AUBURN — It’s 1 p.m. on a mid-winter Tuesday, and the waiting area at the Social Security Administration’s branch office is bustling.

 About a dozen people are waiting for service while two clerks help another five people at their respective windows.

 Some of those waiting are seeking replacement Social Security cards, but most are working through the process of applying for federal disability or retirement benefits.

 A computerized, take-a-number machine doles out tickets, and while the clerks — each one friendly, patient and polite — are helping people as quickly as they can, the waiting area seems to hold steady at between 12 and 20 people. For every two or three who leave, another two or three enter.

 In the decades to come, the scene at the waiting area in Auburn is  likely to become busier, say state and federal officials, as well as those who help the disabled in Maine.

 Growth in the disabled population in Maine — the nation’s oldest state with a median age of 41 and the sixth-most disabled per capita (behind Arkansas, Mississippi, West Virginia, Alabama and Kentucky) — continues at a steady pace.

 Federal statistics show 6 percent of Mainers receive some form of federal disability benefits — about one out of every 15 people.

 Applications for benefits in Maine rose 17 percent from 2008 to 2009. Nationally, the Social Security Administration estimates 3.3 million people will file for disability in 2010, up 300,000 from 2009 and up 700,000 from 2008.

 Each month, Mainers on disability collectively receive an estimated $16 million.

Who are the disabled?

 Historically, increases in claims correlate closely with increases in the unemployment rate. The current uptick is reflective of the poor economy, said Scott Mack, director of Maine’s Office of Disability Determination Services.

 Mack’s office serves as the initial clearinghouse for claims. The agency’s mission is to answer the question, “Can they work or can’t they?” Mack said.

 He said there’s no one type of disability that stands out as being approved more than others, but that most who are approved have multiple issues and often it’s a combination of physical and psychological conditions. “It all adds up to what got them there,” Mack said.

 An estimated 30 to 35 percent of claims are approved on the first application, he said.

Rejected applicants can appeal for a second review. With new or additional information, a small portion of rejected claims are approved on second review. Denied a second time, an applicant’s next step is an appeal to an administrative law judge. That step and subsequent ones can become a complicated process, usually involving the help of a lawyer specializing in Social Security law.

 The fastest approvals take about five months to process, while those that end up on appeal can take years to resolve. On average it takes about 12 months in Maine to be approved. For many states, the wait for those appealing a denial of benefits can be as long as two years, said Andrew Bernstein, a lawyer with the law offices of Joe Bornstein.

 Bernstein, one of three lawyers and 16 support staff who specialize in disability claims at the firm, said they’ve seen a 50 percent increase in cases over the past year.

 “Its not something you can dabble in,” Bernstein said of the complexity of Social Security appeals. Beyond that, the nature of the cases are such that it takes a certain kind of individual to handle the clients. Lawyers are not paid unless they win an appeal for a client, but they also need to be prepared or grow conditioned to hearing hard-luck tales.

 “These are sad, sad, sad stories,” Bernstein said. “Most of them would break your heart.”

 Most people seeking disability do so reluctantly, but many must be declared disabled not just for the monthly income but to retain or become eligible for government-sponsored health care programs including Medicaid, Bernstein said.

 An aging population of U.S. veterans, many suffering from disabilities acquired during service, are unable to receive treatment or help from an already overburdened Department of Veterans Affairs, Bernstein said.

 Workers in Maine who have largely labored in manufacturing, farming, fishing or timber harvesting compound the plethora of disabilities that come with age-related disabilities, Mack said.

 Those on or seeking disability are generally not lazy or looking to game the system, said Lu Zeph, director for the Center for Community Inclusion and Disability Studies at the University of Maine in Orono.

 Beyond the portion of Maine’s population — about 33,000 people — getting federal benefits for their disabilities, another 12 percent — 153,000 people — are disabled to some degree, according to U.S. Census data.

 Zeph said it’s more fiction than fact that people are flocking to Maine because it’s easier to get declared disabled here or that waiting times are shorter.

 Most people with conditions severe enough to warrant them being deemed disabled are not capable of plotting a scheme to defraud the government, she said. And most people resist going that route as long as possible for the simple reason that you can earn more money working than you can get from disability payments, she said.

 “What people have to realize is once you go down this road, you are largely relegating yourself to a life of poverty,” she said. “You are talking about subsistence living. It’s not like anybody is getting rich off Social Security.”

Defrauding the system

But some in Maine and elsewhere are, in fact, gaming the system and may be considered rich even if they gained their wealth illegally.

 A recent report to Congress by the Office of the Inspector General, the federal agency assigned to police the system, highlights some of the most egregious crimes against the Social Security system.

The report identifies, among other problems, loopholes in the laws governing Social Security that saw nearly $27 million in benefits paid to former prisoners who should have been deemed ineligible because they had violated their parole conditions.

 In Maine, one of the most remarkable recent federal cases involved a Bangor-area man who was part of a marijuana smuggling and dealing operation in 2004 and 2006. During the time he was drug-trafficking, according to the federal indictment, Michael Pelletier was collecting disability benefits. He also concealed the cash purchase of property worth more than $50,000, according to the indictment.

 “The entire time he was profiting from his drug trafficking, he was receiving (Social Security Disability Insurance) benefits,” said Paula Silsby, the U.S. Attorney for Maine.

As a paraplegic, Pelletier qualified for disability, but the amount of money he was making illegally disqualified him from receiving benefits.

 Silsby said Pelletier falsified periodic reports, defrauding the government and essentially taking benefits that could have gone to a person who was legitimately entitled to them.

“The important point is that those benefits are not available just to people who are disabled,” she said. “If you are disabled and you are a millionaire, they are not available. They are there to assist people who are disabled and otherwise meet income guidelines.”

At his sentencing, Pelletier was ordered to forfeit two automobiles, a farm tractor, three pieces of real estate and nearly $21,000 in cash. He was also ordered to pay a $4.8 million judgment and nearly $84,000 in restitution to the Social Security Administration.

 Two other recent convictions in Maine involved drugs and suspects who were collecting SSDI benefits, but most beneficiaries are not looking to defraud the system, Silsby said.

 “There are hundreds of thousands of people who are legitimately receiving benefits,” she said. “But obviously, that’s not what we are seeing, but also why we take any kind of government fraud very, very seriously, because those are monies that are dedicated to people who are in need.”

Funding fix is needed

 The rapid growth of people in Maine and across the country seeking disability benefits is a serious concern for federal lawmakers, who are already wrestling a federal debt expected to reach $14 trillion by 2015.

“As baby boomers begin applying for Social Security and disability claims increase, it is absolutely critical that Congress provide the appropriate funding to address this shortfall and prepare for future challenges,” U.S. Sen. Olympia Snowe, R-Maine, said in 2008.

 At that time, the Social Security Administration was $1 billion short of what it needed to process claims, and Snowe was seeking to address that issue. Advocates for the disabled, like Bernstein and Zeph, said funding remains one of the biggest problems in the system. How the federal government will pay those claims, once processed, remains a question.

sthistle@sunjournal.com

Copy the Story Link