SSA rush to reduce backlog criticized Non-judges allowed to approve disputed disability benefits


WASHINGTON -- Moving to cut a backlog of 1.2 million disability cases, the Social Security Administration has begun expediting the appeals of some applicants who already have been denied benefits, awarding many of them monthly checks without the approval of judges who normally make those decisions.

Social Security is now allowing 500 staff attorneys and paralegals who are aides to administrative law judges to screen incoming appeals and award benefits when they conclude that a judge would make the same decision in that case.

The effort has stirred concern that the Woodlawn agency is trying to buy its way out from under a mountain of claims by rushing applicants who may be undeserving onto the rolls -- increasing the costs of its $66 billion disability programs and further straining the retirement trust fund.

Critics are worried that the staff attorneys and paralegals, feeling pressured to lower the number of pending cases, will grant benefits to applicants who would be turned down if the cases went to judges.

The attorneys and paralegals have the power only to award benefits, not to deny them.

Social Security "will end up with a large number of erroneous decisions," predicts Glenn A. Fait, associate dean at the McGeorge Law School at the University of the Pacific and a consultant to Social Security.

"They are desperate to get caught up."

"We are worried," said Jane L. Ross, an official of the General Accounting Office, the investigative arm of Congress.

She said some Social Security personnel whom GAO has interviewed share the concern that pressure to reduce the backlog "may lead to incorrect disability decisions."

Social Security officials insist that their effort -- under way since mid-July -- will merely get benefits to deserving applicants quicker than they otherwise would receive them, in many cases relieving genuine hardships created by long waits for decisions.

They are pleased with the initial results.

In August, the first full month of the plan, a record number of cases was processed at the appeal level while the award rate was reduced slightly.

Attorneys and paralegals approved awards to 3,808 applicants. They declined to do so in another 11,500 cases, which they passed along to judges for hearings.

"This is only one month's experience," said Charles A. Jones, the official in charge of reducing the backlog.

"It's early yet, and we definitely need to keep an eye on that."

On the other hand, he said, "We have 3,808 people in August who will get their benefits much sooner as a result of this initiative, and we think that's significant."

Judge admits it's working

Raymond F. Faby, the chief Social Security judge in Baltimore and an opponent of this intrusion on the authority of judges, nevertheless acknowledged, "It's working. I think we've turned the corner."

But the effort to streamline the appeals process may backfire.

Even as the current backlog is being cut, some critics fear that a fresh onslaught of appeals could be triggered once it becomes known that cases are being resolved more quickly.

In fiscal year 1994, three out of four applicants who were turned down by caseworkers -- 1.2 million people -- did not appeal to judges.

4 Of the 387,000 who did, two-thirds won benefits.

If only 5 percent of those who did not appeal in 1994 had done so and managed to win monthly checks, the cost to the government and the Medicare and Social Security trust funds would be more than $5 billion in lifetime benefits.

"We're convinced from the cases that we see that a large percentage of those who don't appeal would be approved" if they appealed beyond caseworkers, said Jerry A. Thomas, who heads the Georgia agency that makes disability decisions in that state for Social Security.

Social Security operates two disability programs that send monthly checks to 10 million people.

One, Disability Insurance (DI), is for people who have paid into the Social Security trust fund.

The second, Supplemental Security Income (SSI), is for the aged and disabled poor who don't qualify for checks from the trust fund.

Payments doubled in 6 years

Since 1989, payments have nearly doubled while the rolls have increased more than 40 percent.

Applications have soared 53 percent to 2.6 million a year, producing the huge backlog and long waits for decisions that sometimes stretch to more than a year.

Social Security has been redesigning and simplifying its process for handling claims, but it expects the effort to take five years.

NTC Meantime, even with an extra $640 million from Congress in the )) past two years, it has been unable to reduce the overall backlog significantly, though it has stalled the growth.

In the past 11 months, it has managed to reduce the number of cases awaiting decisions at the initial approval level by 16 percent to 611,126, largely by paying overtime to the caseworkers.

In the meantime, the backlog of appeals to judges has jumped 15 percent to 557,126 -- with the average processing time reaching nearly a year.

The use of staff attorneys and paralegals to speed the appeals process is the most controversial aspect of an ambitious 19-step Social Security plan to trim the backlog by 312,000 cases -- about 25 percent -- before the end of 1996.

Authority for action questioned

Social Security's 1,000 administrative law judges, highly protective of their independence, are critical of this effort and believe the agency hasn't the legal authority to delegate decision-making power previously held solely by them.

And, they claim, it will be expensive.

Early this year, eight judges in Chicago wrote to 43 members of Congress, saying the new procedure "not only increases the initial benefit payout by billons of dollars, but it will also add thousands upon thousands of persons to the federal disability rolls permanently."

"This is a scheme to really get out of the backlog by paying down the backlog," said Ronald Bernoski, a Social Security judge in Milwaukee.

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