"Failing The Disabled"

Investigation: Disability Benefits System Harbors Culture Of Denying Help To Even The Most Unfit To Work

(CBS)  This is the second part in a CBS News investigative series about federal disability program.

---

Two years ago, 52-year-old Sherry Farner was a manager at a Denny's restaurant. But heart problems, strokes, and kidney failure put an end to her employment.

"I can't be alone, because I fall a lot. This is the hardest thing I've ever been through," Farner told CBS News chief investigative reporter Armen Keteyian. "And I wouldn't wish this on nobody."

When Farner filed a claim against a lifetime of paying into federal Social Security disability, she was turned down -- twice. Even though a rejection letter acknowledged she was severely disabled. But not disabled enough: Unable to perform work of any kind.

"It's a very tough standard," said Michael Astrue, commissioner of the Social Security Administration. "And you can argue whether that should be the standard or not, but I'm stuck with that."

A two-month CBS News Investigation uncovered a system whose own standards have been called into question - a federal agency reeling from budget cuts and high staff turnover. Doctors making decisions outside their specialties, and inexperienced examiners under pressure to keep costs down.

"We're failing the disabled on a very large scale," said Trisha Cardillo, who worked inside the system for years, reviewing 200 federal disability cases a month in Ohio.

She now fights for those seeking disability benefits.

"There were a lot of times when I was fighting with management because I wanted to approve a claim," Cardillo said. "And I had to go through so many steps and - jump through so many hurdles to do that, it just seemed ridiculous,"

All part, says Cardillo, of a culture built on denial. Examiners warned by their superiors that approving claims today could cost the government millions tomorrow.

"So are you saying, in essence, there was a quota system?" Keteyian asked.

"Every state had different numbers," she said. "They know that a certain percentage of people, once denied, will never file an appeal."

CBS News has learned that two-thirds of all applicants denied last year - nearly a million people - simply gave up after being turned down the first time.

Given how many claims are ultimately approved, that could mean hundreds of thousands of Americans are not getting the benefits they paid for - and deserve.

---

Read Part I of the series: Disabled And Waiting
FYI: Resources about disability benefits

---

Keteyian asked Astrue: "One of the state examiners we spoke to, told us that people were singled out, talked to, if they approved too many clients."

"You can approve too many, and you can approve too few. And they're both wrong," Astrue said.

That's not what the examiner told CBS News. She said that in her state there were quotas to be kept at a certain level.

"It's not the way the system works," Astrue said.

Keteyian said: "That's the way it worked in her office."

"You can always find a disgruntled person," Astrue said.

But we found nearly three dozen former examiners from 14 states who told us about a system-wide "culture to deny."

Part of the reason for that, says Jim Allsup, who employs former SSA employees at his Illinois-based company Allsup Inc., is that there is “an inherent conflict-of-interest between protecting the disability trust fund and providing the appropriate level of service to the claimant.”

That’s something CBS News found in a review of 50 cases across the country, where patients diagnosed with strokes, heart attacks, even brain cancer, were rejected for disability payments.

"Nobody cares if a case is denied. If you approve it, it will be subjected to intense scrutiny," Cardillo said.

No surprise to Sherry Farner, whose case was finally approved by a judge a few weeks ago - after a two-year wait. But not before losing her car, her life savings, and nearly her home.

[Vetturneddown]

Also, If going to Florida means that I am exagerating, and that I must feel fine...then what of all those terminally ill children that visit Disney parks through the "Make Wish Foundation"? I guess if those children do go, they must be exagerating as well!!
The all knowing, everwise, ever-criminal Social Security Administration. Mine is in located in Richmond, VA. Where's yours?

[Vetturneddown]

I was turned down as well. I served in the US Army, and have been out for about twenty years now. I became ill and it became increasingly apparent that I was going to have to working. All of my written applications were turned down. At a support meating a lawyer told us to save ourselves alot of headache and begin the process immediately, as it has been routinelytaking about 16 months after the applications have been submitted, to to get a hearing. The lawyer also strongly suggested I have a lawyer as well. About 16 months later I did get a hearing date and with Lawyer by my side, made an appearence. After the hearing my lawyer felt that things had gone very well. We had been told to expect a decision in writing between 30 to 60 days. About 75 days later I received a decision against me.
Their reasons were that they felt I was over-exagerating my pain and illness, and I had repeatedly told my doctors (when asked how I felt today) "Okay considering". (Meaning I am enduring pain and dealing with problems as I usually do.) The reviewers say I stated "I am Okay. No pain, no ilness." Another reason was that I "felt well enough to go to Florida, so I must not be in too much pain."

