'Lost that hope' waiting for a disability decision
Author: Katie Wilcox, Chris Vanderveen
Published: 5:17 AM MST February 19, 2018
Updated: 5:17 AM MST February 19, 2018
INVESTIGATIONS 3 Articles

Americans with legitimate disability claims are routinely denied benefits under the Social Security Disability Insurance program, then find themselves trapped waiting months, even years, to get a decision on an appeal, a 9Wants to Know examination of federal data found.

The investigation found that while more than 1 million people wait for their appeals to be heard nationwide, many lose their savings or retirement funds, others their homes, sometimes ending up on the streets.

Thousands have died while waiting for a hearing, according to the Office of the Inspector General.

“It’s this major injustice,” said Denver disability attorney, Will Viner. “What has happened with the increase in the backlog is people are losing their house, unable to pay for food and shelter. In the past year we have had nine clients pass away.”

The problem, well known within the halls of Congress and the Social Security Administration, continues to push some of the country’s most vulnerable to the brink of financial disaster.

And the delays are getting worse.

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In Denver for example, the average wait time to come before a judge was 18 months in January 2018. In the same month of 2014, the wait was 11.5 months.

The Social Security Administration provides disability benefits to workers, and sometimes their dependents, who are too disabled due to illness or injury to continue working. However, federal data show that more than two thirds of applicants are denied every year based on medical criteria. After getting denied, applicants have the option to request a hearing before a judge.

Those workers who are waiting for a hearing hope to be granted the benefits, about $1,200 per month on average, through the federal disability insurance program they paid into via the payroll tax. In 2015, 85 percent of the funds for the disability insurance program came from payroll taxes, according to the Social Security Administration. The rest came from the account’s interest earnings, taxes on the benefits themselves and treasury funds.

“Somebody would not choose to go homeless if they could work,” said Colorado disability law attorney Dale Casares. “They are going homeless because it is taking so long for them to get a hearing date in front of the judge. And then hopefully they win.”

Not who are denied file for an appeal, but data reviewed by 9Wants to Know suggest more than half of people nationwide who appeal ultimately win.

In other words, some people must wait years just to be proven right.

EXPLORE

'Lost that hope' waiting for a disability decision

INVESTIGATIONS
Chapter 1

'So I skied off a cliff. Oops.'

At just over 14,000 feet, Mount Huron, near Buena Vista, stays snowcapped for much of the year. In early May 2014, the summit was covered in white powder.

And like many mountain tops, the weather – even on a seemingly perfect day – can deteriorate rapidly.

“We are skiing down and we are doing the final ski out back to the camp when the light changed,” said Steve Burns. “The light got super flat and I just couldn’t see anything.

“So I skied off the cliff. Oops,” said Burns with a slight smile.

Burns fell more than 30 feet of the side of Mount Huron.

Kyle Brengel, a friend, was skiing with Burns and saw the accident. Brengel climbed down the drop, attempted to revive Burns, who was unconscious. Brengel sent out an SOS signal, and rapidly climbed back to the nearest parking lot to call for help.

May 2014, Steve Burns and Kyle Brengel summit Mount Huron Courtesy Steve Burns

“They sent in a Flight for Life helicopter and the weather was atrocious,” Burns said. “The helicopter pilot couldn’t see anything.”

In an promotional video made by Centura Health, flight paramedic Chris Carr said the helicopter was unable to reach Burns for five or six hours after the time of injury.

Ultimately, Burns was transported to St. Anthony’s Hospital where he underwent emergency brain surgery and remained in a coma for nearly a month.

His wife, who was at the time his fiancée, Keeley Burns, was told that Steve might never fully recover.

Steve Burns proposed to wife, Keeley, at the top of the Grand Tetons in 2013. Courtesy: Steve Burns

“We needed to be prepared that Steve would be living in a nursing home for the rest of his life,” Keeley said.

Doctors encouraged her to apply for Social Security Disability Insurance on Steve’s behalf. That decision lead to a nearly 3-year battle for cash benefits, all while Steve learned how to walk, talk, feed himself, and eventually gain the strength to go back to work.

Chapter 2

'Yep, you're insured. We'll be right out...in about 3 years.'

In order to be considered “disabled” by the Social Security Administration, an applicant has to meet very strict definition: “the inability to engage in substantial gainful activity due to a medically determinable physical or mental impairment that has lasted or is expected to last at least one year or to result in death.”

Put more simply:

  • You are physically or mentally unable do work that you did before
  • You are not able adjust to other work because of your medical condition(s); and
  • Your disability has lasted or is expected to last for at least one year or to result in death.

About 70 percent of all workers who apply for disability benefits are denied each year, in part because of the strict definitions and complicated application process, according to data maintained by the Social Security Administration.

