Today, advocates from New York Legal Assistance Group (NYLAG), the Urban Justice Center (UJC), and Community Legal Services of Philadelphia (CLS) released a new report about wasteful and harmful Social Security policies, which discriminate against adults and children with disabilities. The report focuses on issues arising in New York State and Pennsylvania, but this is a national problem, stemming from federal policy failures.
The Social Security Administration’s (SSA’s) disability programs, SSDI and SSI, are often the only sources of income for people with disabilities and seniors who are struggling to make ends meet. To qualify for SSDI or SSI, claimants (people who are applying) need extensive medical records to confirm their disabilities. When the evidence is not enough, SSA sends people to consultative examiners (medical providers or psychologists paid for by SSA) to do one-time exams and evaluations of claimants.
In Pennsylvania and New York, as in more than 30 other states, a private company, Industrial Medicine Associates (IMA), is contracted to do these consultative examinations (CEs). The authors of the report released today have found that SSA routinely makes people go to CEs when it would have been possible to get records from their personal treating doctors, wasting millions of dollars and making disabled people jump through unnecessary hoops to prove their case. In New York alone, the state agency sends fully half of applicants to IMA, costing over $25 million each year.
“In New York, we see CE exams in half of our cases even though almost all of these claimants have active treatment. It makes no practical sense to send all of these people for a new exam with a total stranger. SSA’s quality review process should take a critical look at the widely disparate rate of CE exams in different states and identify and fix practices leading to overuse,” said Ann Biddle, Litigation Supervisor, Mental Health Project, Urban Justice Center.
Overuse of CEs is a problem because CE reports often offer a poor snapshot of a person’s disability symptoms. CE exams are rushed and the examiner is often asked to evaluate conditions outside of their specialty. Unsurprisingly, CE reports often fail to include important diagnoses or functional limitations.
“Consultative exams are rushed, generally lasting less than 30 minutes, and often fail to note key impairments and functional limitations due to limited time. The consultative examiner typically does not read a claimant’s actual medical records so the medical opinion is constructed on an incomplete foundation. This is not a sound basis for SSA to use to determine disability,” said Michelle Spadafore, Senior Supervising Attorney, New York Legal Assistance Group.
These CE reports play an outsized role in claimant’s cases because recent SSA policy changes allow these CE reports to be treated as equally persuasive to records from a claimant’s treating doctor. SSA then relies on these reports to deny people disability benefits, subjecting people to months or years of appeals without an income. Some claimants die before a final decision is made on their case and many more become homelessness, face incarceration, or fall further into deep poverty.
“It’s far too difficult, and takes far too long, for eligible people to qualify for disability benefits from SSA. CEs make the process worse, because they’re difficult to schedule and stressful to attend. This is especially true for people with limited English proficiency, serious behavioral health conditions, chronic and invisible illnesses, or other barriers. That’s why SSA should revisit its policies related to CEs with an equity lens,” said Sara Lynch, Staff Attorney at Community Legal Services of Philadelphia.
As a result of the findings of the report, NYLAG, UJC, and CLS are calling on SSA to implement the following policy changes:
- Eliminate the need for CEs in many cases by giving state agencies sufficient time to get medical records and medical opinions from a claimant’s own doctors;
- Reform SSA policy to require that SSA decision-makers assign greater weight to records and opinions from a claimant’s personal doctors than those provided by one-time CEs;
- Change the rule that allows incomplete CEs to determine the outcome of cases, especially when the claimant has a treating physician;
- Increase and tighten SSA’s supervision of CE providers through regular quality reviews and by implementing an accessible, accountable complaint procedure for claimants;
- Recruit and hire qualified and diverse providers to perform CEs; and
- Address the impact of structural inequality in SSA’s policies regarding when and how CEs are used.
“SSA needs to reform its policies to prevent consultative exams from taking an outsized role in disability applicants’ cases, particularly where there’s good information from the applicants’ doctors. SSA can do this simply by restoring the treating physician rule. People’s own doctors can provide a much better picture of how people’s disabilities affect their daily lives, and SSA policies need to reflect that,” said Jen Burdick, Supervising Attorney at Community Legal Services of Philadelphia.