I went Florida alittle over a week to try and work for a friend of mine (it would only require about 2 hours a night with a total of 6 nights involved and a few emtpy days in between those 6) This friend understands the nature of my illness and had made allowances for me. I was to ride down with some other persons working for him as well, and then I could stay at his home in a private room so if I did not feel well (as often the case is) I could remain in bed without being bothered. Also if I could not attend the event for any particular night, I could stay in bed as well. A perk of working for this individual is that by coming to Florida, he will reimburse all gas remoney (with receipt) and he makes arrangements to feed us; either through the grace of his good natured wife who cooks some of the meals; or at a restaurant in the area. Another perk is that he obtains tickets for us to enter Disney World a couple of times while we're there as we have some days and nights that we do not have attend one of his events.
This last trip I was able to attend 3 out of 6 of his events (where I was stationed in a chair in one place for the night.) , and visited the Disney park (he chauffers us all) about two times out of the four times that the others went.
-I attended the park on the first day from about 10:00 am to 4:00 pm .
_I missed the second day they went due to my illness.
-I attended the park from about 5:00 pm to 9:00 pm on the third visit.
-I attended the park from about 1:00 pm to 7:00 pm on the fourth day they visited.

The others from my group that visited the park were there from open to just about close on all four days. And each day that I was able to attend, I did so in a rented wheelchair (some of the rental paperwork which I still have.)
On the day of my hearing the judge was trying to hurry up with the case, and kept cutting me off when I was trying to explain what my life is now like with this illness. The decision was actually made in the weeks and months after the hearing took place by an examiner that was not present, is not able to ask me questions but can have extra files or paperwork sent to him to make his decision.
I must now wait for 15 months for another hearing to address these issues, at which time I fully expect their office will find other things to bring up after the hearing,; thus throwing me back another 15 months.
In reference to the previousissues.
- My response to my doctors is "Okay, considering", which they see as "He's okay".
- I am not exagerating my suffering with this. If anything, most times I try to play it down and not let everyone around me know how bad my pain actually is.
- I now have gotten in touch with some of the people who attended that particular series of events in Florida, to ask them to either attend the next hearing or send affidavits explaining what they witnessed of my experiences on that trip. And I will bring the paperwork with me showing that I rented wheelchairs.
Just to throw more fuel on the fire in dealing with this process that is quite obviously tainted against those of us that apply in what can only be described as criminal in what they are doing. There is a movie (based on actual events?), starring Matt Damon as a young lawyer on a case where an insurance company (Great Harvest) adopted the standing operating procedure of denying most every claim they received in hopes that the majority of the policy holders would eventually, and quite simply give-up; thus leaving the company to enjoy a sizeable financial windfall. What IS the difference here.

[zingheim]

The game is more sinister and malicious than your report indicated: when I was told that I''d need to appear before an ALJ, I asked the Social Security clerk if I''d need an attorney; she said that an attorney would take big chunk of the Disability payments, and I''d get a fair hearing by the judge. In reality, no one wins a disability hearing without an attorney getting their pound of flesh. Ask any SS clerk today, and they will tell you the same; it''s the standard way they disqualify clients.
Then they send you to a doctor who specializes in a completely different field; but that doctor is, in my case, cardiologist who the judge decided had superiority over the orthopedic surgeon who said I was "definitively disabled" because the cardiologist was also an Internist. The cardiologist refused to re-examine me because his contract with the SS prohibited it, but said that the surgeon was "world famous" and if he could see me he would revise his report. The SS wouldn''t hear of it.

[sglloyd-2009]

To: ALL

The main problem I see dealing with an SSD claim is (time line) Social Security Administration will send a form to be filled out and demand you return the form in 30 day''s or else.
Now after you send the information to them you are lucky to hear back from them in a year or even two.
This is because in all the laws listed in CODE OF FEDERAL REGULATIONS their is no (time line)they must follow, this is why people wait 2,3,4,5,6,7,8 years to finaly get a claim resolved.
I believe it is set up this way to discourage folks from makeing a claim.(WRONG and a CRIME!)

BUT NO TIME LINE FOR A SSD CLAIM.LOLOLOLOL
This is because after you have used up your usefulness and are now a liability the federal government turns there head,they know you are sick,weak,tired and can not fight for your rights.
I say we put a (6 and pay) time line starting TODAY NOT NEXT YEAR OR WHEN Congress FINDS TIME.(6 mounths after a claim is filed payments must be paid to a claiment IF their are (any) (sever)medicaly determinable conditions)PEOPLE ARE HURTING AND SOME DIEING FOR GOD SAKES! while are leaders drink and dine on every Americans hard work and taxs we pay.
Then ask us to vote for them,they promise to make a change. LIES all LIES.
SHAME ON ALL OF YOU ELECTED OFFICIAL''S FOR LETTING THIS HAPPEN IN THE COUNTRY I LOVE, SHAME ON YOU!
Signed: "6 years and still fighting for resolve"from Michigan, The good old USA.

