|06-01-2003, 10:39 AM||#1|
Wiped out by the wait
Wiped out by the wait
Katie Bradshaw encourages Denise Hall, front, during a benefit for the Hall family at the Roseboro community center. Denise's husband, Robert, tried for two years to get disability benefits after an accident left him unable to work. In the meantime, the Halls lost their home. Robert Hall died three months after he was finally approved.
Staff Photo by Ethan Hyman
Robert Hall had worked since age 16, paying into Social Security for three decades.
Denise Hall visits the Roseboro grave site of her husband, Robert, with their son Charlie, 9. Hall died in a swimming accident three months after he was approved for Social Security disability benefits. A car accident had left him unable to work. The application and approval process took two years.
Staff Photos by Ethan Hyman
THE SERIES TODAY The Social Security Administration takes months, and often years, to approve applications for disability benefits. Many applicants sink into poverty as they wait. INSIDE: In North Carolina, applicants for disability benefits are rejected at a rate above the national average. TUESDAY A medical or psychological report can play a vital role in determining whether an applicant qualifies for benefits. Yet many doctors treat the exams casually. THURSDAY Mountains of letters and complaints serve as evidence that Congress and the Social Security Administration have long known the disability program is broken. What they don't do is fix it.
Denise Hall and her son Charlie talk after visiting Robert Hall's grave. Denise is still bitter about her husband's struggle to get disability. 'Yeah, I blame the disability department for ruining my life,' she said.
Nekia McDonald picks up case files that have been completed by disability specialists at North Carolina's Disability Determination Services and are ready to be mailed back to the Social Security Administration.
Staff Photo by Ethan Hyman
By BILL KRUEGER, Staff Writer
The way Denise Hall figures it, the government destroyed the last two years of her husband's life. Robert Hall was a working man. He laid telephone cable for more than 30 years after dropping out of school in seventh grade. He was good at what he did and made a good living doing it. Good enough to buy his family a double-wide trailer on a one-acre lot in Roseboro, a spit of a town on the edge of hog country in Eastern North Carolina. Good enough to put a swimming pool in the back yard and a new Ford pickup in the driveway. Good enough to put a thankful prayer in his wife's heart.
Then he got hurt.
And in two years -- two agonizing years when Hall's body ached so badly he could barely walk, let alone work -- it was all gone. The house. The pool. The pickup.
That's how long it took the Social Security Administration to approve his application for disability benefits. That's how long it took to get some of the money that Social Security had taken out of his paycheck all those years.
That's how long it took for Hall's life to fall apart.
Denise Hall gets angry thinking about it. Her husband died three months after he was finally approved for disability benefits last summer. He was 50. By then the damage was done.
"It's the worst thing in the world to go through, to know your government would do that," she said.
"To know that the money's there, that you've paid it in, and you've got to fight to get it when you need it. And sit back and lose everything you've worked your whole life for.
"We didn't have everything. We didn't live in a mansion. But it was ours."
The government has done -- and continues to do -- the same to thousands of disabled workers in North Carolina. The Social Security Administration takes months -- and often years -- to approve claims it receives for disability benefits.
Social Security benefits are only for those who are completely disabled and, therefore, unable to work. So while they wait, applicants struggle to get by with little or no money. Many lose their homes and sell their possessions to buy food and to keep the utilities running. Some fall into depression. A few commit suicide.
"The system is designed to hope you'll give up and go away," said U.S. Rep. Cass Ballenger, a longtime member of North Carolina's congressional delegation who has seen many constituents get squeezed by Social Security's bureaucratic wringer. "We always tell them, keep appealing until maybe they'll come through."
One particular case still bothers Ballenger, a Republican from Hickory. After months of trying to help a woman "who was obviously in terrible shape" get her disability benefits, Ballenger's office got a call from someone at Social Security saying the woman's application had been approved.
"We said, thanks a lot, she died last week," Ballenger said.
An overwhelmed system
The Social Security disability program is massive, with about 5.5 million disabled workers nationally receiving benefits. They receive a total of $4.6 billion a month. And while the overall numbers are big, no one gets rich on disability benefits. The average monthly benefit is $834, well below federal poverty levels for families.
In North Carolina, almost 200,000 people receive disability benefits.
Social Security disability is not a welfare system. It is a government insurance program paid for by workers through taxes automatically taken out of their paychecks.
While the program is intended to provide a safety net for workers who are hurt or ill, it has become a bewildering web of state and federal agencies that most applicants can't navigate without the help of a lawyer or a member of Congress.
It is a system that is overwhelmed, both by the number of applications and by the inability of those in charge to identify and repair the system's flaws.
