Changes to disability benefits cost £4bn in extra welfare payments

Be it PIP, Universal Credit, ESA it has cost more to implement than the status quo, but then we all know the welfare “reforms” were never about saving money:
The central objective has not been, as is generally claimed, to save money but rather to ensure a level of desperation that drives people into low wage precarious work and depresses the level of real wages. source

Changes to disability benefits cost £4bn in extra welfare payments, OBR’s figures will bolster disability groups’ calls for overhaul of PIP system

Person in wheelchair
 The OBR said the growing number of appeals from disabled people was one of several causes of the unexpected rise in costs.

Changes to the disability benefits system that has caused huge hardship to some of the country’s most vulnerable people has cost the government more than £4bn more in extra welfare payments than ministers estimated.

The Office for Budget Responsibility (OBR), the Treasury’s independent forecasting unit, said predictions by the Department for Work and Pensions dramatically under-estimated the costs of rolling out the personal independent payments (PIP) system, which began to replace disability living allowance (DLA) in 2013.

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A saving of £2bn was expected by 2018, but that has since been revised to an over-spend by £1.5bn to £2bn, leaving an estimated £4.2bn gap in the public finances. The figures are expected to bolster calls by disability groups for an overhaul of the PIP system, which has been described as a “vicious attack” on disabled people. MPs on the work and pensions select committee concluded an investigation last year that found the assessments of claimants by private sector contractors to be “shoddy and error strewn”, leading to hundreds of thousands of successful appeals.

One charity, Parkinson’s UK, complained that about a quarter of people living with the disease in Britain had lost some or all of their support after benefit reassessments, only to have the payments reinstated on appeal.

The OBR said the growing number of appeals was one of several causes of the unexpected rise in costs. It said the system had also come under pressure from legal challenges, which had altered the scope of the scheme, and an increase in claimants, especially of working age adults when this group was due to see a large fall.

The OBR said: “The government assumed initially that PIP would be rolled out by 2015-16 and that it would cost 20% less than DLA would have done. In fact, by 2017-18 it was costing around 15 to 20% more, with rollout only around two-thirds complete.”

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Ministers claimed, when the system was launched, that a programme of rolling medical assessments by three private sector contractors would ensure payments were only made for as long as a claimant needed them.

Critical of the system run by public sector staff, the DWP expected that independent medical reassessments would lead to a dramatic fall in the number of people staying on benefits.

A report in 2016 by the OBR described the PIP system as “a failure” after it reduced the forecasts of cost savings to 5%. In its latest report it said the inability to achieve savings, which were now nearer -20%, had pushed its forecasting of the welfare budget significantly off track.

 

Frank Field, who chairs the Commons work and pensions committee, said: “DWP told us PIP would save taxpayers money and introduce a fair, transparent assessment process. Today’s report lays bare that it has achieved neither. PIP will cost a fifth more than the system it replaces: a sorry situation largely thanks to DWP’s failure to cost the reform accurately before bringing it in.

“Far worse, though, is that the PIP assessments are riddled with repeated and serious errors and have caused untold anxiety and misery for far too many of the people who rely on the benefit to live. The cost of those mistakes is also knocked forward into the tribunal system, not back to the contractors who made them.”

source

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More than 21,000 sick and disabled people died waiting for vital benefits

Campaigners warn the ‘appalling situation’ is set to get even worse under Universal Credit.  By Sue Jones
Photo credit: Knox O (Wasi Daniju) via photopin cc

The Department for Work and Pensions (DWP) has admitted that over 21,000 ill and disabled people died waiting for their Personal Independence Payment (PIP) assessment to be completed, between April 2013 and 30 April 2018.

PIP is claimed by people with a range of health conditions and disabilities, many of which are chronic, degenerative or life limiting.

Sarah Newton MP, the Minister of State for Disabled People, published the figures on 11 January following a question raised in parliament by Labour MP Madeleine Moon in December. She asked: “How many people have died while waiting for their personal independence payment assessment to be completed; and what were the conditions those people died from?”

