January 8, 2014

The disability fraud epidemic in the US

Gotcha.
There isn't one.
But in the news today was the story  of a "ring" set up to fraudulently claim payments for 9/11 responder injuries. In the past 6 months was another story of someone making bogus disability claims based on their "trauma" after being profiled in the news for their brutality against unarmed peaceful protesters.
If your personal prejudice is that disability fraud is the norm rather than the exception, these stories are going to reinforce those beliefs.

But the facts are very different.

Chart 11. Final outcome of disabled-worker applications, 1999–2009
The final award rate for disabled-worker applicants has varied over time, averaging nearly 45 percent for claims filed from 2000 through 2009. The percentage of applicants awarded benefits at the initial claims level averaged 28 percent over the same period and ranged from a high of 37 percent to a low of 26 percent. The percentage of applicants awarded at the reconsideration and hearing levels are averaging 3 percent and 13 percent, respectively. Denied disability claims have averaged nearly 53 percent. 

SOURCE: Tables 59–64.
NOTES: Awards are calculated as medical allowances minus subsequent technical denials. Technical denials include both nonmedical decision technical denials and medical decisions that were subsequently denied for technical reasons.
The proportion of claims awarded at each level of the process is likely to change as a result of the Prototype Process being tested in 10 states. Under this test, the reconsideration step of the appeals process was eliminated for applications filed October 1, 1999, or later. Elimination of the reconsideration level in these states is likely to result in a decrease in the overall proportion of claims awarded at this step.
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 So the initial claim for Social Security disability benefits APPROVED  "averaged 28 percent over the same period and ranged from a high of 37 percent to a low of 26 percent".
So after you apply and are initially denied, you request reconsideration. Hope you are in the 3% who get approved at that level.
Well, not surprisingly you are going to have to move on to the hearing level before you actually get to talk face-to-face with anyone about your case. This will involve hiring a lawyer if you have any hope of being in the lucky 13% who get approved here. And it will only cost you 25 - 50% of your final award amount. Lucky you.
Per the Social Security Administration, they deny over half the disability claims that are presented.
That does not just include "back pain" claims. That includes every paraplegic, every schizophrenic, every gravely disabled person in this country. All the babies that now survive who require medical interventions their whole lives? They are in there too. Every brain injured person on a ventilator, every person dying of a terminal illness. Everyone who has applied for the benefit.

So my prayer for you this new year is this, I pray that you and yours do not ever have need of this benefit. I pray that reason and compassion will someday win out over political expediency and those that have the most needs are no longer treated as "entitled".
And frankly, I pray that I am in that 13%.


2 comments:

Rhianon Jameson said...

I don't doubt that someone, somewhere, claimed that there was an epidemic of fraudulent disability claims, or that the majority of such claims were unjust, but I haven't seen anything like that.

My guess is that the vast majority - 90%? 99%? - of disability claims are genuine. As you point out, the Social Security Administration does try to make sure that claims are legitimate. Most people are honest, and most people would prefer to work than not, and would be embarrassed to collect a disability payment fraudulently.

But you're not suggesting that there is no fraud in the system, or that the New York cops named in the piece weren't defrauding the system, right? Because just as most people do the right thing, there are going to be others who don't mind working all the angles, even the illegal ones. And those people take resources away from the one who truly need the benefit.

In my own county, in Maryland, something like half the police retire early on a disability claim. Some are clearly legitimate; others - who are later pictured working at other jobs or playing sports - are clearly not; and yet others are murkier cases. Being a cop is a dangerous job and more cops are going to have career-ending injuries than most other professions, but half seems like a big percentage. I want the fraudsters uncovered, and I'd think everyone, including the most committed advocates of disability pay, would want that as well.

Fogwoman Gray said...

Not suggesting there aren't folks trying to defraud any system. Certainly there are. But does it justify the horrific process and low rate of approval for legitimate claims? Does it justify the fact that a lawyer becomes necessary just to get a very straightforward and well documented claim through the approval process? It does not.
But targeting the least powerful is much easier and less risky than going after the rampant fraud and abuse at much higher levels of income.