Reconsideration

If an application for Social Security Disability ("SSD") benefits is denied, the next step is to request reconsideration.  Reconsideration is basically an appeal to the same State agency that made the initial decision. At reconsideration, a different analyst reviews the case for a new perspective.

We represent a 52-year-old Insurance Coordinator from Old Bethpage, who suffers from severe IBS, ADD, and hypothyroidism. Her claim was recently approved by the State agency during the reconsideration phase. The only new evidence we provided were treatment notes from her last three monthly infusions with her doctor, which have been ongoing since we filed the initial claim. Although the agency requested records that we had already submitted, we had to clarify this for them. In reality, the extensive medical evidence presented at the start should have sufficed for benefit approval. The SSD process ended up spending unnecessary resources and caused delays for a claim that should have been resolved much earlier.

SS Delays Worsening

The Social Security Administration (SSA) has been facing challenges for years due to understaffing, underfunding, and an outdated infrastructure that has impacted millions of Americans. In January 2025, President Trump authorized Elon Musk to establish DOGE, which granted considerable authority to reduce funding for government agencies, with the intent of curbing federal spending and minimizing inefficiency. DOGE’s stated objectives included modernizing information technology, enhancing productivity, and reducing excessive regulation and expenditures. However, budget reductions have compounded difficulties for agencies already facing operational struggles, and in particular, the SSA.

According to The Washington Post, delays at the SSA have intensified as a result of DOGE's measures, such as workforce reductions, early retirements, and office closures. These changes have had far-reaching consequences for individuals nationwide. While the Trump Administration has claimed improvements, such as shorter wait times to reach customer service representatives, the experiences and data reported by both claimants and the SSA employees differ significantly. Although telephone wait times may have decreased, callers are now routed to offices outside their local area, which can prevent access to complete and relevant information. This shift frequently results in inefficiencies, as representatives may lack the necessary knowledge or training to resolve specific inquiries.

Additionally, reduced staffing has led to increased wait times for hearings, decisions, and benefit disbursements. The expedited claims process, previously available for individuals facing urgent financial hardship, no longer moves as swiftly as before. For example, some clients experiencing homelessness continue to face extended waiting periods for hearings, even when their cases are designated as expedited, such as our client, who has been living in his car for months.  Even worse, thousands of claimants die waiting for their claims to be processed completely.

While DOGE initiatives may have achieved cost savings, they exacerbated many existing issues within the SSA. Potential solutions could include rehiring experienced staff to address the backlog and streamlining administrative procedures, such as reducing redundant paperwork, to improve efficiency without compromising service quality.

 

 

Listing Approval

Typically, Social Security processes disability benefit applications very slowly, and the government shutdown has made the wait even longer.

We represented a 45-year-old Patent Examiner from Freeport, New York, who struggled with several severe mental health conditions. Over the past 20 years, she had been hospitalized more than eight times. Her difficult childhood contributed to diagnoses including severe PTSD, schizophrenia, bipolar disorder, depressive disorder, along with hallucinations and panic attacks.

After being denied benefits at both the initial and reconsideration stages, our client retained us when her case was sent to the hearing office. We collected all her medical records, including each hospitalization. We also secured detailed questionnaires and letters from her treating physicians, one of which confirmed that she met Social Security’s criteria for Listing12.03. To reinforce our case, we compiled a chart comparing her symptoms, as documented in her medical records, directly to the listing requirements, clearly demonstrating to the administrative law judge ("ALJ") that she was unable to work in any capacity.

Just three days after the hearing, the ALJ who rarely approves mental health cases, issued a favorable decision.  The strength of the evidence we submitted convincingly established our client’s inability to work, and the medical expert had no choice but to concur with the opinions of the treating specialists.

Compassion v. Calculation

We recently handled a difficult, yet unfortunately common, case that perfectly illustrates a critical flaw in the Social Security Disability ("SSD") Insurance system.  Our client, a 57-year-old golf cart technician from Port St. Lucie, Florida, was recently diagnosed with Stage 4 Pancreatic Cancer. This devastating diagnosis immediately met the criteria for a Compassionate Allowance.  The good news is that the Compassionate Allowance designation worked as intended: his claim was approved in just three weeks. In a time of unimaginable stress, this rapid decision was a small victory, lifting the burden of uncertainty from his family.  However, this victory was overshadowed by a hard reality: the mandatory five-month waiting period for SSD benefits.

