Backlog of claims makes some wait nearly two years for Social Security disability hearings

A plastic model shows how problems with the discs between spinal vertebrae can push against nerves. Fresno resident Tammy Johnson is seeking Social Security disability benefits because near-constant pain from bulging discs in her neck and back keep her from working since a fall in 2015. She has waited for 20 months for hearing to appeal a denial of her disability claim.
A plastic model shows how problems with the discs between spinal vertebrae can push against nerves. Fresno resident Tammy Johnson is seeking Social Security disability benefits because near-constant pain from bulging discs in her neck and back keep her from working since a fall in 2015. She has waited for 20 months for hearing to appeal a denial of her disability claim. Creative Commons

Since 2005, Tammy Johnson had worked as a travel agent – one of a number of jobs she held through nearly 40 years of her adult life.

But that was before a serious fall while shopping in July 2015 caused injuries to discs in her back and neck, a tissue tear in her back and an injured shoulder – a combination that she said has left her largely unable to sit or stand without pain, and thus unable to work.

Now 58, Johnson is part of a backlog of thousands of people in Fresno and the Valley whose initial claims for Social Security disability benefits have been denied – and who are growing increasingly frustrated with a backlog of cases that has them waiting, sometimes for almost two years, for an appeal hearing with an administrative law judge.

In the meantime, Johnson has managed to survive on what savings she had before she had to stop working, as well as financial help from her boyfriend, for her living expenses and to pay for myriad doctors and specialists.

Tammy Johnson.jpg
Tammy Johnson, now 58, has waited since December 2016 for an appeal hearing over a denial of Social Security disability benefits for back, neck and shoulder injuries. She is among more than 6,600 people waiting an average of 21 months for a hearing at the Social Security Administration's Fresno hearing office. Contributed Tammy Johnson

"Sometimes you want to just throw your hands up and give up," said Johnson, who's been waiting since December 2016 for an appeal hearing. She recently learned that she finally has a hearing date in August.

There are more than 6,650 applicants for disability benefits who are waiting – in some cases for months or even years – for an appeal hearing at the Social Security Administration's Fresno hearing office after their initial claims for benefits were denied. Five years ago, the average processing time was 367 days from the date when a person requested an appeals hearing until a judge's decision was processed. As of May, that average processing time was nearly double, at 705 days.

That's more than three months longer than the national average of 601 days. And it is the longest average processing time of all 18 Social Security hearing offices across California, and 15th worst out of 163 hearing offices nationwide. As of May, the average wait just to get a hearing at the Fresno office was 21 months.

"There are days when I have headaches and days when I have terrible pain. … I know people who have gone through the process and they told me it took them six years," Johnson said.

And there's no assurance that an administrative law judge will rule in her favor; Johnson could, if the voluminous medical information from her doctors isn't deemed convincing, be denied benefits yet again.

"I have no idea what's going to happen when I go to a hearing," she said. "It's just been one hurdle, one roadblock after another. But what else can I do?"

Why is the wait so long?

There are several factors that have contributed to the extended waits for processing and appeals, including a surge in recent years of disability claims and hearing requests, as well as a shortage of administrative law judges in the Fresno hearing office, said Patricia Raymond, communications director for the Social Security Administration's southwestern region.

"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," Raymond said. "We also received an increase in applications during the economic recession and its aftermath."

At the same time, "our resources to address disability claims did not keep pace with the increase in applications, and the backlog grew," Raymond said.

The Fresno office serves Fresno, Kings, Madera, Merced and Tulare counties. In 2016, six of the 10 administrative law judges who handle appeals in the Fresno hearing office either retired or were reassigned, further adding to the strain on the caseload even as the office continued to see high levels of new requests for hearings.

"It's a Fresno disgrace, a state disgrace and a national disgrace that people have to wait so long to hear if they are eligible (for benefits)," said Mary Dale Walters, a senior vice president for Allsup LLC, one of a number of companies nationwide that are available to help people navigate the disability application process. Allsup is representing Johnson in her claim appeal.

The average age of someone receiving Social Security disability benefits is 54, according to Allsup. "When they turn 65 or 67, they start to receive their (Social Security) retirement benefit and the disability benefit goes away," Walter said.

The process is intentional in its rigor, Raymond said. "The Social Security Act has a very stringent definition of disability – 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 result in death," she said.

Walters said Social Security's system for disability claims "is considered one of the most challenging disability programs in the world." As such, she added, it is estimated that the rate of fraudulent claims is less than 1 percent.

Once a person applies for benefits, it's typically a four-month wait for an eligibility decision, Walters said. At that point, the approval rate is only about 35 percent. Most applicants then ask for a reconsideration, where only about 14 percent of applicants are successful.

After the reconsideration, the next step is to request an appeal hearing before an administrative law judge. "For the people who go to the hearing level, the national favorable-decision rate or allowance is 46 percent," Walters said. "In Fresno, it's 41 percent."

Lengthy time takes a deadly toll

But the strict standards to qualify for benefits, combined with the advancing age of disability applicants and the lengthy wait for an appeal hearing, have created a situation in which thousands of people died while waiting for their cases to be decided. The numbers of claimants who died either before their hearing or before a decision is issued has climbed each year from 2010 to 2016, according to a report issued last month by the Social Security Administration. That roughly coincides with the peak of the economic recession in which the number of claims for disability benefits surged.

In 2010, there were 5,940 deaths of people waiting for a judge's decision. By 2016, that had climbed to 9,714 deaths – an increase of almost 64 percent. The number of deaths fell slightly, to 9,570, in 2017.

That death rate is about 2.5 times higher than the death rate among all Americans. "Of course, death rates for claimants pending (a judge's) determination would be expected to be higher than for the general population," according to the report, because the applicants are often claiming severe medical conditions.

The government says it's trying to get out from under the backlog, both in Fresno and nationwide. Nationally, Social Security originally planned to hire about 250 judges each year in 2016, 2017 and 2018, in addition to more staff to assist them. The agency ended up hiring 264 judges in 2016, but only added 132 in 2017. No hiring plan for 2018 has yet been determined, Raymond said.

Some cases at the Fresno hearing office were transferred to other hearing offices, Raymond added. Additionally, five administrative law judges were added to the Fresno office over the past year.

The progress, however, is slow. From October through May, the judges in the Fresno hearing office issued decisions in nearly 2,700 cases, while receiving just under 2,200 requests for hearings.

"As we continue to decrease the number of pending hearings, we will also begin to see reductions in the overall time that people wait to receive those decisions," Raymond said. "At the same time, we have prioritized completing cases for those people who have waited the longest for a hearing decision."

Tim Sheehan: 559-441-6319; Twitter: @TimSheehanNews.