Social Security Commissioner Jo Anne Barnhart declined to talk with The News & Observer, but she has told members of Congress that it can take 1,153 days for an application to work through the system. Only seven days, she has said, are needed to do the actual work on an application.
"It is clear that the disability process takes too long," she told a congressional subcommittee in May 2002.
Meanwhile, those applying try to get by with no income.
Many are blue-collar workers who held jobs that required muscle -- digging ditches, driving trucks, building homes. Many were living on the financial edge, making enough to get by and not much more. And then they got hurt or sick and could not return to work. They often lack the skills or education to get other types of jobs.
"A lot of these people, all they had to offer was a strong back," said Charles T. Hall, a Raleigh lawyer who specializes in disability claims. (He is not related to Robert and Denise Hall.) "Now they no longer have that."
A disabling accident
Robert Hall started laying telephone cable when he was 16. He was the youngest child in a large family, and he had to carry his share of the load. He was making about $45,000 a year before he got hurt.
"He never had trouble getting a job," Denise Hall said. "He was the best in the business of what he did."
Life settled into a satisfying routine for the Halls. They had five children, three of them from Robert's previous marriage, and they did everything together. Hall was up at four every morning to eat breakfast, help get the children ready, and go to work. He was in bed by nine each night after eating dinner with his family. The family followed pro wrestling and NASCAR. When his sons got older, Robert would lift weights with them and they would work on cars together. The driveway was full of go-karts and motorcycles.
"We just lived every day to its fullest," Denise said. "You'd go to bed at night, and you'd thank God that he gave you that day."
Then a hit-and-run driver sideswiped Robert.
He was on his way home one Friday night -- June 2, 2000 -- when someone in a pickup truck tried to pass him on a curve. To avoid an oncoming car, the pickup's driver veered back into Hall's lane and knocked Hall off the road. Hall's car bounced through a ditch before hitting a fence post. The post crashed through the windshield and met Hall's head at the roof of the car.
Hall had no visible injuries, though, so he drove home.
The next morning, he could barely walk. His body ached and his head was swollen. His wife tried to get him to see a doctor, to no avail. Hall was still aching after the weekend, but he returned to work. After struggling for a few days, he agreed to seek medical help.
Hall was sent to a specialist at UNC Hospitals in Chapel Hill. The diagnosis: four vertebrae were crushed and his shoulders were mush. He could have surgery, but the odds of paralysis were high. Without surgery, he would be unable to lift anything and eventually would lose the ability to walk. Nerve damage already was causing his left leg and hands to go numb.
Because of the pain, Hall could no longer pick up his son Charlie, who was 6.
But Hall decided against surgery.
"I'll walk every day that God will let me walk," Denise Hall recalled him saying.
Unable to return to work, Hall applied for disability benefits from Social Security.
'Culture of denial'
Hall's application was sent to a government office in east Raleigh. It is the home of Disability Determination Services (DDS), the state agency under contract with Social Security to make the initial decision about whether an applicant is disabled.
More than 260 state employees -- they are called disability determination specialists -- spend their days at DDS sorting through applications. They decide who gets benefits and who doesn't.
But no specialist ever saw Hall. All the work at DDS is done by paper or over the telephone.
To hear some tell it, what they mostly do at DDS is stamp "No" on applications.
"DDS is a culture of denial," said Mason Hogan, a Wilmington lawyer who specializes in disability claims.
Some say the problem has existed for years.
In the mid-1990s, the director of the state Division of Aging wrote to a Morganton man who had written to then-Gov. Jim Hunt to complain about a disability claim denied by DDS. She let the man know the process might take awhile.
"In practice it is common for the first disability application to be denied," Bonnie M. Cramer wrote. "You have, however, several more opportunities to have this application reviewed and potentially accepted if you file the appeal in a timely manner."
While the problem is not unique to North Carolina, it is worse here than in all but a handful of states.
Officials in each state use the same federal guidelines to determine who is disabled, but a much smaller percentage of applicants in North Carolina is approved initially than in 39 other states. In 2001, the latest year for which data is available, about 35 percent of North Carolina workers who applied for benefits were approved on their first try. In New Hampshire, meanwhile, more than 65 percent were approved on the first try. The national average is about 40 percent.
Denied on the first try
In December 2000, about three months after he applied for benefits, Robert Hall received a letter from Social Security. His application had been denied.
"The medical evidence shows that your condition is not severe enough to be considered disabling," the letter said.
"We realize that your condition keeps you from doing any of your past jobs, but it does not keep you from doing less demanding work. Based on your age, education, and past work experience, you can do other work."
Hall was furious. He could no longer do the only job he had ever known, and the notion of going back to school to be trained for another type of job seemed impossible.