More than 17,000 sick and disabled people have died while waiting for welfare benefits, figures show

Responding to the question, Newton said: “All benefit claims can be made under the special rules for people who are terminally ill which will mean that they are fast tracked. “These are currently being cleared within 6 working days for new claimants to PIP. “The Department would encourage all claimants with a terminal illness to let the department know and to apply using the special rules.”

The private firm Capita were given responsibility to carry out disability assessments for Personal Independence Payments (PIP), have been criticised by MPs over the accuracy of reports sent to the DWP. source

“The cause of death of PIP claimants is not collated centrally by the Department”, she added. Over 3.6 million applications to PIP were made between April 2013 and 30th April 2018. Of these:

  • 4,760 claimants died between their case being referred to, and returned from, an assessment provider;
  • 73,800 claimants died within 6 months of their claim being registered; and
  • 17,070 claimants died after registering but prior to the DWP making a decision on their claim.

Overall, the total number of PIP claimants who died was 95,000. But Newton’s response does not indicate at what stage of their claim the 73,800 people, who died within six months of it being registered, were at.

Nor does it indicate what those people who did not have terminal or degenerative illnesses died of – including those with mental illness. For example, 270 of those mortalities are listed as having had anxiety and/or depressive disorders as their primary disorder.

The DWP has admitted 21,000 people died waiting for benefits

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Of those who did have terminal illnesses, we need to ask why these people were so cruelly left waiting so long for their assessment, if, as Newton claims, they are ‘fast tracked’ through the claim and assessment process.  She also said: “This is unpublished data… It should be used with caution and it may be subject to future revision.”

Linda Burnip, co-founder of Disabled People Against Cuts, said: “It is shocking that so many disabled people have died waiting for their social security claims to be processed at a time when they need and should be able to get support.

“Sadly this appalling situation is set to get even worse with the waiting times for first payments of universal credit.”

The DWP has been contacted for comment.

source

PIP refusal for disabled girl is devoid of humanity and compassion

The mother of a severely disabled Co Tyrone teenager says she is “shocked and disgusted at the lack of compassion” after her daughter’s Personal Independence Payment (PIP) claim was rejected.

Deborah McClenahan with the refusal letter

Talitha Grace McClenahan (17), who lives with her family outside Fintona, was born with Down’s syndrome and the related cardiac condition atrioventricular septal defect. The part-time student at Arvalee School in Omagh also suffers from a range of other serious conditions, and is awaiting major spinal surgery for scoliosis.

Her mum Deborah (47) told the Belfast Telegraph that her daughter’s Disability Living Allowance (DLA) had been stopped and her PIP claim refused. Deborah, a full-time carer for her daughter, has also lost her Carer’s Allowance. She had been told that Talitha Grace would receive DLA for life.

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Despite the family resubmitting the rejected PIP claim, they were told on Friday that the original ruling stood. “I’m angry at the injustice,” said Deborah, who looks after the teenager with her husband Albert (48). “Talitha Grace’s needs are very complex.

“She needs 24-hour nursing care and supervision, someone with her at all times. “As well as the Down’s syndrome and the cardiac condition, she had a traumatic brain injury at three months old, leading to the other conditions. “The atheloid cerebral palsy affects her fine motor skills, balance and co-ordination.

“She has extensive brain damage, which means her left side is badly affected, and the right-sided hemiparesis means there is no movement on her right side. “She can raise her left hand up but can’t bring it to her mouth, and there’s no grip reflex, she can’t hold onto a spoon.

“She is wheelchair-bound, she can’t stand or move her legs, she has problems with her hips. “She has had a growth spurt, one side is growing and one is not growing, so it is in an S-shape due to the scoliosis, which will eventually affect her bowels and lungs. “So not having surgery isn’t an option any more.

“She had major cardiac surgery in 2001, and she could have the surgery for scoliosis in June or July. My daughter has been likened to a newborn baby, but I think a newborn would have more head control. “She can’t walk, wash, feed or dress herself.”

Deborah said she was visited by a PIP assessor in November 2017.