[tcardillo1]

Dear xraysierra:

You stated, "The ex-employee they talked to was obviously not following the proper procedures for their allowances and was in trouble for other reasons."

Actually, dear, I was never "in trouble" at DAS, and my performance was repeatedly good enough to warrant promotion to a training position, but your vote of confidence is much appreciated. I left because I grew a conscience--and because the weather in Ohio during the winter stinks.

Again, I don''t think you should assert so strongly that the way things are in your little corner of this world is the way things are EVERYWHERE. They aren''t, and you have no exposure to what has gone on in states around the country, nor do you actually know or follow the law. Not that it''s your fault--you weren''t trained to follow the law, and I''m sure you are just as overworked, underpaid, and (at least occasionally) stressed out as most adjudicators are. I think we should funnell some of the tax money being shipped overseas BACK INTO SSA. You wouldn''t mind a raise and a few extra adjudicators in your office to lessen your caseload, would you?

Trisha Cardillo
Buford, GA

[steelfoot73]

No matter how you look at it, 2 to 5 years is too long to have to wait for these payments when you do qualify and do EVENTUALLY get approved.

[wvmtnguy]

The entire system is extremely inefficient in the way it processes claims. It is swamped with paper work with is half helpful and not always completely intact when cases are evaluated. The system has delays throughout the process and those that work at the front of the line are sometime the poorly educated on the process. SSA has for the most part been staffed with government (civil) service employees many with years of service getting them to the level they are. Proper medical/rehabiliation professionals should be there to be able to make judgement on issues related to medical conditions. If more workers were able to understand the medical aspects of disability more consistency.

[petalwing_ms]

Thank you so much for letting the public know about the problems people have receiving SSDI. My husband has extremely bad asthma that has worn his body out and has been waiting 2 years to receive this very important benefit that our government says that we qualify for. Perhaps by your coverage, the SSA will make the needed changes.

God Bless,
Claire Brooks

[myndful]

DDSSSA, yes, some of the ALJs go out of their way to deny claims. Not all of them. There is one in particular who, if we are called to schedule a hearing, we already know it will be a denial. This ALJ will even discredit (as non-treating) the CE docs she sends the claimants to after the hearing, if the CE doc says the claimant is disabled. The atty I work for almost had a heart attack when we got an allowance from that alj, of course this allowance was after we filed a complaint and that hearing office started being investigated.

[faithgirl4hi]

I have Fibro/CFS, Anemia, Asthma, Migraines, Osteoarthritis, DDD, Sciatica w/ nerve root compression, Scoliosis, Hypermobility, PTSD, Depression, Anxiety and ETC, they tell me I''m not disabled?????? I have chronic pain 24/7. This is insane.

[openmouthed]

prjwdc FYI_Fibro is a condition that was first discovered 200 years ago. ALL of the causes are still unknown. There is no cure for it. Sure you can stuff your face full of pills, or face dibilitating pains. But NO ONE PERSON who has it, has it exactly the same as another or at the same "level". Good for you, Hallelujah, you are still able bodied. Not all of us are, and not all of us "only have Fibro". As I pointed out in my earlier post, if these were the only conditions I had that are disabling me, I''d jump up and down singing praises! Unfortunately they are not. Before you tell us how able bodied you are and what conditions you have, think a minute, or do a little research, there are MANY levels of these dibilitating conditions, I''m happy for you that yours is obviously mild.

[ddsssa]

myndful,

You mentioned the ALJ''s going out of their way to deny???

In our region they allow great numbers we never would be able to get thru QA. My cubicle neighbor who does CDR''s was yesterday showing me a claim that the ALJ had allowed for COPD and the PFS was totally normal!

[xraysierra]

Tell you what. We''ll quintuple everyone''s taxes, then we should have enough to cover every person that comes in with a letter from their doctor, stating that they can''t work. If that doesn''t work for you, then you''ll just have to wait. Imperfect as it is, that''s the system we have. As an employee of a DDS, I can also add that there have NEVER been quotas for approving or denying anyone. The ex-employee they talked to was obviously not following the proper procedures for their allowances and was in trouble for other reasons.

