Administrative law judges overturn denials of disability claims in Hawaii at easily the highest rate of any state in the country, raising questions about a state agency that historically has been criticized for emphasizing speed over quality in deciding whether someone is entitled to benefits.

The judges in 64 percent of cases ruled in favor of Hawaii applicants who appealed their benefit denials — by far the highest rate among the 50 states and substantially above the national average of 43 percent, according to the website disabilityjudges.com, which tracks appeal outcomes nationally.

The state with the next highest rate was Maine at 52 percent, according to the website. Alaska had the lowest rate at 17 percent, meaning few denials there were overturned. The data analyzed by disabilityjudges.com was current through early March.

“Those are pretty telling numbers,” said Louis Erteschik, executive director of the Hawaii Disability Rights Center. “If Hawaii is that far skewed from the national average, it certainly makes you ask, ‘What’s up?’”

Erteschik said his organization has about an 80 percent success rate when challenging denials by Hawaii’s Disability Determination Branch, part of the state Department of Human Services.

Like other state agencies across the country, the DHS branch processes disability applications — more than 13,000 last year — on behalf of the U.S. Social Security Administration and decides whether the applicants are eligible for federal benefits covering two different programs. If benefits are denied, the state agencies also handle requests to reconsider the initial decisions.

If the denial is upheld upon reconsideration, as is often the case, the applicant can file an appeal with an administrative law judge who works for the federal government.

Hawaii appeals were denied by judges in only 19 percent of the cases, the lowest rate by far among the 50 states, according to disabilityjudges.com. The national average was 36 percent. Maine was again the state with the closest rate to Hawaii at 28 percent.

DHS officials said they couldn’t comment on why Hawaii is an outlier based on the appeal data, noting that the administrative judges do not fall within their jurisdiction.

But they said the branch has scored well in a key metric the federal government uses to gauge performance.

In the 2018 federal fiscal year, the office’s accuracy rate in processing initial disability claims hit 98.3 percent, compared with the national average of 96.9 percent, according to DHS. In two of the four prior years, Hawaii also exceeded the national average and in the other two years, it was only barely below.

The federal government does accuracy checks to monitor each state agencies’ compliance with U.S. regulations and guidelines, helping to ensure the effective and uniform administration of the disability programs.

Processing delays

Hawaii has not fared as well in another key metric tracked by the feds: timeliness of processing claims.

For Title 2 claims, which average about $1,200 per month and cover employees who have accumulated enough work credits, Hawaii’s average processing time in 2018 was 98.7 days, compared with a national figure of 85.5.

For Title 16 claims, which cover low-income people who have never worked or lack sufficient employment credits to qualify for Title 2 benefits, Hawaii’s average was 104.9 days, compared with 86.8 nationally.

“The improvement in time is something we’re striving for, and we’re making headway on,” said Maureen Bates, administrator of the department’s Division of Vocational Rehabilitation, which includes the disability benefits branch.

If the Hawaii branch denies a claim, an applicant wanting to appeal the decision faces a long wait — an average of 16 months — before getting a hearing before an administrative judge. That’s better than the national average of 17.3 months, according to the disabilityjudges.com data.

Long wait for benefits

Local advocates say their clients, typically unable to work because of their condition, can end up homeless if they don’t have other means of financial support while waiting for benefits. The time from when an application is submitted to receipt of the first funds can be about two-and-a-half years, advocates say.

“It’s rough on them,” said attorney Danielle Beaver of the long wait.

Melody Betts-Cossens knows just how rough.

Her husband, Christopher M. Betts, applied for disability benefits in June 2012 after a severe form of psoriasis — psoriatic arthritis, which affects the joints — became so debilitating that he couldn’t work, according to Betts-Cossens.

Betts also suffered from liver disease and a host of other ailments, according to case documents.

The DHS office denied Betts’ disability application in November 2012 and upon reconsideration in September 2013. An administrative law judge in October 2014 upheld the denial.

