All of America is aware of the ongoing financial problems within the Social Security Administration and how politicians claim funds for SSA will be gone by 2030. But, the majority of Americans are unaware of the Social Security Administrations Appeal process for those people who apply for disability benefits and are denied. The government entity that oversees these type appeals is known as the Office of Disability Adjudication and Review, (ODAR) which are located in 169 offices across the US.
Each case for appeal is brought in front of an Administrative Law Judge (ALJ) who examines medical evidence in support of the claimants appeal. The ALJ then makes a determination based on the information on hand within the case file, expert witnesses and lawyers that represent the claimant. Over the past year, evidence has surfaced in the Huntington West Virginia ODAR office that shows the ODAR system is not working as intended. Enough so that Congress is investigating that location for numerous violations including alleged collusion between at least one former ALJ and an attorney in a case-fixing scandal that awarded 98% of that lawyers cases.
It now appears that the ongoing scandal within the Huntington SSA Appeals office overshadowed problems in another West Virginia ODAR office. According to one of our sources inside the Huntington office, their media scandal and congressional investigation kept the heat off serious issues being exposed in ODAR Charleston WV. Problems that include reports of management mishandling evidence, failure to mail out ALJ decisions, hampering access to the courts and condoning questionable decisions by two judges.
With the national media attention focusing on Huntington ALJ David Daugherty's high appeal awards and alleged case-fixing ties with attorney Eric Conn, upper management in Charleston had the opportunity to fix their potential scandal without anyone finding out. Until now anyway. At first, most people felt that the problems in the Huntington office were isolated. Now, according to that inside source and records available, it appears management in Charleston had operational issues just as damaging to the SSA if found out.
Over a 3-year period of time, hundreds of ALJ case decisions were never mailed out until the 60-day time limit for claimants to appeal was about to expire. That in it self is a serious issue because once that deadline is up, a claimant may never be able to re-address their case again. SSA "recommends" that all decisions be mailed within one day of being prepared. And, if that wasn’t trouble enough by itself, management also knew that there were stacks of unopened mail routinely left in the office that contained doctors reports or other evidence that ALJ’s never saw before making some of their decisions.
Evidence, that if made available at the time, may have been the deciding factor to grant or deny a claim. Compile both problems; that of the ALJ decisions not being mailed out in a timely fashion and the closed mail evidence not being opened and or filed correctly, caused the appeal process to be defective and denied claimants due process. Eventually all of the mail was opened and placed into files, but once a case is decided and closed, there are no assurances that a judge would want to re-open or change their previous decision.
One excuse given was that there was a lack of adequate staffing in the office. Bottom line, there is no excuse for either problem to have occurred. And there is no way to know the number of people who were denied equal access to the courts because of what happened. Reportedly, the problems have now been corrected, partly because of electronic filings and adequate staffing.
Coincidentally, during this same time period, HOCAL Judge Theodore Burock and Office Supervisor Teresa Bowen were both transferred and new upper management were brought in. Correspondence between employees in both offices we obtained verify the problems existed.
One ALJ’s High Number Of Decisions And Another’s Low Rate Of Denials
As with the Huntington SSA scandal that instigated congressional hearings over Administrative Law Judges having higher than normal caseload decisions and or lower than normal denial ratios, we found two ALJ’s in Charleston whose statistics raise the same questions if not more? How did one judge manage to decide twice the number of cases as his counterparts while another averaged only a 1.5% denial rate in a 4 year consecutive period?
According to online reports linked below from 2005 to 2008, Charleston ALJ Harry Taylor decided twice the number of cases compared to his counterpart judges. And, many of his decisions were made without ever conducting hearings. Taylor decided a total of 4,091 cases over the 4-year consecutive time period noted above. Out of that, he only denied 173 of those appeals or 4.25%. Now, in the most recent published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Taylor has already decided twice the caseload as any other Charleston ALJ. He has rendered 428 decisions and denied 34 or 8%.
Reportedly, like former ALJ Daugherty’s SSA high approval ratings now being questioned, Charleston management allegedly condoned Taylor’s high caseload decisions because his totals made the overall office numbers look good. Also, after the Huntington SSA scandal was exposed in 2011, Taylor was reportedly instructed to hold a minimum of 40 hearings each month.