By law, an applicant cannot receive their first SSD benefit payment until up to six months after their established onset date when they became unable to work.  Our client stopped working last month.  This means that despite his terminal diagnosis and rapid SSD approval, his first payment will not be due for about six months from the onset date.  The cruel irony is undeniable. Our client, with a terminal illness recognized by Social Security as immediately disabling, may not survive long enough to ever receive the benefits he and his family desperately need and deserve.  Common sense would suggest that when a disability is recognized as terminal, this five to six month waiting period should be inapplicable. Unfortunately, the delay from the waiting rules runs counter contrary to the issuance of a a Compassionate Allowance.

As experienced disability advocates, we knew going into this case that a quick approval meant we would not receive a fee.  We were happy to help our client and his wife navigate the complexities of the SSD application process during this excruciating time.  Our priority was to shoulder the stress of the paperwork and give them back precious time to focus on what truly matters.

This case is a stark reminder that while the Compassionate Allowances program speeds up the approval process, a necessary reform is still needed to bring true compassion to the payment schedule for those with terminal conditions.

 

Quality Review Increases

The Social Security Administration pulls disability claims for review that have been decided by the Stage agency at the initial application.  Social Security Disability claims selected for Federal Quality Review are said to be chosen at random, including both approved and denied cases. However, in my three decades as a disability attorney, only approved claims have been reviewed. Each time we check with the local office, only approved claims have been pulled, which shows the process is not random.  Since the beginning of this year, every one of our cases that have been approved at the initial application were pulled by Quality Review.

Meeting A Listing

When representing a claimant seeking Social Security Disability ("SSD") benefits, we obtain medical records from each of their treating physicians. We also ask these doctors to complete a Medical Findings Summary, which is a questionnaire designed to assess a patient’s restrictions and limitations (“R&Ls”).  The Social Security Administration relies on these R&Ls when making its determination. If the R&Ls from a claimant’s medical impairment is severe, they may satisfy the requirements of one of Social Security’s “Listings.”

We represented a 41-year-old dental assistant from Melville, NY, who suffers from a significant vision impairment. We requested that her doctor to review Social Security’s Listing criteria for Visual Disorders. The physician supported our case by providing medical evidence showing our client met the Listing.  Along with a vision test requested by the State agency, we submitted this information, and our client was promptly approved during the initial application stage.

Retaining an experienced disability attorney is in your best interest if you are planning on applying for SSD benefits.  Our office, located in Melville, NY in Suffolk county, offers a free phone consultation.

Meeting SS Grid Rules

When applying for Social Security Disability (“SSD”) benefits, your likelihood of approval at the initial application stage increases significantly if you meet the criteria outlined under the “Grid Rules.”  These rules are designed to assess disability claims based on three main factors: your age, your highest level of education completed, and your past employment history.  Satisfying the Grid Rules can be crucial in securing benefits, as the Social Security Administration uses these benchmarks to determine whether a claimant can adjust to other work given their impairments.

I represent a 54 year old laborer from Port Washington, NY.   My claimant’s highest completed education was the 5th grade, and he began working as a laborer during his teenage years.  He remained in this occupation until health issues, specifically cardiovascular problems and musculoskeletal ailments, prevented him from continuing.  Social Security classifies the laborer role as an unskilled occupation, meaning it does not provide transferrable skills that could be applied to other types of work.

In this case, the client’s doctors provided substantial support by completing questionnaires that clearly detailed the patient’s restrictions and limitations.  These medical opinions, combined with the client’s age, limited education, and unskilled work history, created a compelling record that led to his approval at the initial application stage.  Although the State agency attempted to delay the decision by requesting a Consultative Exam (“CE”), the evidence provided from the client’s treating physicians was so strong and conclusive that the CE was ultimately canceled. The approval was granted based solely on the evidence already in the file.

Obtaining a favorable decision from the Disability Determination Services (“DDS”) has become increasingly difficult. Rather than thoroughly reviewing claimants’ files, DDS analysts often overlook submitted evidence.  In many cases, it falls upon us to identify and direct the analyst to the relevant documentation within the file.  Effectively, this means doing both our job and part of the analyst’s job to ensure the claim is properly considered.

This case underscores the importance of retaining an experienced disability attorney when applying for SSD benefits.  An attorney can ensure that all necessary evidence is submitted and highlighted for review, increasing the chances of a favorable and expeditious decision.  For those considering an application, my office, located in Melville, NY in Suffolk County, offers a free phone consultation to assist with the process and answer any questions.