“He didn’t ask to see Talitha Grace, who was in the next room, even though I offered,” she revealed. “I was quite surprised when, the following summer, I got forms and they needed to know how Talitha Grace’s disability affected her daily living.

“I was meant to have the forms in at the end of August but I got them in at the start of September, as Talitha Grace took a very bad chest infection and was admitted to hospital, where she had to be put on IV antibiotics. “She also had a pressure sore that was being dressed by nurses every other day for five weeks, then I caught the chest infection.”

On November 5, 2018, she received a letter from the Department for Communities (DfC) informing her that Talitha Grace’s DLA would come to an end on November 13, and that her daughter’s PIP claim had been rejected “because you haven’t provided the information we asked for”.

Deborah then phoned the PIP helpline. “The man said that they had received it late, but they had all the information and that they could look at the claim again without the need to submit anything else. He confirmed that he had resubmitted it,” the mum-of-seven explained.

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“The next day I got a letter which also said they could look at the decision again without anything else needing to be submitted. Just to make sure, I responded with a note telling them to go ahead, as well as a note telling them about Talitha’s Grace’s disabilities.”

Deborah says she subsequently received a letter claiming that additional information hadn’t been received over Talitha Grace’s case, despite the fact it was never requested. Then, last Friday, the family received a letter from DfC stating that it was “unable to change the original decision”.

Deborah said: “When they made the PIP decision they knew she was in nappies. “Every single bit of information they asked for was supplied. “I’m angry at the injustice. I was shocked that someone could have looked at that evidence and ruled against it.

“That money made a difference, we used it for sensory equipment, for days out. “I have no idea what they expect her to do now in terms of making money. “I would like to invite them to meet Talitha Grace and to see the struggle she has every day.”

She said that the family had received an outpouring of support since revealing their case on social media. “It seems that there is a lack of humanity and compassion, not only in Talitha Grace’s case,” she added.

“I have had so many people contact me, including a Belfast-based solicitor, who has offered to take on Talitha Grace’s case for free. “Without the support we have received, I would be very despondent.

“I was never told why they took this decision over Talitha Grace, and I want definite answers. I intend to send a letter off tomorrow. “Unless they reverse their decision we will appeal. I hope I can make a difference, not just for Talitha, but for others.”

The Department for Communities said: “While we cannot comment on individual cases, the department and Capita, who deliver the Personal Independence Payment assessment service, will look into the concerns raised and get in touch with the family.

“If after review a person continues to disagree with the department’s decision not to award PIP, there is then an opportunity to appeal to an independent tribunal.

“All PIP assessors in Northern Ireland are health professionals with specialist training in conducting functional assessments. They must go through the formal Department for Communities’ approval process to ensure they meet the department’s experience, skills and competence requirements.”

source

DWP begins moving existing PIP claimants to 10 year light touch’ reviews

The DWP has begun deciding which existing PIP claimants will be moved to having only have a ‘light touch’ review every 10 years, instead of a more frequent full review.

Back in June we highlighted a statement by Sarah Newton Minister of State for Disabled People in which she announced the end of ‘unnecessary’ PIP reviews, saying:

“We’ve listened to feedback from organisations and the public, and this common-sense change will ensure that the right protections are in place while minimising any unnecessary stress or bureaucracy.”

In a written statement released just before the Christmas break, Newton explained that new guidance had been issued to decision makers in August 2018 “to ensure those who are awarded the highest level of support whose needs are unlikely to improve or will deteriorate receive an ongoing award with a light touch review at the 10 year point.”

Newton added that work had now begun to identify existing claimants who should be covered by the ‘on-going award’ procedure:

“This is still in the early stages and being dealt with in date order, prioritising claimants whose awards are coming up for an award review, but commencing this activity is a really important step to reducing the number of individuals having to undergo an unnecessary award review where their needs are only likely to deteriorate.”

The light touch reviews will be aimed primarily at claimants who have been awarded the enhanced rates of both components of PIP and whose condition is unlikely to improve.

