Analysis: My Mom Lost Disability Benefits Like Thousands of Californians — This Is The Wrong Way to Prevent Fraud 

The author’s mother, Karen Campbell. Photo courtesy of Denzel Tongue.

Late last year, my mother lost access to State Disability Insurance. 

Like thousands of other Californians, this was not due to any of her own missteps — it was an overreaction of the state as it tries to crack down on fraud. 

The unintended consequence is that people like my mom are having to go without monthly checks that, in many cases, allow them to put food on their tables and a roof over their heads. 

I recently spoke with my mom about her debacle dealing with a state department that ostensibly exists to provide Californians with access to the benefit programs they’ve paid into for years. During the fall of 2021, my mother underwent surgery forcing her to take paid sick leave. Following the surgery, she noticed herself becoming weaker, and she had difficulty breathing. After a series of tests and consultations, she was eventually diagnosed with a case of pneumonia.

Her bout of illness meant that she needed to take time off from her job as a legal process assistant with the Alameda County Superior Courts to recover. She proceeded to apply online for state disability benefits to replace her wages since she had exhausted all paid sick leave. My mom and her medical provider both filled out the necessary paperwork for her benefits. While she did receive benefits for one month, they were abruptly cut off in December 2021. 

“They never gave me any indication that my claim was fraudulent, never asked for additional information,” she told me. 

My mom quickly contacted the Employment Development Department and was informed that her claim had been marked as fraudulent and that her case was under review. This was the beginning of a months-long saga as my mom desperately attempted to access needed benefits during a time in which she had no income. 

“We were left out in the cold during the holidays,” she said. By the time her state assembly member’s office got in touch with her to provide support, it was too late: She had returned to work prematurely due to the lack of income and was waiting on back pay from the state. These months were incredibly challenging for my mother who, like many Californians, lives paycheck to paycheck due to the high cost of living in the San Francisco Bay Area.

I did my best to support her, but the ordeal was incredibly stressful for both of us. It opened my eyes to the realities that many other vulnerable Californians are facing during the pandemic.

California’s Employment Development Department oversees the implementation of key programs such as the California State Disability Insurance program and the state’s Unemployment Insurance program. These programs provide wage replacement benefits for eligible Californians during times of crisis or serious illness. For Disability Insurance recipients, this includes being unable to work due to an illness or injury unrelated to work, pregnancy or childbirth. The benefit delays may also be causing pregnant people or those who have just given birth to return to work before they are medically ready to or before they have had adequate time to bond with their newborns. 

Unfortunately, the Employment Development Department has become overwhelmed as it sifts through an influx of new claims for benefits. Reportedly, some of the new claims are fraudulent. The department estimates that it has paid roughly $20 billion in fraudulent claims during the pandemic. To combat claims of fraud, the department has worked to implement stricter identification verification measures. These added measures may help reduce the amount of state funds going to fraudulent claims, but they also have another impact: suspension of vital benefits for Californians truly in need of support.

My mom’s experience made me reflect and consider a few questions. What went wrong? Why did it take so long for the state to verify my mom’s claim? And, importantly, were other people dealing with the same thing? 

I spoke with Katherine Wutchiett, staff attorney at Legal Aid at Work, to learn more about the current status of State Disability Insurance. Legal Aid at Work is a nonprofit legal services organization that supports low-income families and workers. The organization runs a free hotline for workers and families that receives thousands of calls per year. According to Wutchiett, many callers are experiencing the same issues my mother faced. 

“I applied and I didn’t hear back for months” is a common refrain from frustrated callers. Wutchiett noted that many workers are prematurely returning to work, a move that could be detrimental to their health.  People are facing increased scrutiny when applying to State Disability Insurance, even though this program already requires verification from medical providers. 

Notably, Wutchiett said, the majority of the more than $20 billion in state funds paid to fraudulent accounts seems to have been for Unemployment Insurance benefits — not disability benefits — although a recent wave of disability fraud still led officials to freeze hundreds of thousands of claims. Fraud remains a major worry of elected officials and administrators, yet efforts to combat it have left many sick Californians out in the cold with limited recourse.

So what is the state doing to solve this problem? The Governor’s May Revision for the 2022-23 budget includes significant investments in the Employment Development Department including $136 million for modernization efforts over a five-year period. These efforts will include call center improvements, simplification of forms and development of new data analysis tools to curb fraudulent claims. Still, advocates are concerned that these improvements will not be enough to protect vulnerable Californians from having their claims frozen. 

“In addition to improving the systems, how do we protect individuals so they’re able to get the benefits that they need?” said Sasha Feldstein, economic justice policy director at The California Immigrant Policy Center. The state’s efforts to combat fraud may ultimately help reduce the amount of funds paid to fraudulent accounts, but they have the potential to directly harm those in need of vital benefits when they are unable to work due to disability. 

Ultimately, my mother prematurely returned back to work in late January 2022 to cover her bills. She did not receive backpay for her benefits until mid-February. The two months she went without benefits exacted a heavy toll. 

“I was worried about how I was gonna pay rent, pay bills and get a least a couple of Christmas presents,” she told me. “It was depressing.” 

My mom dealt with a feeling of helplessness during this time, and she relied on savings to make it through the holiday season. The situation my mom faced was unacceptable to me. Not only did it affect my own mother, but countless Californians were also dealing with the same issue.

State officials need to do more to address the needs and concerns of Californians like my mom who was temporarily locked out of benefits she had spent years paying into (as do all working Californians). This could take the form of the Employment Development Department working more closely with community groups to craft their messaging around identity verification and fraud prevention. Further, state officials need to continue to streamline and expedite the review process so that Californians aren’t shut off from vital disability benefits. Crucially, policymakers need to weigh the impact of any proposed anti-fraud measure and consider how it would impact the day-to-day lives of Californians. 

Preventing fraud is important, but it should not come at the expense of working Californians who are simply trying to access their hard-earned benefits that they have been contributing to for years.

Denzel Tongue writes a column for the California Health Report about the intersection of racial justice, public policy and health equity. He is a master of public policy candidate at The Goldman School of Public Policy and a California Initiative for Health Equity Fellow.

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