From Follow-up on Claims Denied Because Claimants Were Not Insured for Benefits, a report by Social Security’s Office of Inspector General:
… This audit is a follow up to our 2016 review of Retirement Claim Denials Because of Lack of Insured Status.
Generally, to be insured for retirement benefits, a claimant must have 40 quarters of covered earnings and have attained age 62. SSA employees should not deny a retirement claim if the claimant is not insured for benefits at the time of filing but will become insured within 4 months and evidence of the earnings is available.
We obtained the records of 450,209 retirement claims filed between May 2014 and June 2023 that SSA employees determined the claimants lacked insured status. From this, we identified 4,077 claimants who may have been insured because they had 40 or more quarters of coverage in the year of filing. Of the 100 claimants in our sample, SSA employees denied retirement claims for 43 who alleged lag earnings when they filed their claims, were fully insured, and entitled to retirement benefits but employees did not consider their lag earnings. Despite reminders issued to employees after our prior review, employees denied the retirement claims because they determined the claimants lacked insured status; however, the claimants had lag earnings when they filed their claims.
Based on sample results, we estimate, from May 2014 to June 2023, employees denied retirement benefits to 1,753 claimants who were insured for benefits. Of these, 1,347 claimants were entitled to over $3 million in retirement benefits.
Without controls and processes to ensure employees identify, review, and document lag earnings, SSA will continue denying millions of dollars in retirement benefits to claimants who should be receiving them. Depriving retired individuals of the benefits to which they are entitled could have a significant and harmful effect on beneficiaries, including financial hardship and emotional distress. …
This problem is not limited to retirement claims. I’d say it’s more common in disability claims.
2 comments:
Quantity over quality is the understood mantra at SSA and that’s enforced by the lack of training at the agency. It’s all about the numbers.
what I didn't understand about this report is that they had a universe of cases where the person appeared to have 40 QCs, and a chunk of them were denied improperly for lag earnings. A few more turned out not to have sufficient lag earnings, or got insured and qualified for a higher benefit on another's earning record. But the report didn't really explain what the deal was with the majority of cases--those who appeared to have 40 QCs but were denied. Did they not actually have 40 QCs? If so, why was their earnings record wrong? Were they insured and improperly denied for reasons other than lag earnings?
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