As baby boomers reach their most disability-prone years, the SSA has seen its disability workload grow significantly in the last five years. In order to speed up and improve the quality of the disability determination process, the agency intends to ensure that individuals who are clearly disabled receive a decision within 20 calendar days of filing an application for benefits, reach an online filing rate of 25% for disability applications by 2012, regularly update the regulations to incorporate the most recent medical advances, and develop a common case processing system for all of the individual state disability determination services.

The SSA has already begun to speed up determinations for those clearly disabled with the Quick Disability Determination (QDD) initiative. Under this program, approximately three percent of all new applications are identified for the QDD process. It takes the SSA six to eight days to favorably decide over 965 of them. Using computer models, the agency expects to increase the percentage of the types of cases identified for QDD. A second initiative, Compassionate Allowances, also allows the SSA to quickly identify individuals who are clearly disabled by the nature of their disease or condition. With both initiatives, the agency expects to fast track six to nine percent of initial disability applications by 2012. Full article here:

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Viewers in our area filing for Social Security Disability insurance benefits and waiting years for answers. Sadly, some die before they even get a final answer from the government. So what’s being done to help and how is the backlog here, one of the worst in the country, getting reduced?

Talk about waiting. The SSA says the hearing office in Greenville is one of the most backlogged in the country. The latest stats they gave us show the average processing time for a case is more than 2 years. There are only four other offices in the country that have processing times worse than this one: Dayton, Indianapolis, Altanta North and Atlanta.

We went to the SSA’s regional headquarters in Atlanta to get answers from spokesperson Patti Patterson.
When we asked Patterson why 65% of cases are denied at initial level she replied, “Congress has imposed a very strict definition of disability for us. The definition of disability for our purposes is that your condition must be so severe that you are unable to work for at least a year or result in death.”

Some of those wait times are so long in 2007 the head of the SSA testified before Congress people have died before they get their day in court.

“At the hearing level we win, nationally, we win over 65% which tells you those earlier denials were not right,” an attorney said.

If you have applied for disability benefits and have been denied make sure you appeal. Many people hire attorneys for help. They can’t charge a fee unless they win. Also contact your local Congressman to get your case the attention it needs. They have staff members who deal directly with social security disability claims. For a list of Congressmen in your area click here:
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US News and World Report asks the question. Many retirees who have reduced spending power because of depleted 401(k) accounts are thankful that President Bush’s plan to partially privatize Social Security was never realized. But the debate over personal Social Security accounts rages on.

The success of private retirement accounts is dependent on the amount a worker contributes, the investment strategy, and the unpredictable whim of the market. Workers who contribute more and get better returns will have more retirement income than those who tuck away less and achieve smaller gains. Social Security benefits, on the other hand, depend on lifetime wages and the age at which benefits are claimed. Workers who retire at the same age with the same earning record generally receive similar benefit amounts regardless of the year in which they claim benefits and the ups and downs in the financial markets. Full story here:

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THe Wall Street Journal reports that more than 55 million Americans will see a 5.8% boost in their Social Security benefits in 2009, the largest jump in 27-years and a development that could add more than $200 billion to federal spending over the next decade.
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Social Security has that announced it will fast-track applications for Social Security disability for applicants with any of 25 rare diseases and 25 cancers whose medical conditions are very severe. Currently, many people with rare diseases experience devastating delays when they apply for Social Security assistance because those making the decisions are not familiar with their diseases.
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By ROBERT WOODMAN MCSHERRY, Andrews Publications Staff Writer

UnumProvident Corp., America’s leading private disability insurer, defrauded the Social Security Administration on disability claims, a Boston federal court jury has found following a bellwether trial.

Chris Collins, Unum’s senior vice president and general counsel, said in a statement that the claims underpinning the verdict “have no merit.”

“We think we will ultimately prevail upon appeal,” he said.

At stake may be the disability insurance industry’s practice of requiring claimants to apply for Social Security disability insurance and offsetting any consequent payments against the carriers’ own claims liabilities.

Whistle-blower Patrick J. Loughren, a Pittsburgh attorney who reportedly learned of the alleged fraud from Unum employees, filed the case against the Chattanooga, Tenn.-based insurer eight years ago in the U.S. District Court for the District of Massachusetts.

The suit says the insurer’s SSDI application requirement violates the False Claims Act. Unum’s management services subsidiary, Wayne, Pa.-based Genex Services Inc., is also a defendant.

The FCA allows private citizens to file suit on behalf of the government in fraud cases involving federal funds and to share in any consequent settlement or court award.

The government declined to intervene in Loughren’s suit four years ago but has since said in court filings that it reserves the right to enter the case in the future.

According to the suit, Unum forced policyholders to apply for SSDI and threatened to cut off their benefits if they refused.

The definition of a “disability” is more stringent for SSDI than for Unum disability insurance policies, and Loughren claimed that the applications were illegal because Unum knew or should have known that many of its policyholders did not qualify for the government benefits.

In a second amended complaint he alleged that the government spent up to $6.2 billion denying SSDI applications from 1999 to 2005, including many “false claims” submitted by Unum policyholders at the insurer’s “express direction.”

Since 2003 Loughren has successfully beaten back Unum’s motions to dismiss and for summary judgment, most recently on Sept. 15.

Three days earlier U.S. District Judge Patti B. Sarris had ordered a bellwether trial on six of 62 false-claims cases, with each side choosing three cases. In her order, the judge said she hoped the outcome of the trial would lead to “serious settlement discussions.”

“If settlement efforts fail, the court will have a much better understanding about Unum’s policy and will attempt to resolve the remaining claims by summary judgment and/or another jury trial,” she said.

Five of the cases went to trial, resulting in two jury verdicts for Loughren – one of which was on a case Unum had picked – and two for the insurer. The fifth case ended with a hung jury, and Judge Saris issued a directed verdict in favor of Unum on the sixth.

The 19-day trial included four days of jury deliberations.

Loughren’s attorney, Colette G. Matzzie of Phillips & Cohen in Washington, said trial testimony supported allegations that Unum’s business practices resulted in the filing of unlawful SSDI applications and that in some instances the insurer even knew its claimants had the ability to work as defined by Social Security regulations.

The U.S. attorney’s office for the District of Massachusetts did not respond to an e-mail asking whether it planned to intervene in the case now that a jury has found that Unum sent fraudulent claims to the government.

Matzzie said her side is ready to move forward with the suit regardless of the government’s position.

“We are prepared to do whatever is necessary to finish up this case,” she said.

Matzzie and Phillips & Cohen also represent the plaintiff whistle-blower in a companion case in the same court. United States v. Cigna Corp., No. 03-CV-12382.

In that case, former Cigna Corp. employee Dawn Barrett says the insurer and its wholly owned disability insurance subsidiary Life Insurance Company of North America sent thousands of false claims to the SSDI program from 1997 to 2004.

To comment, ask questions or contribute articles, contact West.Andrews.Editor@ThomsonReuters.com.

United States ex rel. Loughren v. UnumProvident Corp., No. 03-CV-11699, jury verdict returned (D. Mass., Boston Oct. 22, 2008).
10/29/2008

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