According to the guidance issued to decision makers:

On-going awards for claimants can be reached in one of two ways:

following advice from the AP that no review is required and the claimant’s restrictions on Daily Living/ and or Mobility are stable and unlikely to change significantly or they have very high levels of needs which will only deteriorate.

and where the claimant is awarded enhanced/enhanced and their needs are not going to improve or would only deteriorate.

Note: You may also consider an enhanced daily living award alone where the claimant is State Pension Age or over and has either not been awarded the mobility component or has been awarded the mobility component at the standard rate and their mobility needs are not going to improve.

You can download a copy of the guidance on award periods from this link.

SOURCE


Also see

WHERE IN THE WORLD IS THIS?

 

Please spare a thought for this 64 year old severely disabled client of mine? Please share this post to see if we can garner a response from the Tories although, I doubt we will.
My client was thrown off ESA by ATOS 18 months ago. Since then, he has been expected to sign on. Obviously, he’s been sanctioned and forced to go hungry. so much so he weighs 6 stone. On Friday, not surprisingly he was at death’s door with pneumonia. Fortunately, I was able to get him into hospital.Evidently, his left lung was full of fluid with his right not much better, he’s now on the mend.
He has been unable to heat or look after his home properly because his health has deteriorated which I suggest is obvious from the photographs. He lives in one room of his 3 bedroom house he rents from a private landlord. It is rat infested, he cannot use the toilet nor is he strong enough to put water in a kettle. He relies on bottled water. I am making efforts to have him rehoused in sheltered accommodation. However, I think he may have to go into a nursing/residential home in the interim.
Birkenhead Benefits Centre has ignored my continuous please for help, heartless bastards!

SOURCE

The decimation of the welfare state

It’s sickening that the British welfare state is being gradually demolished by successive governments, to be eventually replaced with private healthcare insurance [1] and what’s even more galling is: they [some members of the UK govt] went to the USA to find out how to decimate our welfare state and NHS, encouraged by American corporate funders. Mo Stewart has written extensively about this in her book Cash not Care.

Amber Rudd has the absolute nerve to say Universal Credit has not always been compassionate whilst her dept have overseen the demolition of the welfare state causing misery not seen seen Victorian times [2] and I have added hundreds of  DWP atrocities like the one of Alan Chrisman [below] which have contributed to many suicides [3] 

Since 2010


Denied: How some Tennessee doctors earn big money denying disability claims

Alan Chrisman holds medical bills and records near the McDonald’s where he worked at as a maintenance employee before being diagnosed with stage 4 colorectal cancer

By the time Alan Chrisman was diagnosed with stage 4 colorectal cancer, he was too sick to work. The cancer had spread to his lungs. His doctors said he may never get better. He applied for disability, the federal safety net program he contributed to with every paycheck during his 30 years working as a stonemason.

But a doctor hired by Tennessee’s Disability Determination Services to review applications quickly concluded Chrisman wasn’t sick enough to get the $804 monthly benefit.

That physician, Dr. Thomas Thrush, is one of about 50 doctors contracted to review applications for Tennesseans seeking disability. The doctors are paid a flat rate for each application file they review. How much they earn depends on how fast they work.

Thrush, like many of the doctors who contract with the state, works very fast. In fiscal year 2018, he reviewed — on average — one case every 12 minutes.

Thrush’s productivity has paid off. He earned $420,000 for reviewing the applications of 9,088 Tennesseans applying for disability during the year ending June 30. He has made more than $2.2 million since 2013. On average, 80 percent of the cases he reviewed were denied.

6 takeaways from this investigation: Doctors speed through disability claims, make millions

Tennessee has among the highest denial rates for disability applicants in the nation, rejecting 72 percent of all claims in 2017. The national average for denials was 66 percent. Outside experts and former and current state employees say it’s impossible to review cases so quickly without making mistakes that lead to wrongful rejections of disability benefits.

In Chrisman’s case, Thrush failed to obtain one critical piece of evidence: a discharge paper from a hospital that stated Chrisman’s cancer was inoperable and had metastasized. The prognosis clearly qualified him for disability, even under the complex rules set by the Social Security Administration. The mistake was discovered only after Chrisman hired a lawyer.

