QR Increases on Approvals

It is no coincidence that all of our cases approved by the State agency at the initial and reconsideration levers are being reviewed by the Federal government's Quality Review ("QR") unit. The QR process process is supposed to select State agency decisions at random.  However, the QR unit only pulls approved cases to evaluate.  In most instances, the approvals are confirmed. 

For decades, only one or two of our cases annually would be selected for QR, and rarely overturned. We spoke to a State agency analyst who verified that almost every approved claim is currently being pulled for further examination. This new policy is counterproductive to efforts to reduce costs and spending.  Overturning approvals makes it harder for disabled people, who cannot work due to medical conditions, to receive Social Security Disability benefits. This alarming treatment of individuals with disabilities is deeply concerning.

Rare Remand Approval After a Decade

 A decade is defined as a period of ten years. Although this is a considerable length of time, it can feel especially prolonged for individuals who have been unable to work due to significant medical conditions and have had no income during this period. No dedicated worker anticipates experiencing such circumstances; however, these situations often arise beyond their control due to unforeseen health challenges.

We represent a sixty-year-old former NYPD police lieutenant from Massapequa, NY, who suffers from fibromyalgia, carpal tunnel syndrome, and pain and fatigue in her back, neck, and shoulder.  She worked 27 years for the NYPD.  She has been unable to work at any job since July 2009 due to her medical conditions.  She had hoped to return to work, but her condition never improved, even though she had surgery, physical therapy, medication regiments, and other medical modalities including injections and steroids.

On March 27, 2015, we applied for Social Security Disability (“SSD”) benefits, alleging a disability beginning on November 28, 2010.  The claimant has had strong supporting objective medical evidence from her treating neurologist, primary care doctor and physiatrist from the initial application.  After her claim was denied on September 5, 2015, we requested an administrative hearing.

On September 5, 2017, Administrative Law Judge (“ALJ”) Andrew Weiss held a hearing.  ALJ Weiss had two witnesses testify, Amy Leopold, a vocational expert, and Steven Golub, M.D., a medical expert.  Our client testified as well, with ALJ Weiss hounding her with every answer she gave.  We were horrified at the way he conducted himself during the hearing.

On October 25, 2017, ALJ Weiss denied our client’s claim without any substantial evidence for doing so.  He gave little weight to our client’s treating doctors, instead playing doctor and forming his own conclusions.  We appealed the case to the Appeals Council (“AC”) and submitted additional supporting medical evidence.  The AC not only upheld the ALJ’s denial on September 10, 2018, but declared that our additional evidence would not change their opinion and did not even consider the evidence.

We filed a lawsuit in Federal Court.  On November 20, 2020, Federal Court district Judge Joan M. Azrack remanded the case back to ALJ Weiss.  She found numerous, serious flaws in ALJ Weiss’s analysis of our client’s case beyond giving our client’s treating providers little weight.   In her decision, she pointed out that the ALJ relied on incorrect dates at multiple points in his analysis of the claim and referred to irrelevant periods of time.  She even stated “Additionally, the Commissioner concedes that the ALJ “misunderstood or mischaracterized” the opinion of the medical expert, Dr. Golub…”.

Our client had to wait an additional nine months from Judge Azrack’s decision to have a second hearing with ALJ Weiss.  Incredibly, ALJ Weiss repeated the exact same errors in this decision that Judge Azrack had asked him to correct, and on September 2, 2021, he again, denied our client’s case, claiming that our client had the residual capacity to perform the full range of light work after previously finding she could only perform sedentary work.  We appealed the decision again to the AC, and on February 23, 2023, eighteen months after ALJ Weiss’s second denial, the AC “found no reason under our rules to assume jurisdiction”  In other words, they upheld ALJ Weiss’s second denial.

We immediately filed another appeal in Federal Court where the case was assigned to Honorable Unites States District Judge Gary R. Brown.  In a decision dated January 10, 2024, Judge Brown criticized ALJ Weiss for repeating the same errors as he did in his first denial, and for his blatant mishandling of the medical expert testimony.  Judge Brown concluded that ALJ Weiss based his decision on “non-existent” opinions  from “non-existent doctors.”  Judge Brown reprimanded ALJ Weiss for not developing the record and remanded the case back to be heard by a different ALJ.

