Judging of disability claims flawed, Senate study finds

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More than one out of every 20 Americans of working age was collecting Social Security disability payments as of March, but the system designed to judge claims is overloaded and bungles more than a quarter of the cases, according to a new report by a Senate investigative subcommittee.

Investigators looked at 300 cases in which disability was approved and found adjudicators regularly ignoring red flags in applications, such as incomplete or inconsistent information.

That finding is consistent with the Social Security Administration’s own internal reviews and signals a system in need of an overhaul, said Sen. Tom Coburn, the ranking Republican on the subcommittee, who led the study and said some of the decisions coming from administrative law judges (ALJs) — one level of the process — are so bad they make the final judgments seem almost arbitrary.

“I think you could flip a coin for anybody who came before the Social Security Commission and get it right just as often as the ALJs do,” he said.

Disability is one of the two major parts of the Social Security system and is designed to provide support for Americans who are unable to work because of physical or mental impairments. Benefits start months after a claim is approved, and two years later, beneficiaries also can begin to collect Medicare.

The panel looked at 300 cases in which claims were approved, selecting applications from Virginia, Oklahoma and Alabama. Mr. Coburn said he’ll next take a look at cases in which claims were denied and said he expects to find applicants who should have qualified but were denied.

“My worry is we’re going to find a lot of people this system was designed for, that didn’t get disability,” he said.

Social Security spokesman Mark Hinkle said the agency shares investigators’ concerns. He said “a small number of judges” have failed to conduct proper hearings or require proper documentation.

“We have undertaken a vigorous set of quality initiatives since the time most of these cases were decided about five years ago, and data indicates that we have made substantial progress,” he said in an e-mailed statement. “We have substantially reduced the number of ‘outlier’ decisions (i.e., decisions that applied the law too harshly or too generously) and our affirmance rate in the federal courts is better today than it has been in decades.”

Disability payments rely on a trust fund that is expected to be exhausted in 2016.

The report was issued Wednesday night by the Republican staff, ahead of a Thursday hearing. The investigation itself was bipartisan and conducted in cooperation with Sen. Carl Levin, Michigan Democrat, who is chairman of the investigative subcommittee.

The 132-page report highlights one ALJ in Oklahoma, Mr. Coburn’s home state, who has issued more than 1,000 decisions each year since 2006. Judge W. Howard O’Bryan Jr. peaked in 2008 with 1,846 decisions and regularly approved 90 percent or more of the claims. The average approval rate is about 60 percent.

The committee investigation said his decisions “were most notable for their decidedly poor quality” and said Judge O’Bryan regularly used the same boilerplate language in approving cases.

He decided cases so quickly that the agency began shipping him ones from around the country.

“I may have taken a few shortcuts,” he told investigators, though he stood by his decisions. “You do whatever you can to make them go. You try to get through them the best you can.”

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