A USA TODAY NETWORK – Tennessee investigation examined 5½ years of data for physicians and psychologists who review disability applications. The investigation found that between January 2013 and July 2018:

• Some doctors raced through cases. More than half of all contract physicians outpaced the federal standard of 1.5 cases per hour, and 1 out of every 5 doctors doubled that pace.

 A whistleblower was fired. The contract of a former medical consultant was terminated in 2017 after he raised concerns about some physicians reviewing a high volume of cases.

• Speed pays. Seven high-volume doctors billed for more than $1 million each between fiscal 2013 and 2018. These physicians’ annual payments range from $103,000 to $451,000. By contrast, the acting chief of the Social Security Administration, a Cabinet-level position, earned $240,000. For some physicians, this was not their sole source of income.

 Staff doctors take more time. The state employed a small number of staff doctors whose compensation is not tied to the number of cases they review. These doctors reviewed cases at a rate that is in line with federal recommendations. They typically earned less than $150,000 annually, according to the state’s salary database. Beginning this year, however, the state is terminating all doctors on salary and relying only on contract physicians.

 Some doctors have a history of misconduct. At least two doctors under contract with the state are felons, including Thrush. Two other physicians had their medical licenses placed on probation. Another physician had his license revoked twice in the past 20 years and now works on a restricted license that bars him from treating patients.

Five current and former contractors and state employees said they believe disability applicants are being wrongfully denied in an effort to process as many applications as possible. Most spoke to The Tennessean on the condition of anonymity, for fear of reprisal.

“It’s like a cash register,” said one contract physician. “From our perspective it’s unethical. From a consumer’s point of view it can be a tragedy.”

One doctor who raised the issue through official channels lost his contract. Dr. John Mather, the whistleblower, was the former chief medical officer for disability programs at the federal Social Security Administration, and worked as a contract doctor for the state after he retired.

“Who knows how many applicants for disability benefits have had their applications denied without justification,” he said.

A whistleblower

Mather said he warned James Stanfield, director for the state disability department, and Raquel Hatter, then commissioner of the Department of Human Services, in 2016 about the dangers of some doctors performing large numbers of reviews. The Human Services Department’s general counsel responded in a letter saying there was nothing illegal or fraudulent.

Mather emailed the Social Security Administration, which referred the matter to the Office of Inspector General. That office determined no investigation was warranted. Mather met with auditors at the Comptroller of the Treasury, then received no further response.

In 2017, Stanfield declined to renew Mather’s contract. “I don’t think they care about the claimant,” Mather said of administrators. “They just want to see the cases out. I don’t think they care too much about quality. People who are high producers — they are very happy to have them around.”

Current and former personnel said they were speaking up now because they want an outside investigator to review all cases to ensure individuals have not been wrongly denied.

“These findings are troubling,” Tennessee U.S. Rep. Jim Cooper said in a statement. “Physicians, especially those dealing with state and federal funds, should be careful and thorough in their work. Social Security Disability Insurance is a vital program, and we have to keep it strong.”

Alan Chrisman walks with his wife, Joyce, near the Sevierville, Tenn., McDonald’s where he worked as a maintenance employee before being diagnosed with stage 4 colorectal cancer. Chrisman applied for disability but was initally denied by a medical contractor hired by the state to review claims.

A spokesman for the Department of Human Services, which oversees the disability program in Tennessee, disputed any connection between how fast doctors review case files and their mistakes. “We have no reason to believe that doctors that average faster reviews are more prone to have errors in their reviews,” Sky Arnold said in a statement.

The Social Security Administration provided its own statistics that showed Tennessee doctors were spending on average 47 “medical minutes per case.” Patti Patterson, a spokeswoman, noted that was more than the national average of 38 minutes.

But the federal data adds the time multiple physicians spend reviewing the same case, a common occurrence when someone is claiming both a mental and physical disability requiring two different specialists. The state data analyzed by The Tennessean details each doctor’s speed.

