ATLANTA — Getting approved for disability payments from the Social Security Administration isn’t easy, but depending on where you live, it could be even harder.

In North Alabama, for example, three of the judges who hear disability claims have the lowest approval record of any administrative law judge in the state; two of them also have among the lowest approval rate of any of the 12,000 judges nationwide.

In 2020, 39% of initial disability applications were approved nationwide, according to SSA data. August 2021 data shows that Alabama has the fourth lowest disability claim approval rating — 32.3% — while nationwide data shows a 41.7% approval rate.

Receiving disability payments isn’t easy to begin with and that’s by design. In the past decade, the Social Security Administration has changed the regulations to make it harder to get disability claims approved.

Social Security has a tight definition of disability: “the inability to engage in substantial gainful activity (work) due to a medically determinable physical or mental impairment that has lasted or is expected to last at least one year or to result in death,” said Patti Patterson, regional communications director for the Atlanta region Social Security office, which represents Alabama and seven other Southern states.

The Social Security Disability website lists a range of impairments and disorders that could qualify for disability including mental, respiratory system, immune system and cardiovascular system if it is deemed through medical records to be severe enough to prevent one from working.

Many disability applicants think they’ll only need a letter from their doctor saying that they need to be on disability. Not only has it never been that simple, but in 2017, the Social Security Administration made it even easier to dismiss the recommendation of doctors by allowing denial due to the doctor’s specialty, and length of treatment and type of treatment, among other factors.

Rachael Henderson of Georgia Legal Services Program, which represents disability clients in 155 counties outside of metro Atlanta, said access to transportation has been a longstanding barrier in rural counties where its clients have tried to get disability.

“In rural areas you will frequently not have any physicians. Over the last few years in some of our rural areas, in one or two counties, they lost the hospitals,” she explained. “You have to get to a city of significant size in order to get to a physician.”

While current income, previous denials and any failure to follow treatment plans are among the top reasons disability claims are denied, lack of adequate medical evidence also plays a large role in applicant denial.

“It’s very important that you have good and reliable health care (because SSA) requires sufficient visits for the doctor to give them and provide adequate diagnose supported by laboratory tests and symptoms,” Henderson said. “It becomes a vicious cycle. … If you don’t get the treatment then you get disparate treatment and then you don’t get adequate treatment. Then if I’m (representing a) disability (claim), it’s extra hard because I have to work back through all those steps to make sure you have everything to meet the requirements.”

The claim goes through several levels, and at each level, according to federal disability decision data, more claims are denied than are approved. At the level where administrative law judges are called upon to make a decision, slightly more than half, 53%, are approved.

But if a person files for disability in the Florence, Ala., office, which covers the northern part of Alabama including Cullman and Limestone counties, the chances of getting a claim approved fall dramatically depending on which judge is assigned the case.

Overall, the district has a claims approval rate of 42%; and three of the judges are the only ones in the state approving less than 30% of the claims that come before them.

Judge Cynthia Weaver approves only 12% of claims, giving her the lowest claims approval rate of any judge hearing disability cases in Alabama. Among nearly 50 judges in the country with similar disposition caseloads, between 250-260 dispositions, Weaver had the lowest approval rating for claims based on data reported in recent months.

An applicant’s odds are only slightly better if they go before Judge Patrick Digsby, who approves about 13.6% of the claims that come before him. Judge Mallette Richey has the third-lowest claims approval rate at 26%

While the Florence office had an average wait time of 288 days, fairly low nationally — ranked 41 of 170 offices — the office, along with Mobile and Birmingham offices, had some of the lowest amount of caseloads per judge per day, all ranking in the bottom 16% at an average of 1.9 cases per judge.

If a claim is denied at the ALJ hearing stage, applicants can choose to appeal to the Appeals Council or dismiss their claims and start all over, hoping to get a different judge and outcome the next time. In 30% of the cases assigned to Weaver, that is what applicants have done.

Patterson declined to set up an interview with Weaver or an SSA representative but said the Appeals Council is essentially the accountability arm for ALJs.

“The Appeals Council uses several methods to ensure the quality of ALJ decisions,” Weaver said in an email. “In addition to handling the final level of the agency’s appeals process, and remanding cases with any deficiencies back to the ALJ, it conducts pre-effectuation reviews on a random sample of ALJ allowances, and post-effectuation reviews that look at specific issues to help inform our training needs and potential policy changes.”

If applicants choose to appeal, their odds aren’t good. The Appeals Council denies 82% of claims and remands another 14% back to the judge who heard the case. There is no data on the final outcome of cases sent back to judges. Only 1% of claims are approved by the Appeals Council.

An applicant whose claim is denied by the Appeals Council can choose to appeal in federal court, which looks at whether or not the ALJ followed federal rules in denying the claims. Though ALJs are under federal rules and regulations, many disability lawyers and groups have asserted that judges’ decision may oftentimes be made with hidden biases.

“The ALJ is going to have some subjectiveness and internal biases,” Henderson said. “It’s how the ALJ looks at the person and some of them have written some interesting decisions.”

Tom Jedlowski of Tennessee Disability Coalition referenced a case in which an ALJ denied the claim of an applicant with a heart condition, who he said appeared to be biased toward the applicant’s history of alcohol and drug use.

“Anything at scale is going to have bad actors. … I think what ends up happening to these people in the disability community is that those stories end up dominating the narrative and giving the impression that everyone who receives those benefits is guilty of the same crimes,” Jedlowki said. “I think it’s an unfortunate narrative because it truly is people’s lives who are at stake. These decisions disproportionately affect marginalized communities for sure.”

Patterson said ALJs are bound by rules of impartiality. Coupled with at least seven years of attorney experience, judges are also required to complete trainings throughout their career.

“A quality decision is one that is both timely and accurate. We use tools to provide individualized feedback to our adjudicators. This gives ALJs information about their (Appeals Council) remands including the reason for remand but also information on their performance in relation to other ALJs in their office, their region and the nation,” she said.

Tennessee currently has a disability approval claim rate of 37.9%, comparable to Georgia and Mississippi, which are approving at just more than 36.5%. Those states join Alabama in the top 16 states with the lowest approval ratings for disability claims in the nation.

“We have a rural health crisis in the state of Tennessee,” Jedlowski explained. “Because we chose not to expand Medicaid, many rural hospitals have closed because they relied on those payments to stay open. Should those communities have broadband, which is also a crisis in Tennessee, then perhaps they could maybe have a telemedicine visit with a specialist in one of our major markets.”

A January 2019 report in the Tennessean found that more than half of all contract physicians reviewing disability applications outpaced the federal standard of 1.5 cases per hour, and one out of every five doctors doubled that pace; they are paid a certain amount for each case they review.

“The more claims that are processed, the more they’re paid,” Jedlowski said. “And that doesn’t always lend itself to having the most scrupulous set of review on every applications.”

Four out of Tennessee’s six hearing offices ranked in the top 36% with quickest hearing time; the state’s average is 297.5 days.

Here are states with the lowest disability claim approval rates as a percentage through August 2021:

Oklahoma: 30

Hawaii: 30.2

West Virginia: 31.9

Alabama: 32.3

Kentucky: 32.9

North Carolina: 33.5

New Mexico: 34.4

Florida: 35.0

Indiana: 35.2

Maryland: 35.9