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All posts by Jonathan.

The Appeals Council Is Not a Second Hearing: Understanding How it Works in Disability Cases

Appeals Council judge reviewing ALJ denialOne of the most common misunderstandings I hear from clients and visitors to my Wednesday evening livestreams has to do with the role of the Appeals Council. As you may know, if the hearing judge (called the Administrative Law Judge or ALJ) denies your disability claim, the next level of appeal is called the Appeals Council.

Many people assume the Appeals Council is simply a next step in the process—a second chance to tell their story and hope for a different result.

That is understandable, but it is not quite right.

The Appeals Council does not act like a second ALJ. It does not rehear the case, and it does not decide disability from scratch. Its job is much narrower and more technical. In most cases, it is not looking for a better answer. It is looking for a legal mistake.

Understanding that difference can mean the difference between a strong appeal and one that is almost certain to fail.

What the ALJ Does

To understand the Appeals Council, it helps to first understand the role of the Administrative Law Judge.

At the hearing level, the ALJ is the main decision-maker. The ALJ represents the Commissioner of the Social Security Adminstration and serves as both the representative of SSA and the finder of facts in your case.  This is where the case is developed, reviewed, and decided. The ALJ listens to testimony, reviews medical records, weighs medical opinions, and decides what the claimant can still do despite their impairments. Continue reading →

The Age 55 Paradox: How Social Security Quietly Shifts Disability Outcomes

When disability claimants first learn that turning 55 can dramatically change the outcome of a disability claim, they often assume it’s some kind of loophole, a kind of “soft retirement benefit” quietly built into the system. But it’s not that simple. What happens at 55 is more subtle, more structural, and far more revealing about how disability evaluation actually works.

The rules don’t explicitly say that older workers deserve a different standard. They don’t even acknowledge that aging itself should matter. Yet something fundamental shifts in the disability process the moment a claimant crosses that milestone birthday—a shift from asking what’s possible to asking what’s likely.

This is what I call the “Age 55 Paradox,” and understanding it is essential to navigating the entire disability evaluation process.

Age Alone Changes Nothing in Terms of How SSA Defines “Disability”

Let’s be clear from the start: turning 55 is never, by itself, a reason for approval. The Social Security disability standard remains grounded in medical severity, just as it always has been. This isn’t like Social Security retirement, where you automatically qualify upon reaching a certain age. Continue reading →

Unlock Thousands in Social Security Disability Back-Pay with the Borderline Age Rule

One often-overlooked rule in Social Security disability cases can mean the difference between approval and denial—or even add thousands of dollars in back pay to your client’s award. That rule? The “Borderline Age” regulation. You can read the actual regulation at https://secure.ssa.gov/poms.nsf/lnx/0425015006

I’ll exactly how the borderline age policy works in Social Security disability cases, why it matters, and how strategic use of this rule can significantly increase a claimant’s past due benefits. I have used the borderline age policy in several recent cases without any push back from judges and the net result meant thousands of dollars added to lump sum payments for my clients.

WATCH A SHORT VIDEO ON THE BORDERLINE AGE RULE

What Is the Borderline Age Rule?

The Borderline Age Rule comes into play when a claimant is close to aging into the next higher age category defined by the Social Security Administration (SSA). These categories are:

  • Younger individual: 18–49
  • Closely approaching advanced age: 50–54
  • Advanced age: 55–59
  • Closely approaching retirement age 60+

SSA uses these categories to determine how easily a claimant can adapt to other work, which is a critical factor in disability decisions under the Grid Rules (also known as the “Medical-Vocational Guidelines).” I publish a website explaining how the grid rules work – you can find it at https://gridrules.net. Continue reading →

What Does October 2025 Government Shutdown Mean for Social Security?

As all of you are undoubtedly aware, the federal government shut down on October 1, 2025 because Congress and the President could not come to an agreement regarding funding to keep the government open. The early indication is that this may last for some time. Understandably, this creates concern for our clients. Below is the best information available right now about how this might affect clients who are in the process of applying for benefits.

Benefits to Current Claimants

Clients already receiving Social Security, SSI, or SSDI benefits will continue receiving payments without interruption. This has been true in all 20 previous shutdowns since 1976, and disability benefits remain funded as “mandatory spending” outside of congressional appropriations.

Pending Claims and Applications

Hearings: The Social Security Administration (SSA) will hold already scheduled disability hearings.

Initial Applications: State Disability Determination Services will continue processing initial claims, but processing speed may vary because each state controls its own staffing and funding during a lapse. Each state must independently determine whether it can maintain operations (pay its employees) during a federal funding lapse. This could lead to some states processing claims more or less as usual, but others, more affected by the funding lapse, may be processing claims more slowly.

Appeals/Reconsiderations: These will continue but probably with reduced support staff, resulting in extended processing times. Continue reading →

Winning Social Security Disability Claims for Lyme Disease: What Works for Me

Lyme Disease and Social Security disabilityAs a Social Security disability attorney, Lyme disease cases represent a complex, frustrating, and often misunderstood type of disabling chronic illness. While the acute phase of Lyme disease is widely recognized and typically responsive to antibiotics, a subset of individuals develop long-lasting symptoms—often referred to as “chronic Lyme disease” or “Post-Treatment Lyme Disease Syndrome” (PTLDS). These cases are challenging both medically and legally, particularly when pursuing Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.

