Calls overwhelm disability benefits call centers
Calls to California’s Employment Development Department disability insurance call centers surged to 12 times their normal volume in late 2021 and early 2022 as the department dealt with fraud. Many went unanswered, leaving some Californians in the lurch for months.
Christina Cedillo has a sticky note on her computer, reminding her what buttons to press when she calls California’s employment department with questions about disability benefits.
But at this point, she doesn’t need it. After calling hundreds of times, she can recite the whole phone tree from memory.
Cedillo, who works as a bartender, gave birth to a girl in October 2021 and immediately filed for disability benefits, which cover pregnancy. By mid-December, though, the payments stopped.
She couldn’t find anything on the department’s website that explained why, so she started calling. The worker she reached said many payments had been delayed due to fraud, but that they should restart soon, Cedillo recalled.
When they didn’t, Cedillo estimates that she called the department between 300 to 500 times in late 2021 and early 2022. She would sit and redial, often while nursing, sometimes 40 times in one day.
She wasn’t alone. Less than half of unique phone numbers calling the Employment Development Department’s disability insurance branch call centers were answered on average between November 2021 and April 2022, according to department data. That’s down from about 80% between May and October of 2021.
Without wages coming in, Cedillo put more charges on her credit card.
“I had budgeted for this and I knew that I was going to not get very much from the state anyways,” said Cedillo. “And then to not even have that — and I was depending on that — was really, really frustrating.”
In February, Cedillo got a letter from the department asking her to fill out a form and send back documents to verify her identity. She sent the form and documents the next day, she said. Weeks went by. In April, she got another payment. She thinks she’s still owed $168, but, she said in a June interview, “now I feel like I’ve just given up.”
Employment department flooded with calls
The deluge of calls began in late 2021. In December, the department said it was taking action to halt “suspected organized criminal elements filing false disability insurance claims.” California’s disability insurance replaces some wages for people who are unable to work due to illness, injury, or pregnancy, and medical providers certify the existence of a disability.
The agency had experienced a massive surge of new medical provider accounts and suspected many were fraudulent, said department spokesperson Gareth Lacy in an interview with CalMatters. Typically, the department received 70 new medical provider registrations per week, but during four weeks from late November to early December, they received about 30,000, Lacy wrote in an email.
To sift through the influx of claims, verify medical provider and claimants’ identities, and answer an uptick in calls, the roughly 1,000 staff in the disability branch worked 22,000 hours of overtime per month from December 2021 to May 2022. That’s ten times the normal monthly overtime average, according to Lacy. The disability branch also borrowed 133 employees from other branches of the department, and brought back nine retired employees to help with the additional work, according to Lacy. To confirm the identities of claimants and doctors, staff sent out emails and letters, he said.
In January, the department said it had suspended approximately “27,000 suspicious medical provider registrants and 345,000 claims associated with those providers or other suspicious activity.”
Meanwhile, the number of calls to the disability insurance branch call centers, which also handle paid family leave, was swelling. In January 2022 alone, the call centers received about 5.7 million calls, after receiving an average of about 443,000 per month for May through October of 2021, according to data the department provided to CalMatters. The vast majority of those calls, Lacy said, were regarding disability benefits.
“Generally, when we have to pause payments to separate out fraud then we’ll see an increase in calls to the call center in response to that move,” said Lacy. Also driving the increase were calls from people with questions about the emails and letters the employment department sent to verify people’s identities.
“When the verification process adds extra layers of review and it slows down the system that people normally experience to be quite quick and responsive, then people will call in to find out: ‘Why is this taking longer than what I’m used to?’” Lacy said.
The department increased staff to the disability insurance call centers, from 134 on average in November of 2021, to 228 in February 2022, according to the department.
Difficult to respond
Some call center surges are predictable; Black Friday, for example, is likely to be extra busy for retailers.
Call centers should also be able to handle unexpected surges, at least of a certain scale, “without going to pieces,” said Keith Dawson, vice president of Ventana Research, where he leads customer experience research.
But, when it comes to a more than twelve-fold surge in call volume, like the employment department experienced, “there’s no possible way that they can be prepared for something of that magnitude,” said Dawson.
One strategy centers can use when faced with an increase in volume is to give callers more information, either online or in an automated message, so that they can get their question answered without talking to a human, Dawson said. But, he said, that approach is less effective if people are calling with questions unique to their specific situation. Another option is to rapidly increase staff — which is difficult — or outsource some of the calls to a contractor, which is costly and requires training, said Dawson.
In January 2022 alone, the call centers received about 5.7 million calls, after receiving an average of about 443,000 per month for May through October of 2021.
But the recent surge isn’t the first time callers have had difficulty getting through to a human. From May 2021 to October 2021, before the spike in calls, about 80% of unique phone numbers calling eventually got an answer, according to department data — meaning that about 20% of callers never did.
The difficulty of getting through to a person has always been an issue with both disability insurance and paid family leave, said Katherine Wutchiett, a staff attorney at Legal Aid at Work, a nonprofit that helps low-income workers and runs a hotline for questions about people’s rights to take leave or get accommodations. The organization has “always heard from folks who are having a hard time getting just that one-on-one, you know, ‘What is the answer to this question? I’m confused. I’m running out of money. What can I do?’” Wutchiett said.
Answering all the calls that come in is the goal of any call center, said Dawson. “If you’re not answering all your calls, you’re doing something wrong,” he said.
As the Legislature and the governor tussle over how California spends its money next year, the employment department made some budget requests to boost its fraud prevention and investigation efforts and modernize its operation.
One request, for $23.6 million in the coming budget year, focuses on fraud and includes an advertising campaign to raise awareness about how to prevent identity theft. The department also wants 13 new staff positions to work on fraud prevention, including in the disability insurance and paid family leave programs, and funds to support local law enforcement’s prosecution of fraud. The Legislature rejected that request, but did include $136 million for the first year of a multi-year modernization project.
That project would, among other things, reconfigure the keypad teleprompter process, add multilingual functionality, redesign forms to make them easier to complete, and establish a new customer experience team to conduct user research and design and test new features.
The Legislature also approved $10.2 million for the coming year to improve cybersecurity, assist with fraud mitigation, and improve suspicious event monitoring, as well as $96.3 million for a bevy of contracts, including several aimed at fraud prevention.
Though the Legislature passed a budget Monday, the deal isn’t final; as negotiations continue with the Governor’s office, changes could be made via additional bills.
In the meantime, Californians who struggled to get their questions answered are left frustrated.
Manar Hassan, who lives in the coastal city of Pacific Grove, applied for disability benefits shortly after giving birth in late February. She could see on the department’s website that her doctor had certified her claim in early March, but when the payments still hadn’t begun arriving two weeks later, she began calling.
One of two things would happen: She’d get a message saying the maximum number of callers had been reached, instructing her to call back later. Or, she said, “it would just hang up.”
“I just felt like: What do I need to do to get a hold of somebody? I can’t just sit on the phone all day, I have to take care of a child,” she said.
A friend who was also a new mother mentioned that the department sends letters to employers to confirm the last day of work, Hassan said, and she had a hunch that was the holdup.
In mid-April, following advice she found on YouTube about how to get through to a human at the department, she connected first with someone who couldn’t help her, and then, seemingly with a stroke of luck, with someone who could send another letter to her company. Then the process moved relatively swiftly; her employer responded to the letter and the benefits began flowing in late April.
“I take pride in living in California,” said Hassan. “I always tell my friends about how progressive California is.
“But when you’re trying to actually get paid, and you basically have to beg for your money, it’s just — it’s hard.”