But a U.S. District Court judge in 2017 reversed the decision, citing a flaw in the administrative judge’s ruling, and sent the case back for review.

In April, nearly six years after Betts applied, the benefits were approved — posthumously. Betts died in 2015 at the age of 57.

Without a job, Betts, who designed swimming pools, was unable to pay his rent, according to Betts-Cossens. He was evicted at the beginning of 2015 and ended up living on the streets, where his psoriasis-related wounds became infected, she added. He died in a hospital a week after becoming homeless.

At the time, Betts-Cossens was separated from her husband of 30-plus years, living on the mainland. She said she left Hawaii in July 2014 because she no longer felt safe around him. After becoming disabled, Betts’ personality changed dramatically, and he became paranoid, violent, forgetful and unreasonable, according to Betts-Cossens.

“He was a whole different person,” she added. “I didn’t even know him.”

Betts-Cossens continued to pursue her husband’s disability claim after he died.

Under pressure

That the DHS office has had many of its denials overturned does not surprise former workers who say staff were pressured to make quick decisions without thoroughly evaluating the records, largely to chip away at a big backlog of cases. That pressure, they said, often resulted in unfair denials.

“It’s just generally well known that they (the staff members) get a lot of pressure to turn people down,” said attorney Diane Harr, who represents clients seeking disability benefits.

Beaver said the branch — which is federally funded — relies on too few physicians to review hundreds of cases, some with thousands of pages of documents. “There’s no way these physicians are looking through the full file to make recommendations,” she said. “There’s no way.”

An internal management assessment conducted by DHS’ Budget, Planning & Management Office in 2014 raised questions about the branch’s operations and leadership.

The report, obtained by the Honolulu Star-Advertiser, portrayed a workplace plagued by mismanagement, poor morale, ineffective policies, lack of planning, overwhelmed employees, high staff turnover and vague communications.

Referring to employee concerns about “an unyielding pressure to close cases quickly,” the report said an emphasis on numbers and output drove branch policy, procedures and daily interactions.

“A balance between quality and quantity is not established, and many staff struggle with competing obligations to clients to reach a fair decision versus the branch emphasis on speed,” the report said.

One of its multiple recommendations was to “eliminate the demand for quick closures that occur at the expense of comprehensive and compassionate determinations.”

DHS officials said they could not address specific findings from the 2014 report, which they said was not formally adopted by the department, addressed issues from a previous administration and may contain some inaccuracies.

Asked what was inaccurate in the report, they couldn’t say. “We’re just not 100 percent sure, but we do know it never became an official report even internally,” DHS spokeswoman Keopu Reelitz said.

Addressing concerns

Bates, however, noted that the branch has undergone significant transformation since 2014, including implementing measures to address concerns raised in the report. And the department continues to identify ways to improve policy, procedures and work culture, she said.

Among other steps, the branch has hired more employees, is doing more staff training, is getting help from agencies on the mainland and has established a mentoring program for new hires.

“We do strive to make accurate disability determinations as quickly as possible,” said Bates, who joined the department in January. “That’s consistent since I’ve been there.”

She also said morale definitely is better, job openings are quickly filled and worker retention no longer is a problem. “They’re really dedicated to the residents of Hawaii,” Bates said of the 38-member staff. “They understand their mission is to serve the residents of Hawaii expediently.”

The overall improvements have pleased Social Security officials, who recently provided funds for the DHS branch to hire four additional staff members to help evaluate benefit applications, according to Bates.

Social Security representatives did not respond to Star-Advertiser phone and email requests seeking comment.

Betts-Cossens said the application process moves too slowly for people with legitimate disabilities. She noted that her husband would have benefited from the medical care that comes with a disability designation.

“There’s zero incentive for (the government) to approve you quickly,” she said.

Betts-Cossens said she understands the government has to protect against people who try to take advantage of the system. But in her husband’s case, she added, his disability was real, and the wait absolutely contributed to his death.

“It’s so sad for people who actually need the benefits,” Betts-Cossens said.