William Viner, Denver disability law attorney

“People are getting denied wrongfully, all the time,” said Denver disability law attorney Will Viner. “It’s impossible for them to do the numbers that they are doing.”

So, thousands of people appeal.

Social Security hearing offices received more than 188,000 requests for hearings between Sept. 30, 2017 and Jan. 26, 2018, according to the administration's hearing office workload data.

For years, the agency has received a record number of hearing requests adding to the backlog, that has lead to longer and longer wait times.

Viner provided this analogy: “Social Security Disability Insurance is kind of like car insurance – so you’ve been paying for car insurance your entire life and then one day a storm rolls through… and you call your insurance agent and say ‘hey, I’ve got a policy, I need some help,’ and they say ‘yep, I see you in our system, you’re insured and we’ll be right out… in about 3 years.’

“That’s the disability program today.”

As of January 2018, the 18-month average wait time affecting those in Denver was slightly longer than the national average. And once an applicant finally does get before a judge, he or she must wait another several months before the final decision is issued.

Federal data shows about half of the judges' decisions overturn original decisions and are favorable for the disabled person.

In an email, Cindy Malone, Social Security Administration spokeswoman for the Denver office, told 9Wants to Know: “many individuals who are initially denied benefits ultimately are found eligible. 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.”

Malone also stated in the email that it is a “common misconception that cases are routinely denied at the (disability determination services) level and only allowed at the Hearings Office Level,” and that the Social Security Administration Disability Quality Branch reviews a random selection of favorable and unfavorable determinations from each state. Based on that review, Colorado’s accuracy was 96.3 percent in fiscal year 2015.

Chapter 3

Going homeless, waiting for a hearing

Bill Emmons still hopes that someday, he too will win his appeal.

Emmons used to earn a living as a car salesman, but became an Uber driver due to his medical condition.

In the last few month, Emmons had to stop working completely as doctors told him his neuropathy, a condition that causes numbness and weakness in the nerves of his hands and feet, was now too severe for him to drive.

Bill Emmons applied for a hearing for his disability case in November. The hearing is not yet scheduled.

“My life was totally different, but it went downhill from the time I started getting injured and sick and it’s just gotten worse,” Emmons said.

Nerve damage in his hands and feet have left the 61-year-old without an ability to earn a living. But in November, he received a letter from the Social Security Administration that told him he should go back to selling cars.

Bill Emmons recieved this letter, stating he would not recieve disability benefits.

“According to my doctors and specialists I’m too disabled to work, but according to the state I’m not disabled enough.”

He promptly filed for an appeal, but without any means of earning money, he quickly ran out and was unable to pay the rent on the lot for his trailer.

“I lost my home, I was put in a situation where I had to sell it,” Emmons said. “Each week I am waiting to find out if I am able to get disability or not, and those days never come.”

Emmons is now living in his daughter’s basement, but says it’s only a temporary situation.

Dale Casares, a Colorado attorney who has recently began to take on more disability cases says she has seen several clients lose their homes while waiting on a disability decision.

Dale Casares, Colorado disability law attorney

“I have a few clients who are in shelters and most clients can, for some time, get by with couch surfing with family and friends but that only lasts so long,” Casares said. “They are going homeless because it is taking so long for them to get a hearing date in front of the judge.”

In 2016, the Social Security Administration developed a plan that included hiring 250 additional administrative law judges and corresponding staff each year through 2018 --- or about 750 additional staff to tackle the backlog of cases.

However, hiring freezes across the federal government slowed that process down.

No one with the Social Security Administration agreed to interview with 9NEWS, but in an email, spokeswoman Cindy Malone said, “Reducing the wait times for a hearing decision is of utmost importance to the Social Security Administration.”

“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. We also received an increase in applications during the economic recession and its aftermath. During this time, our resources to address disability claims did not keep pace with the increase in applications and backlogs grew. Primarily for these reasons, wait times for a hearing and the number of pending hearings began to rise,” the email read, in part.

Each stage of applying for disability takes months. For Steve Burns, the case took nearly three years from the time Keeley applied for benefits until the day they received the back pay.

“That was one of the most surprising parts – that it took so long to get this hearing. We were waiting for an incredible amount of time,” Keeley said. “Months in the hospital, medical bills, things of that nature – certainly (the money) would have been helpful to us.”

“We finally had a hearing. Then the judge kind of looked at this and said I don’t see why this got denied,” Steve said. “It was probably a few months after that I got paid… It was almost 3 years after I got hurt that I got paid.”

Unable to work and denied disability, Bill Emmons had to give up his home and move into the basement at his daughter's house.

Bill Emmons said he’s terrified of a multi-month, or even year long wait. After receiving the rejection letter in November, he filed for an appeal, but there has been no movement on the case.

“I feel like I am a file on a pile and everyone just keeps skipping my file,” Emmons said. “Just trying to make it through another day without hope – in the last couple months, I lost that hope.”