In this blog post I will discuss winning strategies that I have used over the past few years to develop a compelling case for benefits based on Lyme disease.

Lyme Disease – the Basics

Lyme disease is caused by a bacteria called Borrelia burgdorferi, transmitted by ticks. While early-stage Lyme disease is well understood, PTLDS is still gaining wider medical acceptance. A recent Johns Hopkins study found that 14% of early-diagnosed patients developed prolonged symptoms such as fatigue, musculoskeletal pain, and neurocognitive impairment. More recently the Wall Street Journal published an article entitled “Chronic Lyme Disease Acceptance Grows Among Doctors After Years of Debate.”

Interestingly, the aftermath of COVID-19 has offered the public and medical professionals a clearer picture of how infectious diseases can lead to persistent, debilitating post-viral syndromes. I believe that this context helps Social Security judges understand chronic Lyme within the broader framework of post-infectious disability syndromes. Continue reading →

Continuing Disability Reviews – What You Need to Know

continuing disability reviewWhen you are approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), that approval is not necessarily permanent. SSA is putting increasing efforts into conducting Continuing Disability Reviews (CDRs) to determine whether you still meet the medical criteria for disability. Members of Congress – both Democrat and Republican – are encouraging SSA to conduct more reviews because the Social Security trust fund is running out of money and they see CDRs as a tool to keep the disability trust fund solvent, and to avoid making difficult political decisions about actually fixing the problem.

In this post, I will explain what a CDR is, how the process works, the strategic decisions you must make if you receive a notice of intent to terminate benefits, and how ongoing medical treatment is your strongest line of defense.

 

Continue reading →

Why Your Long Term Disability Insurance Company Can Demand That You Turn Over Your Social Security Disability Lump Sum Payment

If you are receiving long term disability benefits, you can be certain that your LTD carrier will require you to file for Social Security disability. What is the practical effect of pursuing Social Security disability and how should you handle the insurance company’s request.

Most of the LTD policies I see are company provided. These company sponsored policies are sometimes called “ERISA policies” because the rules that govern how they are administered are set out in a federal law called the Employee Retirement Income Security Act of 1974 (ERISA).

If you worked for a company that gave you the option of purchasing short term and long term insurance as a payroll deduction, you almost certainly have an ERISA policy.

Under the terms of your ERISA policy you are required to apply for Social Security disability if your LTD claim is approved. Why? Because the insurance company has the right to offset what it pays you by what you receive from Social Security.

Here is an example – let’s say that your LTD policy pays you $2,500 per month if you meet the insurance company’s definition of disability. If your Social Security disability benefit is $2,000 per month, then the insurance company will reduce what it pays you to $500 per month since SSA is paying $2,000.

Your monthly payment remains at $2,500 per month but it will come from two sources instead of one. Continue reading →

Solving the Social Security Disability “Workers’ Compensation Problem”

If you have an active workers’ compensation case you most likely will find it difficult or impossible to find a Social Security disability lawyer to take your case. In this article I want to explain why this is and what you can do about it.

As you know workers’ compensation comes into play if you are hurt on the job performing an activity related to your job. Every state has its own workers’ compensation law and there is even a federal workers’ compensation system for federal employees. The common feature of all workers’ compensation laws is that you do not have to prove fault.

If you are hurt on the job, workers’ compensation is supposed to kick in automatically. If you are hurt and cannot work, workers’ compensation will (or is supposed to) provide you with employer paid medical treatment and weekly lost wage payments as long as you are unable to work.

If you have been involved in a workers’ compensation case you know that the insurance companies or agencies that oversee medical treatment and lost wage payments often do not act in good faith and many times you will have to fight to recover your benefits.

For purposes of this article, let’s assume that you were hurt on the job and that you are receiving “temporary total disability” financial payments for your missed wages. Let’s also assume that your injury is serious enough to qualify you for Social Security disability – not only can you not return to your job but your injury would prevent you from performing any job.

Does the law permit you to collect from both your state’s workers’ compensation system and Social Security disability?

Unfortunately, the answer to this question is “no.” Continue reading →

Comedian John Oliver Explores the Social Security Disability Mess

Comedian John Oliver takes a cynical and very funny look at the Social Security disability and SSI system.  For those of you caught up in the nonsense, the humor may be a little bittersweet but hopefully the attention he brings to Social Security disability will result in some positive changes.

June 2024 Change in Past Work Look Back Benefits Claimants

The Social Security Administration has made a significant change in disability claim evaluation by reducing the number of years it will look at your past work.

As of June 24, 2024, SSA will only consider the work you have performed during the past 5 years as “relevant.” Up until this point, SSA looked at your work history over the past 15 years.

This change will benefit disability claimants because it will be more difficult for SSA to argue that you have the skills or capacity to perform past work. This change reflects the reality that (1) jobs in just about every sector of the economy have changed significantly over the past 15 years; and (2) it reflects the reality that the Dictionary of Occupational Titles (the D.O.T. is a resource that described jobs in the U.S. economy but was last updated 40 years ago but still used by vocational experts at hearings) does not accurately describe most jobs.

In cases where the Grid Rules apply (claimants over age 50 with physical limitations), the new 5 year rule will reduce the likelihood that the vocational expert can identify transferable skills. In the absence of transferrable skills, the more likely that you will be found disabled under a grid rule.

In a broader sense, this change to the “past relevant work” look back makes sense. Most jobs have changed significantly over the past 15 years. Continue reading →

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