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Courts find fault with 6 in every 10 Social Security denials

On Behalf of | Jun 16, 2023 | ERISA

If you’ve been struggling with a baseless, inexplicable Social Security disability claim rejection in recent years, you’re not alone.

The highest rate of Social Security Disability Insurance (SSDI) claim rejections in years is gumming up courtrooms nationwide. Citing “legal errors, inaccurate assessments of whether claimants can work, failures to consider medical evidence and factual mistakes,” federal judges have lost patience with the administrative law judges at Social Security.

In a rare show of unity across the political spectrum, judges ranging from conservatives appointed by President Reagan to liberals appointed by President Obama are drafting withering opinions, chastising Social Security for the sheer volume of rejections. What’s worse, after being kicked back to Social Security by district and appellate courts, the same claims are being rejected yet again.

Approval rates are down across the board

We’re used to seeing this song-and-dance from private insurers, but even as applications have gone down, according to Social Security’s own data, the rejection rate has climbed. In 2022, only 38% of SSDI applications were approved. Only about 20% of applicants appealed their rejections in federal court due to a lack of resources and, unsurprisingly, disability-related limitations. And from that small group, only 15% had their claims approved at the first level of appeal.

The source of this flood of rejections is the monthly quotas set by SSDI officials. The pressure to find any excuse to deny claims has SSDI going so far as to dismiss federal court orders to review nonsensical rejections “so vague as to be essentially unreviewable,” according to one district judge.

The SSDI administrative judges who first rejected the claims are often the same judges conducting court-ordered reviews. You can guess how often that results in a different outcome. In most cases, federal judges refrain from outright ordering SSDI to approve claims, instead insisting that SSDI review them. And thus, the cycle begins again. Meanwhile, claimants are put in increasingly desperate financial situations, unable to work and pay for essentials.

A large portion of SSDI rejections are indefensible

A surprising number of denials are so egregious and filled with errors that they never make it to the appeals court. According to one estimate by a disability attorney, lawyers for SSDI concede, known as “voluntary remands,” about 40% of the time before the appeals attorney even gets a chance to submit their brief. For their part, Social Security grudgingly admits that, depending on the state, at least 15% of their denials are too riddled with errors to merit their own attorneys’ time.

Again, quotas are blamed for the many erroneous denials that are kicked back to SSDI by federal judges. A representative for SSDI’s administrative judges says that each judge reviews about 600 cases a year, lasting an average of only three hours when sometimes up to 3,000 pages of medical documentation must be digested. With that kind of volume, mistakes are bound to happen. Meanwhile, morale and burnout at SSDI worsened. Presumably, this ratio of remanded appeals is acceptable to SSDI management, despite what must be an enormous expenditure of agency resources and seemingly unnecessary effort.

When victories aren’t victories

Hard-fought ERISA courtroom wins can take years, requiring the disabled claimant to endure a legal and bureaucratic decathlon. But at least those wins are wins. A successful SSDI courtroom appeal is increasingly merely a symbolic victory. Sadly, they often result in the same SSDI administrative judge reviewing the claim they already rejected and subsequently rejecting it again. How did we get here?

A gross over-correction to a 2012 disability fraud case is the prime culprit. A Kentucky lawyer ran a scheme that ultimately defrauded taxpayers of $600 million in disability benefits. Congress brought the hammer down, and this new oversight upped the pressure to deny all but the most open-and-shut claims.

A 45% drop in approval rates in the ensuing years resulted. This oversight intensified during the Trump presidency when tight-fisted political appointees turned the screws on administrative judges with a record of high claim approvals. Some judges were even fired over their high approval rates. The remaining judges fell in line.

The new normal

A flurry of SSDI policy changes in recent years has stacked the odds against claimants even higher.

Cases that were once slam-dunk approvals are dwindling, and less weight is given to conditions that most reasonable people would consider patently disabling. Additionally, dizzying new bureaucratic requirements can render convincing evidence inadmissible. Even language barriers are being ignored.

Decisions made on the strength of medical evidence were deprioritized in favor of hasty reviews. Judgment calls of who could work and in what capacity were ill-informed, to put it kindly. Opinions from primary care doctors, intimately familiar with their patients’ cases, were disregarded, and instead, contracted doctors were calling the shots after examinations, in some cases, lasting as little as 15 minutes.

All of this is a long way of illustrating how low the respect for beleaguered SSDI administrative judges has become for federal judges, who must continue to play goalie for claimants that would have been waved through on the first pass two decades ago. As of now, Social Security still insists they are performing their duties as charged. Comprehensive reform is nowhere on the horizon.