Then there is the 1.5% denial ratios by ALJ Toby Buel for the same 4 year time period. He decided a total of 1,535 cases. Out of that, he only denied 23 of those appeals. Now, in the latest published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Buel has rendered 333 decisions and denied 60 or 18%. Judge Buel is now listed as working from the Huntington WV Office.
Remaining Charleston ALJ Judges Caseloads From 2005 to 2008
1. Judge Valerie Bawolek
Bawolek decided a total of 1,799 cases over the 4-year consecutive time period. Out of that, she denied 369 of those appeals or 18.5%. In the latest published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Bawolek has rendered 200 decisions and has denied 47 or 23%.
2. Theodore Burock
Burock decided a total of 1,877 cases over the 4-year consecutive time period. Out of that, he denied 532 of those appeals or 25.5%. In the latest published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Burock rendered 166 decisions and has denied 76 or 46%. Judge Burock is now assigned to the Harrisburg PA Office.
3. Ronald Chapman
Chapman decided a total of 2008 cases over the 4-year consecutive time period. Out of that, he denied 104 of those appeals or 5%. There are no recent records for Judge Chapman.
4. Jon K Johnson
Johnson decided a total of 1,505 cases over the 4-year consecutive time period. Out of that, he denied 152 of those appeals or 10.1%. Now, in the latest published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Johnson has rendered 221 decisions and denied 45 or 20%.
5. James P. Toschi
Toschi decided a total of 1,337 cases over the 4-year consecutive time period. Out of that, he denied 257 of those appeals or 19%. Now, in the latest published ALJ Disposition Data from October 1, 2011 to March 30, 2012 (6 months) Toschi has rendered 259 decisions and denied 72 or 28%.
In Closing
If there is any silver lining in the Huntington SSA Appeals Office scandal, it would be a wake up call to other offices across the country to get their departments up to standards. SSA Commissioner Michael Astrue stated back in February that there is "no silver bullet" that is going to fix all of the problems the Social Security Administration is facing. He admits that job related stress, higher workloads and pay issues equal an unhappy workforce.
"I know that fiscal shortfalls create stress in our offices, especially when there are fewer of you to handle more work. Our inability to timely handle work makes the public more frustrated, and you endure that frustration. I also know that outcomes like pay freezes may cause you to question your career choice."
But, there is no excuse for office managers to knowingly let mail sit around "unopened" that contains doctor’s reports and other evidence that could be the silver bullet that either determines or denies a claimants appeal. Nor, is there any excuse for hundreds of ALJ decisions to have been sent out late or possibly not at all. Its good that they finally fixed the problems, but its sad for those who were denied access to the court because of these managers negligence to their responsibilities.
Its possible that the Office Of Inspector General (OIG) is already investigating the problems in Charleston including the high caseload decisions of Judge Taylor and very low denial rates of Judge Buel from 2005 to 2008. Ironically, since the Huntington scandal broke, statistics for the judges who were in the Charleston office from 2005 to 2008, now have decision stats more in line with other offices in their regions.
By and large, administrative law judge hearings have the highest approval rate, with about two thirds of all disability applicants winning their disability claims. These are national averages, which means there are some states or regions that have much lower disability claim approval rates while others have higher approval rates
The Office of Disability Adjudication and Review (ODAR) has over 1600 Administrative Law Judges (ALJs) that conduct hearings and issue decisions for the Social Security Administration (SSA). There are over 160 ODAR hearing offices in the country.
End Of Story
Jack Swint-Publisher
West Virginia News
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ALJ 2005 To 2008 Database
ALJ October 1, 2011 To March 30, 2012 Database
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9 comments:
I worked in the Charleston office during part of the years outlined in the story, this did occur.
Perhaps SS is denying far to many claims before they are appealed to the ALJ's. The denial rate on initial applications is very high. So, perhaps the ALJ's are just correcting the mistakes of SS.
Also, on initial applications, there are no representatives involved. Before ALJs there usually are. So the case is better prepared by someone who understands the burden of proof. That could account for differences as well.
Tear down the system and start over. Why are there so many cases in appeal anyway?? Sounds like a money making racket for somebody. I have always heard it takes 2 to 3 attempts to get approved.