Hall was in crippling pain. Denise Hall once returned home from work to find her husband lying in the back yard. He had collapsed from the pain and been unable to get up. Other days he dragged himself to the front porch to just sit and watch the world go by.
And so Denise, who worked full time as a teacher's assistant, also took two part-time jobs -- 20 hours a week at a Food Lion deli counter and 20 more as a cashier at a pharmacy. The money still fell short of what her husband had been paid.
"Can you imagine being a man and losing your livelihood, knowing that your wife's got to go out and work three jobs to just feed you?" Denise recalled. "It was terrible. He didn't talk. He withdrew. He stayed depressed all the time. I had to handle everything. It just about destroyed our marriage. We fought constantly."
If denied on the first try, disability applicants may appeal back to DDS. That rarely works; in North Carolina only 14 percent of the appeals are approved.
But Hall filed an appeal. His reasons were handwritten on three lines of form SSA-561-U2:
"I can not work due to virtabrays on spinal cord. All my doctors have said that I could be paralised if I trun my head the wrong way and I am loosing my home and I have children who are doing without."
Fred Beckham, the man in charge at North Carolina's DDS, said his agency works hard to ensure it makes correct decisions.
"A lot of people think it's sort of up to us as to whether they get on disability or not," he said. "It's not. It's up to the Social Security criteria. We're gathering all this information and we're fitting it into this criteria."
Disability specialists go through 13 weeks of training in anatomy and the medical and other guidelines provided by Social Security to determine whether someone is disabled. The specialists work with supervisors and staff doctors to determine whether someone is entitled to disability benefits. After one year as trainees, starting specialists are paid $33,023.
The job is a difficult one.
Specialists sit in cubicles in windowless rooms, talking on the telephone and pushing paper. Specialists have as many as 150 cases -- and more than 200 is not unheard of -- at a time.
Some cases are easy -- the medical records clearly indicate that the person is or isn't disabled. Other cases require more work -- applicants must be interviewed by telephone, medical records must be requested, or medical exams must be scheduled.
Turnover is high. Some years, the agency loses as many as one-third of its specialists.
"The consequences are that our state's citizens are not receiving the federal assistance for which they qualify as timely as they should," Beckham wrote in 2001, when the agency's attrition rate was 2 1/2 times the national average of similar state agencies.
Current and former DDS employees said there is never talk of denying a certain percentage of cases. Most of the directives from management, they say, have to do with production.
"We were under enormous pressure to produce decisions, and that was the No. 1 goal," said Deborah Brogden, who retired in 2001 after nearly 20 years as a disability specialist. "If it happened to be correct, so much the better."
Brogden said many cases were easy to decide. Others were not as clear-cut.
When that happened, Brogden said, the pressure to clear cases could lead to hasty decisions. And, most often, those decisions were to deny claims.
"It was not really encouraged to call the attending physician to get extra information," she said. "That took more time. They would shake their finger at me and say, 'Why aren't you working faster?' "
Elbert Grant, who worked as a specialist for three years before quitting two years ago, said supervisors discouraged specialists from taking extra time with difficult cases.
"If it's a close case, it's probably going to be a denial," he said.
Alesia Keevert worked as a specialist for five years before leaving in 2001 to work for a lawyer who handles disability claims. While at DDS, Keevert was promoted to a position where she saw how other specialists handled their cases. She was disappointed.
Keevert said it was common for an examiner to request medical records from three or four doctors or hospitals. When the records didn't arrive, some examiners would not try again to get them. They would simply deny the claim.
"Rather than go above and beyond, which would put so much stress on your case-processing time, they deny them, and out the door they go," Keevert said. "Then people get an attorney, wait two years, and get disability. In the meantime, they have lost their homes."
Despite all that, North Carolina's DDS consistently has received good marks -- both for production and for making accurate decisions -- from the Atlanta regional office of Social Security.
"They are very efficient working within the constraints of the overall system," said Paul Barnes, Social Security's regional commissioner in Atlanta. "When I look at their performance and compare it to the region, North Carolina has done exceedingly well."
Another denial; another try
In late March 2001, almost 10 months after the injury, Hall's appeal was denied.
Meanwhile, the loss of Hall's paycheck was taking a toll. Unable to make their $800 monthly house payment, the Halls moved to a rental house. Household belongings were sold or repossessed. The only gifts the children received for Christmas came from three local churches.
"How are we supposed to live without a home and any means to support our children?" Denise Hall wrote in a letter to members of Congress. "We did nothing to deserve this, but have always worked and paid Social Security taxes. Now when we need our money from disability, we can't get it."
The next step was to seek a hearing before an administrative law judge employed by Social Security. Applicants' chances improve greatly if they proceed to a hearing -- more than 60 percent of those requesting a hearing are approved.
