Government and Health Care

Is Social Security disability fraud running rampant?

Advocate says approval rate in Grand Rapids is declining.

January 17, 2014
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Despite a handful of recent media reports of large-scale fraud by recipients of Social Security disability benefits, Karen Starr, owner of Starr Disability Advocates, cautions against drawing any sweeping conclusions.

“The fraud that is out there is minimal,” Starr said.

Last year the U.S. Government Accountability Office issued a report, “Disability Insurance: Work Activity Indicates Certain Social Security Disability Insurance Payments Were Potentially Improper.” The report stated that “SSA made $1.29 billion in potential cash benefit overpayments to about 36,000 individuals as of January 2013.” The full period of time ran from December 2010-January 2013.

The number has been reported as being less than 1 percent of disability payments made during that timeframe.

Starr, who operates on behalf of clients as a non-attorney representative, said that in reality she is seeing approvals for disability claims decreasing dramatically from years past.

“It’s been harder and harder every year,” she said. “For instance, our approval rates, just in the Grand Rapids area, are down to 39 percent, which is really low.

“The 2010 national average was 70 percent. Now the national average is 43 percent.”

Starr said one of the biggest changes she has noticed is that judges are requiring more information, including more medical documentation, statements from employers and statements from third parties.

“We’ve been able to adapt,” she said. “We’ve been able to figure out what is it that the judges need.”

While growth has been harder in this climate, Starr said her company is doing more outreach, including offering full-day case reviews.

She also has expanded her business to include work with veterans. Starr became an accredited Veterans Administration claims agent in 2013.

“A lot of them don’t know that they can apply for Social Security disability as well as their compensation disability through the VA, which they can,” she said.

Starr said looking ahead she is most concerned with potential changes that would make it so that someone applying for Social Security disability could not also be receiving unemployment benefits.

“Presently, you can accept unemployment benefits and still get Social Security disability benefits; however, on the horizon there is talk of changing that so there is no overlap there.

“It is an extremely difficult thing, because people can’t afford to live until they get their disability benefits because of the time it takes.”

Additionally, clients might find it harder to secure representation from businesses like Starr’s because of how payments would be impacted.

“Not that we would just turn people away, because we don’t, but we also have a business so we have to be able to survive,” she said.

In fact, Starr is already seeing judges reject claims because the applicant is receiving unemployment benefits.

“The judges won’t say that’s the reason, but they will definitely say, ‘They said they were ready, willing and able to work (during) unemployment, and now they are saying they are disabled during that period of time.’ So it affects their credibility, which I understand.”

But she notes it doesn’t change the fact that her clients need help.

“The part that I think the administration doesn’t understand is, then what are these people going to live on?” she asked. “They’re going to be homeless. They don’t have a choice really.”

She noted the application process takes about five months, with an average wait time in Grand Rapids of nine months from an initial denial to a hearing and then usually two months or less for a decision.

Starr said another challenge has to do with the use of medical marijuana.

“Medical marijuana is legal in the state of Michigan, but this is a federal program. So I tell my clients, unless you are going to turn in your medical marijuana card or you’re going to stop using, I won’t represent you because judges will just deny.”

Clients most likely to receive approval are those who are at least 50 years old and who have a work history. She said credibility and continuum of care also are important.

Starr said that, overall, she thinks the approval rates are too low and she would like to see a stronger balance between approvals and denials. She doesn’t seem optimistic about that happening in the current environment.

She said the perception of large-scale fraud as well as negative stereotypes and a growing distaste for entitlement programs would likely continue to impact approval rates.

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