied and compounded if the FO employee doesn't care, wants to cover their mistake or if the claimant is not knowledgeable or capable of pursuing their rights. I'm glad Ms. Witter didn't give up and had help.
Because I was illegally forced out of my SA position and 27+ year career with SSA/ODAR, I finally had no choice but to file for DR, given all the litigation, etc. As part of the process, one is required to apply for SSA Disability.
After submitting everything, including my medical records, I received a call from the DO, and the caller identified herself as the Claims Examiner who will be making the Initial Determination in my case. After she went through her prepared spiel, she asked if I had any questions. I said yes, I want to make sure all the medical records I sent will be placed in my case file.
The Claims Examiner responded that only the most recent medical records will be in my case file, and specifically indicated that any impairments I had when I was still working would NOT be considered in determining disability in my case. Of course, I said that is not true, or how the process works. I said you have to see the history to appreciate how medical conditions developed and progressed to where they are today. She raised her voice, and said no we do not. Even though my ODAR career is clearly identified on my application, I raised my voice in response to her raised voice, and noted my longstanding ODAR career as a SA, and indicated her assertions were incorrect and inconsistent with the law. I may as well have been talking to a brick wall, as she refused to even consider what I said. I could not believe this. So, one thing I plan to absolutely make certain before the Initial Determination is to verify that ALL the medical records I submitted were actually placed in my case file.
I still have not quite gotten over the shock of the incorrect assertions the Claims Examiner made to me, despite knowing and being reminded of my longstanding ODAR career as a SA. If they are doing things like this to me, I hate to think what may be happening to claimants who are illiterate, not well educated or represented.
@1:29
Yep, that sounds pretty accurate to our clients' experiences.
This is, unfortunately, unsurprising. After years of dealing with the Agency as a rep and reviewing DDS determinations, the only concludion is they are either ignorant or apathetic. Often both. When I see those A section ecats, I generally find a half dozen administrative and regulatory no-no's as well as conclusions that stretch even the credulity of the worst ODARs. Failure to apply grids, failure to apply grids nonmech, failure to accord proper weight to sources, failure to contact treating sources, failure to obtain records, failure to obtain records 1 prior to onset, failure to properly note DLI/AOD/App date/priors, failure to provide RFC, failure to do step 4/5 analysis, and so on. I even see MC's who are not even allowed to practice medicine giving out RFCs and anesthesiologists evaluating cardiac or neurological cases.
Only in this realm of law are these types of practices allowed and, depressingly, considered normal.
I got the impression from DDS that they make the decision to deny, then work backwards to give the reasoning. You see someone with back pain that can't stand long and is less than 50, you deny claiming they can do sedentary work. They just ignored the shoulder and hand pain, sleep apnea, eye issues and all other nonexertional limitations. So you give them more medical evidence for eveything... you call the CE and ask what else you need to prove your case during reconsideration. CE says, "We have all we need." DDS promptly denies again! It should be called Reiteration, if truth in advertising were applied!
I realize it's been a while since I processed claims but 1:29 says they got a call from the DO (District Office) and the Claims Examiner is making the initial decision? Thought the DDS made the initial determination and it's not that common for a DDS employee to call the applicant. Is there still an ongoing experiment with DDS employees being placed in the DO (field office)? Just trying to wrap my head around how one can insert themselves into how the claims file is assembled at the initial claims level. It would be a good trick for others to take advantage of, if it can be done.
Agree completely that employees who play the numbers game and cut corners to meet "goals" (I.e. quotas) are going to get better performance ratings and advance faster up the SSA food chain than employees who take time to sort out and resolve time consuming issues. It's at every level of the system. SSA management rewards employees who close cases fast and don't spend "too much time" on them.
12:45
Sometimes--and I know this might blow your mind--there are people who are both quick and thorough.
Sometimes is the key. We have a lot of CR's that are fast in my office. They are nice people too. I don't think they intentionally mess up...but they do, a lot. I wouldn't want them taking my claim.
Are they (DDS) punished for getting it wrong or are they rewarded for making a fast decision? Are they second guessed for denials or approvals? It appears to me that DDS takes the path of least resistance (deny, deny, deny), especially on complicated cases. Obviously, this is what SSA wants... because it is what they reward! The climate at SSA is clearly not about making the best decision in a timely matter at the least damage to the claimants but rather the opposite. It may be that the reasoning behind this philiosophy is that the marginal people will tire of waiting and find something that they could do. However, this doesn't take into account those that have been doing that for years or even decades and wait to apply until it's now obvious that they can no longer do any job, let alone any job with significant numbers.
I always say it is amazing to me how many 55 year old, 5' tall women are suddenly capable of medium exertion when they apply for disability.
So...she returns payments instead of filing for reconsideration -check. She returned the checks and then did not notify SSA where she was, resulting her likely being put in suspense for whereabouts unknown or development of address -check. This means her benefits due were accruing from that point once we figured out where she is, whoops, Post left that part out.
She then contacts the office but has insufficient documentation to establish identity (no photo ID, passport in baggage probably damaged?, guessing here) resulting in SSA being unable to identify and assist her.
The back pay of $100k? It was what she was due from her returning checks and SSA being unable to pay her. She may never have been right in the first place about her payments being wrong.
The only thing immediately obvious was the field office not taking a request for reconsideration and good cause statement for late filing asking for a review of the payments. This was not a numbers thing because the FOs take reconsideration requests on everything and fax it to the PSC most of the time (even on issues not due reconsideration such as enforcement of earnings, date checks paid, etc.).