Social Security officials are hard pressed to explain why an applicant's chances get better as they progress through the system.
In response to a Freedom of Information Act request by The News & Observer, the federal agency said it could not provide reports or studies about differences in approval rates between state agencies and administrative law judges.
"We regret that we cannot comply with your request because SSA does not maintain such data," wrote a freedom of information officer at Social Security.
Barnes, Social Security's regional commissioner in Atlanta, said he believes the greater approval rate at the hearing level is due, in part, to applicants' conditions getting worse while they wait for a hearing.
"It's just kind of the way things work in the disability program," he said.
If the Halls wanted to seek a hearing, a physician encouraged them to get a lawyer. In North Carolina, there are hundreds of lawyers or nonlawyer representatives, who specialize in disability claims.
Statistics indicate that applicants who have attorneys fare better at hearings than those who don't. So the Halls hired Michael Glancy, a paralegal in a Wilmington law firm who is a nationally recognized expert in Social Security disability. Glancy recognized the frustration the Halls felt.
"One of the unfortunate byproducts of this is that people lose faith in their government," Glancy said. "They have paid into this system. Whether they wanted to or not, the money is deducted from their check. There is a social contract that exists -- I do this on the faith that you will help me when I'm down."
All Glancy could tell the Halls was to wait. To get a hearing could take more than a year.
A hearing backlog crisis
Six thousand, two hundred.
That's how many cases, as of February 2003, were waiting to be assigned to one of the 11 administrative law judges in the Social Security Administration's Raleigh hearing office -- one of three such offices in North Carolina.
The average wait for a hearing at the Raleigh office is 13 1/2 months, the longest in North Carolina.
Bob Joneth, a Raleigh lawyer who specializes in disability cases, said his clients are shocked when he tells them how long it takes to get a hearing.
"I tell people, what this does is it gets your case on the end of a long conveyor belt," he said.
Social Security officials declined to make either the chief judge or chief administrator in the Raleigh hearing office available for interviews.
But records obtained by The N&O and interviews with people familiar with the hearing offices indicate that the staffs in the offices can't keep pace with the caseload.
In May 2002, Larry A. Miller, then the chief judge in the Raleigh office, described the problem in a letter to lawyers for applicants seeking hearings. He said the backlog had increased from 2,534 cases awaiting a decision in October 2000 to 6,426 cases in April 2002.
Miller attributed the increase in part to the addition of cases from the Fayetteville area and a loss of employees during a hiring freeze.
"This current backlog is, of course, hardest on the claimants, your clients," Miller wrote. "This backlog also seriously impacts our work as well as yours. Currently we are having difficulty working up enough cases to meet the scheduling need of the Administrative Law Judges."
In a statement prepared for The N&O, Robin Palenske, an administrative law judge in Raleigh, said judges in that office used to conduct 50 to 60 hearings a month. Now, she wrote, some are conducting fewer than 20.
Palenske said the support staff had dwindled from 28 in 1999 to 23 in 2002.
"The [judges] in the Raleigh [hearing office] stand ready to hear and decide more cases, but to do so, those cases must be properly prepared and assigned to us for hearing," she wrote.
Palenske also mentioned a reform attempt known as Hearings Process Improvement that was supposed to reduce the time it took to get cases heard. Instead, the processing time increased.
"Decisions on appealed claims are taking longer to make, fewer decisions are being made and the backlog of pending claims is growing and approaching crisis levels," Robert E. Robertson of the U.S. General Accounting Office told Congress last summer.
In Kevin Dugan's view, that crisis has arrived. Dugan is an administrative law judge in Charlotte and vice president of the national Association of Administrative Law Judges.
"It's broken," Dugan said of the disability system. "Terribly."
Triumph then tragedy
Denise Hall would agree.
"Yeah, I blame the disability department for ruining my life," she said. "I blame 'em a lot."
Last summer, nearly two years after he first applied for benefits, Robert Hall got his hearing. His doctor gave him a shot to ease his pain for the trip to Raleigh.
A month later, Hall finally got good news. He had been approved for disability benefits.
In addition to monthly benefits of about $900, he was awarded $16,000 in back benefits for the period his application was pending. The Halls used some of the money to buy used cars for themselves and their sons, and they decided to go to Carolina Beach for a weekend.
Robert Hall died that weekend when he was caught in a rip current and drowned about 100 yards from shore.
Denise still lives in the rental house. She is not working the part-time jobs anymore, and she is going back to school to become a teacher.
It still hurts, though, every time she looks at her paycheck.
"I look at the Social Security that's coming out," she said, "and I'm thinking, yeah, right."
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