Nicholas

Jim Nicholas and wife Yvonne Nicholas fought for full Social Security benefits for about a decade. (Karl Merton Ferron, Baltimore Sun / August 14, 2012)

Jim Nicholas lay in a hospital bed recovering after a heart procedure when his attorney called with life-changing news: The Social Security Administration would pay him more than $206,000 in disability benefits, bringing an end to his nine-year court battle.

Ever since he began suffering from heart failure, Nicholas and his wife, Yvonne, had been trying to prove he was sick enough to get benefits from the agency, which not only administers Social Security but provides support for those too disabled to work. As they waited, they watched their middle-class status slide into poverty.

The Dundalk couple was dogged throughout the process by denials and delays, a common experience for permanently disabled Americans looking to collect benefits, as the Social Security Administration struggles to manage a larger-than-ever caseload. The growing number of aging baby boomers, combined with a weak post-recession job market, has put unprecedented stress on the federal agency and the safety net it maintains.

"This is how the system works: Usually, people give up or they die," Yvonne Nicholas said. "I wasn't going to let that happen."

About 2,000 cases were dismissed last year because the claimant died, according to the agency.

The claims process often spans years: Most people who apply for disability benefits are denied and then must appeal to an administrative law judge and then in court, if necessary. The process can get bogged down by overcrowded dockets and the hunt for reams of required medical documentation that most patients don't have on hand or never had because they lack insurance.

While Social Security benefits are paid out when workers reach retirement age, people who have suffered permanent disabilities that prevent them from holding a job must apply for benefits from the Social Security Administration. The agency paid out $9.7 billion to disabled workers in June, and $44.7 billion to retirees, according to the latest data.

Efforts to collect disability payments often turn into legal battles that critics say are stacked against the claimant. The agency denies an average of two-thirds of applications from low-income individuals who are disabled and more than half of claims submitted by disabled workers. And some administrative law judges are far less likely than others to approve claims.

Then there's the wait.

More than 63,000 claimants waited at least 635 days for an initial appeal hearing and decision in 2007. While the agency has made strides in making the process quicker, the goal this year is to close the backlog of cases older than 310 days.

And that's after individuals wait an average of 150 days for a claim to be denied and then reconsidered by agency personnel before appealing to an administrative law judge.

The agency declined to comment on individual cases as a matter of policy, but Judge Patricia Jonas, executive director of Social Security's Office of Appellate Operations, said significant reforms are under way. Officials also emphasized that claimants who die while their cases are being considered may have died for reasons unrelated to their disability.

"Contrary to popular anecdote and innuendo, we have made extraordinary gains improving the speed and quality of our hearings and appeals process over the past five years," Jonas said told a Senate subcommittee last month. "We have done so against extraordinary obstacles, including demographic challenges, the economic downturn and fiscal belt-tightening."

Nicholas' attorney, Bruce D. Block, said the system must do better by the people who have paid into it.

"This is a hard-working man who comes from a hard-working family," Block said. "They have four children they raised. He supported his family, and for almost 10 years he had to fight the system. Think about the stress that these people had to go through."

Timothy E. Mering, a Baltimore-based attorney who specializes in Social Security, acknowledged that the agency is an easy target for criticism and said officials often make the right decisions. But, he said, a wrong decision can have devastating consequences.

"It's always easy from our side to wave the red flag and say how bad Social Security is," Mering said. "It is a very, very complex beast. They have two problems they face every day: The phone never stops ringing, and people never stop coming in."

Waiting for disability check

Jeffrey Henline of Ellicott City said the agency's failure had devastating consequences for his family.

He watched as his late wife become weaker and more ill as she waited for the Social Security Administration to approve her request for disability benefits. Marie "Terry" Sorbello died six months after she received her first disability check, following a three-year struggle for benefits, Henline said.