A letter brings crushing news

For weeks, Chrisman did not feel well. Some days he would lose control of his bowels. After stonemason work became scarce, he got a job as a maintenance man at a McDonald’s in Sevierville, Tennessee, two years ago. One day in November 2017, he showed up to work at the restaurant and promptly soiled himself.

At the insistence of his wife, Joyce, he headed straight to a walk-in clinic. It was his first medical visit in a long time. The Chrismans cannot afford insurance. He was referred to a doctor, then another. The diagnosis was swift.

Chrisman had late-stage cancer of the intestine. The cancer had spread. There were two spots on his lung. A golf ball-sized tumor and about a foot of his intestine were removed in surgery.

Alan Chrisman worked as a maintenance employee at this Sevierville, Tenn., McDonald’s before being diagnosed with stage IV colorectal cancer in November 2017. He’s now on his 11th dose of chemotherapy. After his 12th next month, he will return for a scan.
Caitie McMekin/News Sentinel

Weakened by chemotherapy and radiation, emaciated after shedding 40 pounds, and in extreme discomfort with tubes protruding from his backside, Chrisman occasionally can’t sit or stand. On a good day he can walk outside to pick up a single log for the fireplace in the couple’s unheated two-bedroom cabin.

The Chrismans earned about $32,000 a year between his earnings and his wife’s $10 hourly wage cleaning laundry at a Smoky Mountain resort. The mounting medical bills and Chrisman’s lost wages devastated his wife, who tried to arrange payment plans with medical providers. Chrisman applied for disability in November 2017. The rejection letter came six months later.

“Although your therapy is currently causing you discomfort, it is expected these effects will be temporary,” said the denial letter, based on the recommendation from Thrush.

Joyce Chrisman cried when she read the letter.

Mistakes unlikely to be caught

The disability process has two layers of oversight designed to catch errors, but doctors know there is little likelihood anyone would catch a mistake in denying someone’s application.

First, a quality assurance department in Nashville spot-checks approvals and denials to make sure staff and doctors have followed procedures. Then, federal regional offices review a portion of disability applications.

Tennessee has consistently ranked high in the quality of its case reviews, averaging a 95.8 percent quality rating since 2016, said Arnold, the state spokesman. In 2017 DDS earned a Social Security Administration “Phoenix Award” for its performance.

But the state and federal offices review a tiny percentage of denied disability claims for accuracy.

By law, half of all approvals by state DDS personnel are reviewed by Social Security Administration staff — a provision meant to safeguard public funds.

The law, however, doesn’t set specific requirements for denials. As a result, the Social Security Administration reviewed fewer than 2 percent of all rejections, according to an analysis by the National Association of Social Security Claims Representatives.

“If the adjudicator is making poor decisions, if they tend towards denials, they’re just not going to be reviewed,” said Jen Burdick, an attorney with Community Legal Services of Philadelphia. She is is among advocates nationwide asking for Social Security to review more denials.

Wrongful denials may be appealed, but long delays for a hearing can take a devastating  toll in lost wages, lack of access to health care and medical bills. In fiscal year 2017, at least 9,570 people died waiting for their disability appeals to be heard.

Speed pays — sometimes millions

The Social Security Administration oversees two disability programs: Supplemental Security Income, or SSI, for low-income individuals without a work history, and Social Security Disability Insurance for workers who become disabled.

The federal government delegates to the states the administration of the programs. Tennessee received $8.5 million last year from the Social Security Administration to hire medical consultants with a variety of specialties to review medical records.

These doctors never examine claimants in person, although they occasionally order a physical exam by another doctor.

Seven days a week, setting their own schedules, the doctors swipe their badges to access secured floors of a brown and glass office building on the outskirts of downtown Nashville, logging into a computer system that generates a queue of cases to review.

Some applications contain just a few pages. Others include hundreds of pages of doctor’s notes, hospital reports, X-rays, lab results and employment records. Doctors must write a brief report to justify their findings, too.

The decision to grant or deny benefits is officially made by a state employee, but doctors who work for the state say it is their recommendation that carries the most weight.

