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Elon doesn't know what he's talking about. I used to work as an adjudicator for the PA Disability Determination Bureau, and the investigation is so thorough that getting disability through fraudulent means is effectively impossible. The evaluation is mostly based on the claimant's actual medical records and, if those are insufficient, the bureau will schedule an examination. Some information comes from the claimant themself, but most of this is clarification about medical treatment or conditions which are noted on the medical records but that they aren't claiming disability for. The ydo fill out an ADL form, but this is only really taken into consideration in the event that the claim is borderline; in that case it might tip the balance toward an approval but only if the condition is significantly limiting their ADLs in a way that one would expect the condition to limit them. In any event, most ADLs show some limitations but not nearly the kind that would be sufficient to tip the balance in that circumstance. For example, if a guy is claiming disability for a back problem there's probably going to be something about how they don't move around very well and can't lift heavy objects. They probably aren't going to claim that the pain is so bad that they can't get out of bed and have to have someone else do housework for them.
Realistically, the only way you're getting disability on the initial application is if you're over the age of 50, have a job that involves physical labor, and haven't done any other kind of work in the past 20 years. If you're under 50 it's assumed you can adjust to other work, so if you're capable of doing a sedentary job that doesn't require any special qualifications you're denied. If you're over 50 and you have an office job you're denied. If you're over 50 and you have a job that involves physical labor but there's a similar job that uses the same skills but doesn't involve physical labor you're denied. If you're over 50 and you generally work a job that involves physical labor but you you worked the register at your brother's convenience store a decade ago when he was just starting out and needed extra help, you're denied.
Some of the cases I can remember: One approval of the more typical kind involved a 55-year-old black guy who worked as a welder his entire career and had back problems. Claims of back problems are common, but this guy had serious problems documented on x-ray and had undergone at least one surgery. He tried to go back to work after the surgery but had to stop. Another case involved a guy in his 30s with brain cancer who was in such bad shape I couldn't talk to him directly and had to get the information from his sister (cases like this are flagged upon intake so they can be approved quickly). One case involved a 16-year-old girl who had severe psychological and emotional problems to the point that her mother couldn't take care of her and she was put into a group home, but her behavior was so bad that she kept getting kicked out of them. She had been admitted to Western Psych repeatedly over the past few years. I only spoke to her briefly; most of my communication was with her mother, who spent most of the conversation on the brink of tears as she talked about how she didn't know what she was going to do about her daughter and how scared she was about the future. I honestly don't know if this is an approval because I left before the case was resolved. I was pushing hard to get it out the door because it was clear to me that this girl would never be capable of working but my supervisor was skeptical because, if memory serves, while she had frequent hospitalizations it had been close to a year since the last one so maybe things were improving.
Now, I saw plenty of bullshit as well, but it was obvious bullshit that resulted in a denial. The modal case for this was some kid in his early 20s who never worked for any length of time and never had any education beyond high school who was trying to claim disability for psych problems despite having never seen a psychiatrist. He might be taking some kind of antidepressant but it was always prescribed by a PCP and didn't follow any kind of psych workup. That presents a complication, since we can't deny the claim without any psychiatric evidence, so we'd have him evaluated by a psychiatrist who would invariably conclude that the kid had garden-variety anxiety and depression but nothing that would prevent him from working. Psych claims usually require a longitudinal history of progressively worsening problems, or else some kind of huge psychic break that's unavoidable. But most of the cases are people who obviously have problems, just not of sufficient severity to render them disabled. The determination office is basically a denial machine, and most of the claims that are approved at the initial stage are ones so obvious that no one could possibly claim they were fraudulent. There are also a small number of people who have already retired and later have a health problem and figure they'll file just to see if they qualify.
Now, once you get beyond the initial determination stage and into appeals, the success rate is much higher. However, if you're appealing then you have an attorney and the case is heard by an administrative judge who issues an opinion. I think that the reason for this is that few of the bullshit claims get appealed, so the cases the judge sees are of overall higher quality that what are seen at the initial stage, especially since most of the severe cases are sent to a different department for fast-tracking. An adjudicator who spends all day dealing with marginal claims basically turns into a denial machine. I saw a statistic that claims 38% of initial applications that reached the adjudication stage (i.e., not denied for technical reasons, which half of all initial claims are) were approved. This seems way too high. Granted, the numbers are from ten years after I stopped working there and I can't speak to how they do things in other states, but in my office it was like 20%, 25% tops. And that includes expedited cases and cases adjudicated by people who have been there for 20 years and think they can tell an approval from a denial based on gut feeling.
I wasn't there long, but in my time there I evaluated hundreds of claims, and I never once saw anything I thought looked fraudulent. As I said, there were bullshit claims, but these were obviously bullshit, and in any event the claimants weren't lying about anything. It's one of those things that just isn't worth it. The average SSDI benefit is $1,200/month, and the average SSI benefit is $800/month. And if you make more than something like $1,200/month from a regular job your benefits get cut off. So the reward one gets from perpetrating a fraud on the system is a life of bare subsistence living. One thing I can't speak to is fraud at the technical level, for example, people hiding income or assets so they qualify for SSI. Given the high rate of technical rejections, it's clear both that SSA is doing thorough investigations and that people aren't even trying to hide much. I'm not saying that fraud doesn't exist, but the guardrails in place for preventing it are so high and the incentive for committing it are so low that I doubt there's much savings to be had here.
pinging @jeroboam, since I didn't see his comment until after posting this
thanks for taking the time to write this out
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I guess I just wonder how much this sort of thing happens.
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