Dear Mr. Swint:
I read with interest your article concerning problems with the SSA ODAR office in Charleston W.Va. I suggest that these problems resulted from SSA - ODAR's overwhelming focus on "numbers", that is, getting cases out the door ASAP. This is the perpetual "quality" versus "quantity" dilemma. Quantity is easy to measure, quality is not, and when there is pressure, quality is what suffers.
Your article shows that this resulted in a significant denial of due process to individual claimants. I hope these claimants were represented by attorneys who were aware of the problems and did things like keeping the envelopes in which decisions were mailed, to compare the dates on the decisions to those on the envelopes.
That is something I would not have thought of several years ago, when the disability hearing process was treated more as a legal process with rules and evidence. Now, every step has to be monitored.
I urge you not to be taken in by the propaganda that is being pushed by forces opposed to the Social Security programs, especially with regard to ALJ approval numbers. There is no proof that an ALJ who approves a large percentage of claimants appearing before that individual ALJ is "wrong", unless you agree that ALJs who deny more cases than average are also "wrong", and something should be done about them, also. I suggest to you that any fair process that protects decision makers from undue influence must tolerate "outliers".
You are probably aware of the long waiting times for hearings over the last few years, ranging to as long as two years. I suggest that a person who could work and make more money and obtain the other benefits available to working people, such as health insurance, retirement, self respect, a purpose in life, etc., would rather work than wait two to four years, from the date they applied, for a hearing at which they now have, nationally, only about a 50 percent chance of being approved.
You have access to ALJ production statistics over the last several years. I point out to you that the approval rates for ALJs all over the country are declining. Is that because all of a sudden people all over the country, with poor disability claims, are now seeking benefits? Or is it possible that ALJs are responding to pressure to deny more claims, to avoid being named in newspaper articles, or to be watched under a magnifying glass by their employer?
Thank you for your articles about the problems in the West Virginia hearing offices. Please retain a degree of skepticism about ALJs approving "too many" disability claims.
What in the world took so long, this has been going on for many years. The unnecessary use of medical experts in almost every hearing of some judges costs the Agency an enormous amount of money. The taxpayer needs to know how much of their tax dollars are being wasted.
After reading this story about cases that were not properly handled and stacks of mail with doctors reports and evidence not being opened properly, the only word I can come up with to describe it all is "Due Process."
I doubt that any attorney will do it, but, they should go back over their old case files during that time and check whether or not their clients cases need to be re-opend.
I read your story about the Charleston ODAR. The situation you describe is not consistent with my experiences with dealing with that office. I have never had a delay in receiving a decision or lost documents. As far as efficiency goes, from the stats I have seen, Chas has been near the top in the country for getting cases resolved the quickest. Many offices around the country were taking 2 years or more to schedule hearings,while Chas was taking 6 to 8months and sometimes faster than I could be ready. There are a lot of problems with Social security but I don’t think the Charleston ODAR is high on the list. – just my 2 cents.
Actually I agree with the above comments insomuch as the Charleston office has been expedient in handling their caseloads.
But, it appears that is where some of the problem was. There is so much pressure on ALJ's to produce, situations arose where decisions were not being mailed out within the correct time frames and mail was not being opened that contained evidence and other documents needed for the judges to make their determination.
I examined correspondence between employees in Huntington, Morgantown and Charleston describing the problems outlined in the story with the unopened mail and mailing out ALJ's decisions late.
It has now been corrected, but it appears that a lot of claimants were denied Due Process because of it. That is pretty much a fact.
So, why I agree with your comments on the expediting of cases, other problems occurred. Whether it was a shortage of staff or whatever, it happened.
Jack Swint
There is no excuse for hundreds of ALJ decisions to have been sent out late or possibly not at all. Its good that they finally fixed the problems, but its sad for those who were denied access to the court because of these managers negligence to their responsibilities.
With the micro management that goes on, the managers and supervisors were negligent in their duties and let files collect dust until employees blew the whistle and then got nothing but retaliation.
Discrimination has also been rampant at the Charleston ODAR Office, as they wanted their dirty little secret that people other than Caucasian cannot rise to certain pay scales regardless of experience and years of service, and the fact that a minority was never promoted from 1997-to 2010.
Only after internal discrimination complaints had been filed. Then retaliation after such complaints have made for a hostile work environment.
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