For this work, the doctors are paid a flat fee ranging from $30 to $47 per case. Doctors also bill $68 per hour in most instances for the time they spend consulting with staff or mentoring other physicians. Use the database below to search for physicians. Like Thrush, some of these doctors work very fast.

Dr. Kanika Chaudhuri, a pediatrician, evaluated 3,872 cases last fiscal year, averaging more than four cases per hour when she worked. She earned $192,000 in fiscal 2018 and $1.1 million since 2013.

Out of all the cases Chaudhuri reviewed over the five years, 78 percent were denied, according to data provided by the state. State officials later noted that the denial data included cases in which multiple doctors made assessments, meaning Chaudhuri and other doctors may not have made the final assessment.

Asked whether she felt pressured to review cases too quickly, Chaudhuri said: “No direct pressure. They recommend that we must keep up. They always recommend you do your best. There are so many applications and so few doctors. We are overwhelmed with cases.”

Jenaan Khaleeli, a psychologist, has averaged 4½ cases an hour since 2013. Nearly 80 percent of those cases were denied. Over the five years, Khaleeli earned $1.2 million, including $209,000 in fiscal 2018.

Dr. Frank Pennington, an ear, nose and throat specialist who is also a felon, earned $144,000 reviewing cases in fiscal 2018, and more than $1 million since 2013. During the five-year period he reviewed 20,835 cases, at a rate of three per hour.

Pennington is one of five contract physicians with a history of misconduct. Pennington is confined to the administrative practice of medicine after three separate felony cocaine convictions and two stints in federal prison in the 1990s.

Thrush had his license placed on probation for four years in 2008 after he  pleaded guilty to prescription fraud in 2006. Arnold, the DHS spokesman, said the physicians were all doctors in good standing while employed.

“It’s important to remember these are not forward-facing doctors,” Arnold said. “Their role is to examine medical records and reports. They do not meet with patients in person.” Thrush, Pennington and Khaleeli did not respond to messages.

‘A flawed system’

Tennessee’s pay-by-the-case model — and the sums paid to contract doctors — surprised even advocates and attorneys who routinely assist people with disabilities. “There is an obvious financial incentive under such a payment arrangement — to process cases as quickly as possible,” said Russ Overby, an attorney with the Legal Aid Society of Middle Tennessee, who represents individuals seeking disability.

“I am concerned that some clients who are in fact eligible for disability benefits will be denied because there has not been a sufficient review of the case.” Carrie Hobbs Guiden, executive director of The Arc of Tennessee, advocates for individuals with developmental and intellectual disabilities who occasionally apply for Social Security disability benefits. Doctors have to invest the time to properly review cases, she said, especially when it involves people with untreated mental health issues.

“If they’re getting paid based on how many they get done, that’s a flawed system,” Guiden said. “That’s not encouraging quality. You have to question if the purpose is to deny as many people as possible.”

Under pressure to meet ‘workload goals’

State disability determination departments face enormous pressures to meet “workload goals” set by the Social Security Administration.

In 2018, the Social Security Administration set a goal of 103,161 disability applications to be cleared by Tennessee’s office.

The staff and consultants needed to clear those cases in Tennessee have shrunk by 24 percent between 2010 and 2016.

Failure to meet goals can result in a financial penalty from the federal government, according to Jeffrey Price, the past legislative director for the National Association of Disability Examiners.

Doctors elsewhere push back

About half of all state disability offices in the United States operate on a similar model to Tennessee’s, in which physicians reviewing applications are paid by the case, according to Price.

The contract model, in which doctors receive a fee for each assessment, introduces some risks, Price said.

“If you were paid by the case, it behooves you to sign off on as many cases as you can,” he said. “I think that model at least has the potential for increased error rates.

“A doctor can review cases effectively at about two cases per hour,” Price said. “You’re hoping that the doctor will actually look at the whole case, not just what the examiner wrote.”

Doctors like Thrush, who processed more than five cases per hour, might be valued in an office trying to shovel itself out of a large caseload, Price said, but the pace is implausible.

“I think that would be dangerous, actually,” Price said. “Inherently you would be missing something if you’re looking at five cases an hour.”

