White v. Mathews

• Decision Date: 29 September 1976
• Docket Number: Civ. No. H-75-34.
• Citation: 434 F. Supp. 1252
• Court: U.S. District Court — District of Connecticut
• Parties: George WHITE, on behalf of himself and all others similarly situated v. David MATHEWS, Secretary of the Department of Health, Education, and Welfare, as an Individual and in his official capacity.

434 F. Supp. 1252

George WHITE, on behalf of himself and all others similarly situated v. David MATHEWS, Secretary of the Department of Health, Education, and Welfare, as an Individual and in his official capacity.

Civ. No. H-75-34.

United States District Court, D. Connecticut.

September 29, 1976.

Raymond R. Norko (Hartford Legal Aid Society), Hartford, Conn., for plaintiff.

Raymond L. Sweigart, Asst. U. S. Atty. Peter C. Dorsey, U. S. Atty., New Haven, Conn., Thomas Stout, Office of Gen. Counsel, Dept. of Health, Ed. & Welfare, Baltimore, Md., for defendant.

RULING ON CROSS MOTIONS FOR SUMMARY JUDGMENT AND ON MOTION TO DISMISS

CLARIE, Chief Judge.

The plaintiff, George White, brought this action on behalf of himself and other Connecticut residents who are attempting to assert claims for Social Security disability benefits under 42 U.S.C. § 423, but whose appeals from adverse agency action have been impeded by extensive delays in the scheduling and completion of hearings before an administrative law judge, as provided for in 42 U.S.C. § 405(b) and 20 C.F.R. § 404.917. Plaintiff's class was certified by this Court on July 18, 1975.¹ Defendant, the Secretary of the Department of Health, Education and Welfare (HEW), has moved for dismissal based on lack of subject matter jurisdiction and upon mootness. Plaintiff and defendant have in addition entered cross-motions for summary judgment on the merits.

The affidavits and pleadings reveal that this case is a proper one for treatment by summary judgment, there being no genuine issue as to any material fact separating the parties. Defendant's motion to dismiss is denied, since the Court finds that the case is not moot and the exercise of jurisdiction is not precluded by 42 U.S.C. §§ 405(g) and (h). The plaintiff's motion for summary judgment is granted and the Court finds that the existing delay in processing appeals from adverse agency action is so great as to deprive the plaintiff of his statutory right and his constitutional guarantee of equal protection and due process.

FACTS

There is no dispute as to the central facts in this case, the parties having entered into a stipulation. The named plaintiff,² a man in his fifties, applied to the Social Security Administration (SSA) for disability benefits in July of 1972, complaining of a variety of physical disabilities, including laennec's cirrhosis and chronic and acute pancreatitis. At that time he was declared totally disabled and began to receive benefits. As a result of a periodic re-examination begun in September of 1973, however, plaintiff was informed — on December 27, 1973 — that he was no longer considered disabled. His benefits were terminated as of January 31, 1974.

He then applied to have his case reconsidered by the SSA, and was informed on July 11, 1974 that his application had been denied. White then petitioned on July 29, 1974 for a hearing before an administrative law judge. No hearing was held on the matter, however, until April 29, 1975, and the final decision was not rendered thereon until May 21, 1975, when the SSA's earlier decision to terminate White's benefits was upheld.³ In all, 306 days passed between the date of plaintiff's petition for a hearing and the issuance of the final decision.

The plaintiff's experience with the SSA appeals process is not unique. As a result of various factors discussed in more detail below, an extremely large backlog of cases has developed in the SSA's Hearings and Appeals Bureau. In April of 1975, there was a record total backlog of 113,000 pending cases nationwide.⁴ The result has been a chronic delay in the disposition of appeals. During the period between January 1973 and March 1975 the average waiting period between an initial request for a hearing and the entry of a final decision was 195.2 days nationally, and 211.8 days for petitions in Connecticut⁵ — or, approximately six and one-half and seven months respectively. It is of these general lengthy and persistent delays that the plaintiff complains.

(a) The Social Security Disability System

To establish disability⁶ under Title II of the Social Security Act, a wage earner must provide "such medical and other evidence of the existence of the disability as the Secretary may require" in support of the application. 42 U.S.C. § 423(d)(5). This evidence must establish disability by means of "medically acceptable clinical and diagnostic techniques." Id. § 423(d)(3). And it must be shown that the disability in question is sufficiently great that

"the wage earner is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy, regardless of whether such work exists in the immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would be hired if he applied for work." Id. § 423(d)(2)(A).

