Health Care

If you get too sick to work, don’t count on your disability payments for help

People too ill to work are now waiting more than two years for the federal government to cut their first disability check.

Disability checks are meager – averaging about $1,060 a month – but are often the primary source of income for people with mental illness, cancer and other chronic conditions that can reduce once-productive, energetic employees to poverty and dependency.

The U.S. is now seeing unprecedented demand for disability payments as Baby Boomers confront old age and contend with health issues. Nationwide, the number of people awaiting a decision on their disability claims has swelled to 1.1 million, including more than 38,000 people in North Carolina whose cases are stuck in administrative limbo. Each year across the country hundreds of people die while their case drags on.

“These are long-term severe impairments that many people never recover from,” said Mike Stein, assistant vice president of operations strategy and planning at Allsup, an Illinois company that represents people with disability claims appeals, including hundreds of clients a year in North Carolina.

“Think of anything that can keep you from working for a year,” Stein said. “These are the worst of the worst.”

Wait times in North Carolina are slightly above the national average at the four Social Security hearing offices in the state that handle appeals of denied claims. At the first stage of the bureaucratic marathon, most applications are denied by a state review agency, a setback that can eat up six months of a person’s life before the case is appealed to a federal administrative law judge.

Patti Patterson, a spokeswoman for the Social Security Administration, said federal law sets a stringent definition of disability: an inability to work due to a medical or mental impairment that is expected to last at least one year or to result in death. That determination is based on medical records and diagnoses.

About 400,000 people in North Carolina have met the medical standard and receive disability benefits.

After the initial denial, the state agency can review the decision. Those reviews resulted in 35.8 percent of North Carolina applicants getting approved in 2016. The rest must appeal to an administrative law judge to see any benefits. It’s here that the wait for a hearing turns into an endurance test.

The Fayetteville office has the shortest backlog in North Carolina with a 606-day average wait for a hearing date. Greensboro’s office has the longest wait time – 698 days, as of the end of last year.

At the Raleigh office, 9,998 people awaited hearings as of Dec. 29, the state’s second largest backlog after Charlotte, where 11,074 people awaited hearings. The average wait in Raleigh is 643 days.

Today’s situation looks starkly different from 2010, when only 21,656 people in the state were queued up to be scheduled for an appeals hearing. Since then, North Carolina’s wait times have doubled in length. Today, claims filed in 2016 may not be resolved until 2019.

Living on peanut butter sandwiches

Pam Boyer, a former special education teacher, applied for disability benefits in September 2016 and appealed her denial last April. Boyer, 53, expects to wait until next year before a final decision is rendered on her case. She claims a number of chronic conditions, including diabetes, arthritis, asthma, kidney stones and non-alcohol-related cirrhosis of the liver that she expects will eventually require a liver transplant.

Boyer, who lives in Goldsboro, has been largely living off her pension from working three decades as a public school teacher. Her case is pending in the Social Security Administration’s Raleigh office.

“It’s one of those things where you decide which bill do I not pay this month and double up next month,” she said. “I can live on peanut butter sandwiches all month if I have to.”

The Social Security Administration blames the crushing backlog on budget cuts and lack of adequate staffing to process claims that are based on medical reviews of patient records. The agency’s budget has shrunk 11 percent since 2010 and funding for the current fiscal year is caught up in a budget impasse in Congress.

Patterson, the agency’s spokeswoman, said it has been unable to keep up with claims since it was slammed with applicants in the wake of the Great Recession a decade ago, when the agency’s resources failed to keep up with a surge of work demand.

“For several years in a row, the agency received a record number of hearing requests, due primarily to the aging of the baby boomers as they entered their disability-prone years,” she said by email.

The agency’s goal is to reduce appeals wait times to 270 days, a level not seen since 2000.

More administrative law judges needed

To speed up hearings, the agency had planned to hire an additional 750 administrative law judges over three years to handle the influx of cases, but hiring freezes resulted in just 394 hires to date, Patterson said.

Fifty administrative law judges hear cases in North Carolina, including 14 in the Raleigh office; the Social Security Administration has recently added eight judges in the state. The federal agency plans to increase capacity by adding video units in the next several months that will let North Carolina appeals be heard by any administrative law judge in the country, Patterson said.

The appeals are particularly important in North Carolina, which has one of the nation’s highest levels of denials at the initial application level by the state’s Disability Determination Service. Nationwide, two-thirds of initial applications are denied on average, but in North Carolina, three out of four applications are rejected, forcing more people to rely on appeals.

As weeks turn to months and months to years, patients’ cases get stronger as their health deteriorates.

“Many individuals who are initially denied benefits ultimately are found eligible,” Patterson said. “In many cases, the appeals process uncovers more detailed and complete medical evidence and sometimes individuals’ medical conditions deteriorate, which can lead to successful applications upon appeal.”

According to a September 2016 report by the agency’s Office of Inspector General, about 7,400 claimants awaiting an appeals hearing as of March 2016 died before their cases were resolved. That total included 421 who died in North Carolina while waiting for their appeals hearing. Because disability applicants are seriously ill, deaths are not unexpected, but longer wait times multiply the hardships.

“If the people are disabled you would like to give them their benefits because it would alleviate their suffering,” said Marilyn Zahm, an administrative law judge in Buffalo, New York, and president of the Association of Administrative Law Judges. “Every day we judges see the people waiting two years and we see the misery that it causes.”

And in the end, the wait may prove fruitless. Administrative law judges deny or dismiss 53 percent of cases they hear, approving disability benefits for 47 percent of claimants.

Rick Craddock, a 58-year-old former keyboardist and graphic artist, applied for disability benefits in August 2016 and filed his appeal a year ago this month. He lives in a senior apartment complex in Raleigh, occupying the unit adjacent to his 81-year-old mom, who covers his $750-a-month rent.

He said food stamps cover his groceries and he qualifies for charity medical care from UNC Healthcare. He spent three weeks in the hospital last year for various illnesses and estimated he owes thousands of dollars in unpaid medical bills.

Craddock and Boyer, the former schoolteacher, are both represented by Allsup, which handles 30,000 such case across the country each year. Under federal rules, Allsup and others who represent applicants in disability claims can collect up to $6,000 per claim. Lawyers receive no pay if their client loses on appeal and is denied a disability payment.

“If not for my lawyers I would not have a clue what’s going on,” Craddock said. “There is so much stupid paperwork involved.”

Craddock said his body “gave out” from the physical demands of his last job at a bagel shop, which he quit in July 2016. Among Craddock’s health conditions: coronary heart failure, chronic obstructive pulmonary disease and neuropathy, which causes weakness and pain in the feet and hands.

He sold his car last year and doesn’t have cable TV, relying on his mom’s subscription to satisfy his TV-watching habits.

“I would love to get some money so I could pay mom back,” Craddock said. “Even if it just covers the rent I’d be tickled to death.”

John Murawski: 919-829-8932, @johnmurawski