"I always say it is amazing to me how many 55 year old, 5' tall women..."
If you knew our regs/program, you would know that sex, age, body habitus, etc. are irrelevant to exertional and nonexertional functioning. A 5'0 100 lb woman with no impairments would be presumed to be able to perform heavy exertion. Is it plausible in the real world? No, but that's how it works under our system.
@11:14 yes I know that. I should have clarified that it's a 55 yr old woman with physical impairments such as lumbar DDD, knee arthritis, etc.
Worked fighting the Social Security Administration for years. Stuff like this happens all the time. Always tell my clients to find 1 or 2 people in the local SSA office who knows what they are doing. Because most of those at the SSA have no clue about what is going on for some reason. What's sad is the SSA used to be one of the U.S. Federal government's best organization. Sad.
"A 5'0 100 lb woman with no impairments would be presumed to be able to perform heavy exertion. Is it plausible in the real world? No, but that's how it works under our system."
Wait what? I was going to let this go. But you just stated it is not plausible. I'm going to say DDS is straight out lying in their assessment of this 5-0 woman. Not plausible?
And just how it works? I agree. Assume you are stating how corrupt and unfair the SSA disability system is when you state it is "how it work." But it obviously should not work this way.
@ SA 27+, Now you know what it feels like when an ALJ refuses to exhibit medical or other evidence we as reps submit or refuses to include or consider evidence from a prior application. When the Agency makes up its own rules, they can consider or not consider whatever they want.
@1:08,
SA 27 here. You are right. For the Agency to exclude evidence at their whim, which I submit initially with my application, is a violation of due process. I have always understood the conundrum of submitting medical records long past the ALJ hearing, but this is ridiculous.
The justification the CE gave to me is if you still worked when you had the impairments, then they are NOT the impairments which prevent you from working, and we are NOT going to consider them. She was dead serious. So much so that I suspect if I, as a claimant, am able to verify/certify the actual record, much of what I submitted will not be in there. The time and expense I went to gather, copy and deliver all my records to them may very well have to be done again at a later level of appeal. This is not right on so many levels. Until now, I had no idea these due process violations are occurring at the very beginning of the application process.
The CE told me that if she does not consider the medical records I submitted relevant, they will not be placed in the record, or considered in determining disability, and she could care less whether I am an Attorney, or a longstanding ODAR SA. Trouble is I am not sure whether I will even be allowed to verify the actual record. I know everything I submitted should be in the record. If I refuse to verify her cherry picked record, is there any recourse other than continuing to appeal after determinations are made? I should also add all of this took place on the phone - not in writing. This is unbelievable.
11:44,
The poster was identifying the fact that a 50 year old woman and a 55 year old woman with the same exact conditions will be given different RFCs. On for light, the other for medium. If you don't believe this then you love the Kool Aid.
It blows my mind when I see a 60 year old with multiple back surgeries and a scheduled knee replacement that is capable of medium work.
2:22 PM That's how I took the part about the 55+ woman... because if she was restricted to light duty, she would be found disabled. As I indicated above, if you have ailments that could be disabling, but they want to deny... you simply make the RFC the maximum for their age and work backwards... otherwise, why would giving DDS more and more medical limitations not change the RFC. Because, in my case, they would have had to approve! There are no jobs for "less than sedentary!"
@11:18 Going back to the original post about the $100,000 in benefits paid. Totally agree. MBR probably in S6 address suspense and if or when the claimant came into the FO, she could not ID herself sufficiently and office had no choice.
I had one of these cases a few years ago. 80 something old man comes in with a 40 something man. 40 something man says they used to be union workers together and that he had found the 80 something living on the street. 80 had been getting paid his union pension, but his SS retirement benefit had been in some sort of suspense for enough years to add up to $70,000.
But I didn't trust the 40 year old guy. Also, since the 80 year old guy didn't even realize his checks hadn't been paid in years, I made a decision that he needed a bonded agency payee, not the buddy.
The buddy is still around, and keeps helping the 80 year old request money for cars, trips, all sorts of things. Adult Protective Service has also been contacted.
I think SSA probably acted as quick as they could, given all the restrictions and policies. Good for SSA.
@2:22
I think of what you refer to as result-driven decision making. The adjudicator decides whether they want a claimant to win or lose before they do the full legal analysis. Then findings are made to justify the decision. Is it wrong? Of course. Does it happen sometimes? Yes. Ask any very experienced representative frequenting an ODAR office and they will likely be able to tell you which ALJs do it, and what hot-button or extra-legal issues are likely to influence their decision making in that way. In my opinion, it's likely to be a significant factor in the wide disparity of grant rates among ALJs.
It sometimes results in tortured decisions where the facts have to be distorted or ignored in order to support the desired result. This, in turn, leads to many more appeals. The recent ACUS reports overlooked that 800# gorilla in the room, perhaps rightly so since there is little to be done about it currently other than for representatives to keep persistently appealing such decisions.
6:19 AM I'm guessing it happens all the time. Like, hundreds of times per day! Especially at DDS/ME level. They are pressured to make denials in a limited amounts of time. So, if what the claimant states in their comments would require DDS to find the claimant as disabled, the employee/ME give an RFC that just barely denies the claimant. Then DDS claims the claimant is only partially credible or not credible in order to "justify" their decision. If the evidence doesn't support the chosen RFC, then it is just ignored!
A rare news article that actually figured out the real cause for the problem.
http://abcnews.go.com/US/99999-payout-homeless-woman-highlights-social-securitys-struggles/story?id=41589939
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