[myndful]

Bean, thanks. We see both sides of the story in our office. As a representative''s office, we naturally side with the claimants...but our local office is absolutely wonderful to work with. We try to make sure the people we represent are actually disabled, unlike a lot of the "mills" around.

Jette, the private representatives have the same problems with claimants. Either they call every so often checking status and needs, and respond quickly hwen we do need something, or they disappear as soon as they have their initial meeting with the attorney.

[mrkrabs5]

Do you know why the system is so clogged? Because of all the slugs who file frivolous claims. Case in point: a new claim, assigned today, from a guy in his early 20''s who had his appendix removed. That''s it..no other allegations! He had his stinking appendix out! Pretty much a routine procedure with no disabling affects. These claims ahould not even be allowed out of the district office. Its a waste of adjudicators'' time and take time away that should be devoted to the truly disabled. But, per regulations, these claims, no matter how frivolous, even if they''re for a hangnail, have to be developed. We have to contact the claimant, the doctors, pay (with tax money) for his medical records, make followups to doctors, maybe even order an exam (again with taxpayers dollars) if he hasn''t had a recent physical exam. All for a claim that is obviously going to be denied.

[jette711]

At the risk of repeating the comments of other examiners, SSA is VERY strict in determining disability. If you''re not disabled based on the Blue Book, (the link myndful posted), they consider a claimant''s age, education, past work, etc. In other words, if a claimant is 45 yo high school dropout, with a back problem, and worked as a construction worker, chances are that we''ll send back to a his old job or other work because he''s still fairly young and with some training and education, he can find another job. Compared to 55 yo with the same education, job experience and physical allegation. With mental allegations, we have to determine if claimant can do simple routine repetitive tasks according to the SSA guidelines. I may not agree with the some of the decision sometimes, the important thing is that we follow the SSA guidelines--or face to wrath of QA or DQB.

As for the quota, as far as I know, we don''t have an allowance/denial quota in my state, but it is production and statistically driven, so we have to close as many cases as we open (we get at least 5 new cases a day) each week

[jette711]

Excellent point, pulmeria5

I''ve been a DDS examiner for 2.5 years and while MOST claimants are VERY cooperative and will do whatever it takes to expedite the process, there are some who can be quite difficult. They break appointments that we set up for them at our expense without informing us, they don''t return phone calls--even after numerous attempts and I even had one who flat out refused go give me any functional ADLs--and I had no choice but to deny them for all the reasons above for failure to cooperate.

All the DDS examiners, including myself bend over backwards to help the claimants through the process, but they have to meet us halfway as well.

[itsthebean]

Myndful, I just wanted to say I appreciate your thoughtful posts, they are constructive. Also, thank you for mentioning the Blue Book. For those who want to know what conditions are considered impairments, check it out.

[life_writer]

prjwdc:

I was an air traffic controller in the Army. I was a wife and mother. I''m a single parent now. I held a government contractor job for ten years fixing Army training helicopters. I was making nearly $25 an hour with full benefits, paying taxes, providing well for my kids. I was doing it all- on my own.

Then I got sick. It can''t be helped. Yes, I would rather be working, know it all. I didn''t choose to give up $4,000 a month in EARNED income for $1,000 a month in UNEARNED income, plus lose my health insurance. Now I have to find a way to pay for my doctors, my meds- combined costing over $1500 per month, pay for rent, feed my kids, put gas in the 1974 borrowed Cadillac I''m blessed to have to get from point A to point B when my car was repossessed, and I''ll likely never get to go to a dentist again. I lost a home, a great job, I almost lost my kids, and I feel I lost my value and worth as a person when I lost the same job- twice, both times for trying to work when I couldn''t.

Realize that it''s extremely difficult to even be approved for disability and that most of us who are forced to actually rely on this cruel system aren''t here by choice.

Get a clue before you spew.

http://lifewriter.writing.com for those interested in seeing how a real person with real issues is trying to survive the system.

[prjwdc]

Social Security Disability benefits should be available to those who meet the requirements. But, some of those who could or would qualify don''t apply because they want to work. I look at it as a savings account for the financial soundness of my country''s aged population. Someday I will be there and I want to be able to get a Social Security Retirement check. I''m delaying dipping into this fund until I really feel that I need it. We live in a society that doesn''t think about the future. We won''t have Social Security Retirement OR Disability funds if the trend continues to put more and more on the rolls for disabilities that they can work with. As a society, let''s work on turning this around. Remember, I''m not condemning those who can''t take care of themselves or are dealing with critical illnesses such as cancer. They need these checks. But if you can do things but you are in pain from arthritis or fibromyalgia, this can be controlled with good treatment from your doctor. I''m living proof.