Congressional aides say an over-emphasis on clearing up Social Security Disability Insurance (SSDI) program appeal backlogs is hurting the solvency of the program.
The aides — part of the staff at the House Oversight and Government Reform Committee — argue many of the administrative law judges (ALJs) that hear the appeals are handling too many cases, and that some are dealing with unrealistic performance goals by awarding benefits to too many people.
See also: SSDI judge describes lack of information
Many private disability insurances like to see the SSDI program help genuinely qualified applicants as quickly as possible. Private insurers look at SSDI determinations when assessing the people getting private policy benefits, and many private insurers coordinate policy benefits with SSDI. A private insurer may subtract part or all of SSDI benefits payments from the benefits it pays a claimant.
The House Oversight staffers looked at “focused reviews” by the Social Security Administration (SSA) of 48 of the 1,400 administrative law judges who hear benefits rejection appeals. SSA officials conduct focused reviews when they believe there are reasons for concern about a judge’s performance.
All 1,400 ALJs combined awarded benefits worth an average of about $300,000 to 3.2 million claimants from 2005 through 2013. The overall appeal approval rate was about two-thirds.
Thirty of the judges who were the target of focused reviews had “red flags” because they approved more than 75 percent of the benefits requests they received.
All of the 48 focused reviews “show numerous deficiencies in ALJ decision-making,” the staffers write. The ALJs made too little use of vocational experts, made poor assessments of individuals’ ability to work, evaluated claimants with a history of drug and alcohol use improperly, and relied too heavily on claimants’ representatives’ briefs, the staffers say.
The SSDI program has a complicated system for determining eligibility but, in theory, is generally supposed to pay benefits only if a claimant is unable to handle any appropriate jobs available in the national economy.
The SSDI program is facing questions about solvency, and, if ALJs award benefits to unqualified claimants, they are hurting severely disabled workers who truly need and qualify for SSDI benefits, the staffers say.
Rep. Darrell Issa, R-Calif., the outgoing chairman of the committee, organized a series of hearings and reports focused on the SSDI claim determination and appeals system.
Democrats on the committee have argued that the quality of the judges’ decisions has been improving, and that singling out judges with high approval rates may not account for differences in the mix of cases the judges are getting.
Democrats say inadequate SSA funding hinders efforts to speed up claim and appeal processing and also hinders efforts to improve ALJ quality.