San Diegans wait 540 days for Social Security disability hearings

Whether it be an injured back, mental illness, or agonizing disease, scores of Americans are suffering from ailments so debilitating that they can’t work.

But when they apply for Social Security disability for financial relief — money to pay for housing, food and medical bills — they find they are in for a long wait.

In San Diego, the average wait to see an administrative law judge for a disability hearing is 18 months — or about 540 days.

That is a bit more than the national average of 17 months but less than some other regions. Buffalo, N.Y., has the highest wait time of 25 months, according to data released for September.

“That is a long time if you believe you’re disabled and not working. You don’t really have an income, you may need medical care and you may not have access to medical care,” said Marilyn Zahm, president of the Association of Administrative Law Judges. “I think the American public deserves better than that.”

About 1.1 million Americans are currently waiting for a disability hearing — a backlog that is largely the product of budget cuts and understaffing at the Social Security Administration.

In San Diego, 8,853 hearings were pending as of the end of October.

“The backlog has always been with us, but it is bigger than ever,” Zahm, a judge in Buffalo, said in an interview.

The issue was a recurring theme discussed at the annual meeting of judges who hear such cases, held in downtown San Diego this year.

The Social Security judges represent the largest judiciary in the nation, responsible for doling out millions of dollars each year in disability benefits to eligible Americans. In 2015, Social Security paid out $143 billion in payments to some 11 million disabled workers and their dependents, according to the board of trustees’ annual report.

Yet much of what these judges do they do in secret. Hearings by the Social Security Administration’s Office of Administrative Review are not open to the public or media, nor are case decisions public record. No judges are permitted to speak with the news media except for Zahm in her role as labor association president.

There are about 1,500 administrative law judges nationwide. In San Diego, there are 11.

That’s not near enough to deal with the enormous caseload, which grew during the economic recession and continues to spike with the aging of baby boomers, according to Social Security officials.

The process to get before an administrative law judge typically goes like this: A person believes he is disabled for at least a year and cannot work. He first applies for disability though the state, which is denied. He appeals the state decision and is again denied. He can then request a hearing in front of a Social Security administrative law judge to determine if he meets disability requirements.

To prepare for the hearing, the judge will review medical records and other evidence — sometimes more than 1,000 pages — submitted by the claimant, state doctors, worker’s compensation doctors and vocational experts. At the long-awaited hearing, which usually lasts an hour or two, the judge questions the claimant and possibly experts to fill in any gaps, and then authors a decision.

The claimant, if unhappy with the decision, can take it up with an appeals council, and lastly can bring it to the federal courts as a final measure.

In fiscal 2015, Social Security received about 746,000 hearing requests and issued approximately 663,000 decisions.

The number of disability claims has jumped from 2.5 million to nearly 3 million from fiscal 2007 to fiscal 2013, according to the Social Security Administration. That’s an increase of about 20 percent in initial disability claims. Appeals hearings before administrative law judges have also spiked during that same period by 40 percent, the administration reports.

In the meantime, budget cuts and a small pool of qualified judge applicants to hire from have made it hard to fully staff the bench.

The administration as a whole was down some 11,000 employees since fiscal 2011, and more than 21,000 employees are expected to retire by 2022, according to officials.

From fiscal 2011 to fiscal 2013, the administration received nearly a billion dollars less each year than the president requested in his budget, according to testimony from Social Security Deputy Commissioner Theresa Gruber to the Senate Committee on Homeland Security and Governmental Affairs in May.

The reduction in services that resulted included scrapping plans to open eight additional hearing offices in the country.

Short of the obvious solutions of hiring more judges and staff and increasing the budget, Zahm and Social Security officials said there are ways to make the process more efficient that would help with the backlog.

The administration has laid out a plan to help reduce the backlog, with the goal of reducing waiting times for a hearing to no more than 270 days and to decrease the number of pending cases by half by fiscal 2020.

That includes using technology to streamline medical records evidence and using video hearings to expedite decisions. Other programs offer administrative help for claimants who aren’t using attorneys to keep the process running smoothly and provide summaries and analysis in cases with massive medical files.

The backlog has also been the subject of audits by the U.S. Office of the Inspector General.

“To us 1.1 million is not just a number; it is a line of people and their families — many of whom are in desperate circumstances,” Gruber testified. “For many of them, long wait times can mean catastrophic consequences, such as losing a home or making agonizing choices between other basic needs.”

San Diego attorney John B. Martin, who handles such cases, agrees the effects can be dire for some people.

“Some become homeless. They’re just without income for a very, very long time,” Martin said.

He said the people who become homeless get priority for a hearing, but even that is a long wait.

“You can imagine people had a good salary — I’ve had clients making low six figures — and one day become disabled. Because they didn’t have a nest egg, they end up on the streets. It’s happened several times.”

Health conditions can also worsen during the wait, officials said. “Our judges have shared with us having to dismiss cases, or substitute a party, because claimants have died while waiting for a hearing and decision,” Gruber testified.

Among those who start receiving disability benefits at the age of 55, one in five men and one in seven women die within five years of the onset of their disabilities, officials said.

“The toll it takes on somebody when you have to wait that long, that is not right,” Zahm said. “That is not good public service.”

Judges have also seen an increase in Iraq and Afghanistan war veterans who are suffering from traumatic brain injury and PTSD and claiming disability.

“We are adjudicating more claims than ever for veterans,” Zahm said. She said those claimants are moved to the head of the list. “They put their lives on the line for the American public and we owe them that.”

Originally posted on the San Diego Union Tribune