Thirteen months after Judge Brown’s remand, our client’s third hearing was heard on February 11, 2025, by ALJ Alan Berkowitz,  ALJ Berkowitz denied the claim on February 28, 2025, concluding that the claimant was able to perform light work by repeating the same errors that ALJ Weiss had committed.

Bypassing the AC, we appealed the claim directly to Federal Court.  Once again, the case was assigned to Judge Brown.  The attorneys representing the Social Security Administration (“SSA”) were afraid to defend ALJ Berkowitz’s decision.   In an extremely rare decision, Judge Brown accepted the SSA’s stipulation to have the AC issue a fully favorable decision, concluding that our client was entitled to received SSD benefitss stipulation to have the AC issue a fully favorable decision, concluding that our client was entitled to received SSD benefits.

 

ALJ Reverses DDS's Denials

Obtaining Social Security Disability (“SSD”) benefits can be a long and frustrating process, especially for claimants whose disabilities are not always visible. A recent fully favorable decision for one of our clients illustrates how thorough medical documentation and effective legal representation can make a difference.

We represented a 52 year old client from West Babylon who suffered from post-concussion syndrome, cognitive disorder, chronic migraine headaches, and anxiety and depressive disorders.  These impairments caused persistent symptoms such as severe headaches, brain fog, memory problems, difficulty concentrating, fatigue, and emotional distress. Despite ongoing treatment, her condition showed little improvement.

From the outset, extensive and consistent medical evidence supported this case. Multiple treating providers documented her symptoms, limitations, and lack of meaningful improvement over several years.  Detailed records showed near-daily migraines, cognitive deficits, difficulty using computer screens, and significant mental health struggles.  Despite the strong medical support, a Social Security disability analyst from the State agency denied our client’s application at the initial and reconsideration levels.  Unfortunately, these early denials are common and often occur even when substantial evidence is present in the file. 

We requested a hearing before an Administrative Law Judge (“ALJ”).  At this stage, the case finally received the individualized attention it deserved. The ALJ carefully reviewed the medical evidence, hearing testimony, and medical opinions.  The ALJ determined our client was limited to less than a full range of light work, to only simple, routine tasks, to being off-task 15% of the workday, and to missing work two days of work each month.  Based on those limitations, the ALJissued a fully favorable decision.

This case highlights several important realities about the SSD review process.  Strong medical evidence alone is not always enough at the early stages as many valid claims are denied by the State agency analyst. Frequently, a hearing provides the best opportunity for a full and fair evaluation.

Navigating this process without guidance can be overwhelming. With our knowledgeable representation, our clients are better positioned to obtain the benefits they deserve.

Mental Health Approval

Social Security Disability (“SSD”) benefits are not only for older individuals or those with physical impairments. Serious mental health conditions can be just as disabling. Unfortunately, younger applicants often face greater challenges because Social Security frequently believes they can adjust to other types of work even if they cannot perform their past work. Our client’s case shows how proper legal representation can make a critical difference when seeking SSD benefits.

We represent a 36-year-old woman from Huntington with a long history of mental health conditions, including PTSD, panic disorder, generalized anxiety disorder, chronic depression, PMS disorder, and ADHD. After she applied for SSD benefits on her own and was denied, she contacted our office to take over her case. We strengthened the medical and vocational evidence, and secured confirmation from her doctors that she was significantly limited in her ability to function in a work setting, which became a key part of her case.

Ultimately, we requested a hearing before an Administrative Law Judge (“ALJ”). At the hearing, a vocational expert evaluated whether jobs existed in the national economy that our client could perform. Based on the mental health limitations, the expert testified that there were no jobs our client could perform on a sustained, full-time basis. After reviewing the evidence and testimony, the ALJ approved her application for SSD benefits. This case exemplified the difficulty that younger individuals with mental health conditions face with the disability process. With our experienced representation, recognizing the type of medical support needed, and careful preparation, our client was able to secure the SSD benefits she deserved.

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.