Appealing disability claims brings long, painful wait

  • Article by: ERIK ECKHOLM , New York Times
  • Updated: December 9, 2007 - 9:05 PM

With cases backlogged, it can take years to get a decision on Social Security payments. Many cannot wait that long.

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RALEIGH, N.C. - Steadily lengthening delays in the resolution of Social Security disability claims have left hundreds of thousands of people in a kind of purgatory, waiting as long as three years for a decision.

Two-thirds of those who appeal an initial rejection eventually win their cases.

But in the meantime, more and more people have lost their homes, declared bankruptcy or even died while awaiting an appeals hearing, say lawyers representing claimants and officials of the Social Security Administration, which administers disability benefits for those judged unable to work or who face terminal illness.

The agency's plan to hire at least 150 new appeals judges to reduce the backlog, which has soared to 755,000 from 311,000 in 2000, will require $100 million more than the president requested this year and still more in the future. The plan has been delayed by the standoff between Congress and the White House over domestic appropriations.

There are 1,025 judges, and the wait for an appeals hearing averages more than 500 days, compared with 258 in 2000. Without new hirings, federal officials predict even longer waits and more of the personal tragedies that can result from years of uncertainty.

Progress against the backlog, if it happens, cannot undo the three years that Belinda Virgil of Fayetteville, N.C., has worried about her future after her initial application was turned down. Tethered to an oxygen tank 24 hours a day because of emphysema and life-thresatening sleep apnea, Virgil lost her apartment and has alternated between a sofa in her daughter's crowded house and a friend's place as she waits for answer to her appeal.

"It's been hell," said Virgil, 44, who finally got her hearing in November and is awaiting the outcome. "I've got no money for Christmas, I move from house to house, and I'm getting really depressed," she said.

The disability process is complex and the standard for approval has, from the inception of the program in the 1950s, been intentionally strict to prevent malingering and drains on the treasury. But it is also inevitably subjective in some cases, like those involving mental illness or pain that cannot be tested.

In a standard tougher than those of most private plans, recipients must prove that because of physical or mental disabilities they are unable to do "any kind of substantial work" for at least 12 months -- if an engineer could not do his job but could work as a clerk, he would not qualify -- or an illness is expected "to result in death."

Of the roughly 2.5 million disability applicants each year, about two-thirds are turned down initially by state agencies, which make decisions with federal oversight based on paper records but no face-to-face interview. Most of those who are refused give up at that point or after a failed request for local reconsideration.

But of the more than 575,000 who go on to file appeals -- putting them in the vast line for a hearing before a special federal judge -- two-thirds eventually win a reversal.

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