At the North Carolina Disability Determination Services office, where Price has worked for nearly 40 years, managers recently asked doctors to process an average of three cases per hour instead of two. Doctors in that office are all on staff, as opposed to contractors.

“Some of our doctors are pushing back,” Price said. “They say that’s too many.”

A rule put into place by the Social Security Administration in 2017 has made the work of DDS physicians even more critical in deciding an outcome of an application.

Previously a “treating physician rule” required DDS to give more weight to the opinions of an applicant’s personal doctor than doctors hired by DDS. That rule was eliminated, giving doctors hired by DDS more influence in deciding the outcome of applications.

‘Something needs to be done’

After Chrisman was denied, he and his wife found a lawyer in Sevierville to file a request for reconsideration.

In September, Joyce Chrisman came home from work and brought the mail inside their cabin. The letter from Social Security said, “We found that you became disabled under our rules on November 8, 2017.” That was the day after she urged Chrisman to visit the walk-in clinic.

Another physician had examined Alan Chrisman’s file and recommended he be granted disability.

“We said ‘wow,’ ” Chrisman said. “We couldn’t believe it.”

George Garrison, his lawyer, said he was troubled by The Tennessean’s findings.

“People come to me at a point they’re about to lose everything they’ve got,” he said. “They’re sick. They’re dying. They’re having to deal with a complex system.”

The benefit meant that Joyce Chrisman no longer had to worry about paying medical bills. The bills would be paid dating back to the time her husband applied for disability.

His disability approval also automatically qualified Alan Chrisman for TennCare, which is now covering his ongoing chemotherapy, medications and hospitalizations.

Chrisman sits on his couch most of the time. He’s on his 11th dose of chemotherapy. After his 12th next month, he will return for a scan. “Then we’ll go from there,” he said.

Thinking about the months he spent rejected — when he and his wife were barely scraping by — Chrisman gets angry.

“Something needs to be done,” he said. “They’re either getting too much of a caseload or they’re getting greedy.”

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Disabled woman tells how PIP denial forced her to beg for food

Disabled woman who had her benefits stopped after she tried to claim more money said she has been forced to beg for food.

Pauline Bloomfield, 54, of North Walsham, received £90.74 a week since 2016, as back pain and arthritis left her unable to work. Mrs Bloomfield, who was previously a carer for her late husband, said: “I was getting headaches and eye problems [as] he kept hitting me in the head.

“I had back pain from pushing him in his wheelchair.” But her personal independence payments (PIP) were stopped after Mrs Bloomfield tried to claim a greater allowance last year. She has not received any money since November 28.

Mrs Bloomfield, who lives with her partner, said: “I put the claim in on July 11 for my eyes. I was getting headaches from 2011 but I didn’t know I could claim [more]. “I got a letter back saying I had to go for an assessment on October 10, at St Francis Hall in Norwich.

A man who has cystic fibrosis and may need a lung transplant has said the decision to take away his PIP will stop him living an independent life.

“It’s difficult with my mobility.” Mrs Bloomfield said she did not initially understand the assessor would look at her overall health. She said: “I got a letter to say my mobility was alright, so my PIP has been stopped. “I was told ‘we don’t just go by one claim, we go by all the claims’. “[But] my mobility hadn’t got better – it had got worse. I can barely walk anywhere.

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“I put in an appeal against it and it just came back again ‘no’. “I’m down and upset. It’s unbearable. I’ve been having to keep begging to get food. We had to ask neighbours downstairs and they kindly helped us out with it.”

A spokesperson for the Department of Work and Pensions (DWP) said: “A mandatory reconsideration has been carried out in this case, and the original decision was upheld. “The claimant is now entitled to register an appeal with the courts and tribunals service.

“We’re committed to ensuring that disabled people get the full support that they need and PIP helps with the extra costs someone may have as a result of a disability. “When someone’s circumstances change we look at their claim again to make sure they are getting the right support.

“Decisions are made following consideration of all the information provided by the claimant, including supporting evidence from their GP or medical specialist. “Anyone who disagrees with a decision can appeal.”

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