To qualify for disability benefits, then, the worker's disability must be total, such that no "substantial gainful work" opportunity exists. The level of benefit payments is based on a variety of factors, including age and the prior average monthly earnings of the worker while employed. Eligibility under Title II of the Social Security Act is not based directly on financial need.

If it is determined that an individual is not disabled, either on an initial application or as the result of a periodic re-examination, a "redetermination hearing" may be sought with the SSA to review the case.⁷ This review is undertaken on the basis of forms and affidavits submitted to the Agency by the applicant; no face to face meeting takes place at this time.⁸

Should the result of the redetermination hearing be adverse to the applicant, he may then petition for a hearing before an administrative law judge.⁹ At this stage a full evidentiary hearing is held with the applicant in attendance. If the result is again unfavorable, a final discretionary review may be sought before the Appeals Council of the SSA Hearings and Appeals Bureau.¹⁰ It was this latter Council that finally overturned the original determination made with respect to plaintiff White in this case.

To judge from the number of reversals at the administrative law judge stage of appellate review the "error rate" in SSA disability determinations is substantial. The incidence of reversals by administrative law judges exceeds 50 percent of all the cases heard.¹¹ The reversal rate is much lower, to be sure, when measured against the total number of original denials, many of which are not appealed.¹² However with respect to those individuals who feel sufficiently aggrieved with the Agency's decision to seek an appeal (the relevant class in this case), the prospects for a reversal are substantial. It cannot be persuasively maintained that a pattern of extended delay in the completion of hearings before an administrative law judge is but a matter of small consequence to such aggrieved applicants.

(b) Causes of the Backlog and Remedial Steps Taken

A number of factors have contributed to the existing backlog of appeals cases before administrative law judges. In the first place, the government represents that a large volume of "black lung" cases have been filed under the Federal Coal Mine Health and Safety Act of 1969, 30 U.S.C. §§ 901 et seq. While special judges have been appointed to hear these cases, appeals have appeared in such volume that the Hearings and Appeals Bureau has been required to shift some Title II (disability) judges to cover them.¹³ Similarly, the enactment of Title XVI of the Social Security Act, Supplemental Security Income for the Aged, Blind and Disabled (SSI), has resulted in extra work for Title II judges.¹⁴

In addition to such external burdens a variety of internal difficulties have plagued the Bureau. Officials complain of inflexibility in the use of Title XVI hearings officers,¹⁵ of difficulties in recruiting a sufficient number of administrative law judges, and of a growing number of disability appeals.¹⁶

Steps have been taken both by the SSA and by Congress to reverse the flow of this tide. The Agency has, for instance, substantially increased its support staff, added to the number of administrative judges and hearings officers, and instituted various improved techniques to expedite case processing. Productivity has risen substantially as a result of these and other innovations,¹⁷ although officials point to a deluge of incoming cases which have overwhelmed the improvements in recent months.¹⁸

Congressional hearings were held in 1975 to probe the backlog problem, and a piece of remedial legislation, P.L. 94-202, was thereafter passed by Congress and signed into law in January of 1976.¹⁹ This bill provides the Secretary of HEW with temporary authority to permit the use of SSI hearing examiners to review Title II appeals. It may be noted that during the time P.L. 94-202 was before Congress additional legislation was introduced which would have set an express time limitation on the scheduling and completion of appeals hearings.²⁰ In H.R. 5276, introduced by Rep. Seiberling, a 120-day maximum limit would have been imposed.²¹ No such time restriction was included in the final legislation, however.

It was originally the aim of the SSA Hearings and Appeals Bureau to reduce the median delay in obtaining a hearing before an administrative law judge to 90 days by July, 1977.²² Recently the Bureau has abandoned this estimate because of shortfalls in administrative law judge recruitment.²³ Nevertheless it has been shown that productivity gains are possible to achieve, and defendant anticipates the special assignment of two corps of temporary administrative law judges to Region I (which includes Connecticut) to combat the large backlog in this geographical region. It is estimated that through the use of these judges the Region I backlog can be reduced by 40 per cent.²⁴

The primary issue...