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.

To win a disability case at any age, you must still:

• Demonstrate you cannot return to your past work
• Show medically determinable impairments
• Prove functional limitations

Your birth date doesn’t change these requirements. Whether you’re 35 or 65, you must prove that you have limitations in your capacity to reliably perform work.

But here’s where things get interesting: once your age category changes, Social Security’s vocational analysis shifts in a way that rarely gets explained to the public.

What Really Happens at 55: The Vocational Lens Turns Toward Reality

At age 55, Social Security formally classifies you as being of “advanced age.” That label isn’t just cosmetic—it reflects a built-in assumption baked into the system:

Older workers face far greater challenges adjusting to new work.

Once that assumption enters the analysis, several vocational rules move sharply in the claimant’s favor.

The “Grid Rules” suddenly work for you. At light and sedentary exertional limits, a claimant who cannot return to their past work may suddenly fall under a “disabled” grid rule—where a 49-year-old or 54-year-old with the exact same medical limitations would not.
Transferable skills become harder to prove. At advanced age, skills must transfer with almost no vocational adjustment. Even small differences in workplace tools, processes, or environments can defeat transferability.

Non-exertional limitations carry more weight. Pain, fatigue, medication side effects, postural restrictions, manipulative limits, stamina issues, or mental health symptoms shrink the available job base more meaningfully for older workers.

In other words: age doesn’t change the impairment; instead age changes what that impairment realistically means in the labor market.

The Contradictions Hidden in Plain Sight

For all the clarity these age-based rules bring, they also expose deep inconsistencies in how disability cases are decided.

Birthdays create artificial cliffs. The system relies strictly on chronological age. Someone who is 54 years and 10 months may be vocationally identical to someone who is 55 years and 1 day but the rules treat them very differently.

SSA helps older claimants but won’t say so. The grid rules plainly benefit older workers. Yet Social Security rarely frames it this way. Age is publicly described as a neutral “vocational factor,” not a benefit driver even though age changes outcomes more dramatically than many functional findings do.

The rules reflect an outdated economy. The grid rules were designed when the labor market was far more physical and less flexible. Some policy experts argue they’re no longer relevant in today’s economy and influential intellectuals at several Washington, D.C. think tanks are pushing the Trump Administration to remove age as a consideration. Those of us representing real claimants in real life counter that older workers still face the same challenges—or greater ones—when trying to retrain or transition to new fields.

Small details trigger huge outcomes. A one-level shift from light to medium residual functional capacity (RFC), or a minor finding on skill transfer, can completely reverse a case outcome—even when two claimants have nearly identical real-world job prospects.

These contradictions explain why the system feels both predictable and arbitrary, depending on where you happen to fall.

Examples of How Age Impacts Disability Adjudication

A few concrete examples make the paradox unmistakable.

Example 1: Light RFC + Unskilled Work History

Age 54: Denied at step five—vocational witnesses testify that jobs exist
Age 55: Approved under Grid Rule 202.06 or 202.04 with identical limitations

Example 2: Sedentary RFC + Limited Education

For many older claimants, this combination triggers a grid rule leading directly to “Disabled.”

Example 3: Borderline Age Cases

A claimant a few months shy of 55 may still qualify under the higher age category if other factors support it.  Here is a link to the borderline age regulation.

Same medical facts. Same functional limits. Different vocational interpretation—because age shifts how “realistic” job adjustment is presumed to be.

What This Means If You’re Approaching 55

The age rules don’t replace medical findings—they amplify them. This means several strategic elements become critically important for advanced-age claimants:

• RFC documentation must be precise. Small variations in exertional classification have outsized consequences once age 55 enters the picture.
• Work history forms must be accurate and detailed. Skill level, duties performed, tools used—these details often determine whether transferable skills exist.
• Borderline age arguments can’t be overlooked. They can change outcomes in a narrow set of cases, but only when properly raised and supported.

The Truth the System Won’t Say Out Loud

Social Security is designed to make age appear as though it plays only a minor supporting role. But in practice, age 55 is the moment the analysis fundamentally shifts. It stops asking whether an older claimant could theoretically do something new and starts asking whether it’s credible to expect them to succeed in a new field.

That’s the Age 55 Paradox: the rules quietly recognize something that public-facing guidance avoids saying outright: older workers don’t transition the way younger workers do.

And the disability framework finally reflects that reality but only after the medical case is already made.

The post The Age 55 Paradox: How Social Security Quietly Shifts Disability Outcomes appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

Basically the grid rules change the definition of disability. If you are a younger (under age 50) claimant, in order to win disability benefits you have to prove that you are not capable of reliably performing any job that exists in the United States economy.

After age 50, and even more so after age 55 and especially after age 60, you don’t have to prove as much to win. At age 50 you can win even if you have the capacity to perform sit down (“sedentary”) work. At age 55 you can be found disabled even if you can perform light work.

Light work is defined by SSA as having the capacity to stand and walk for six hours or more per day and to lift 20 lbs. about 1/3 of the day. Lifting 20 lbs. for 2 hours per day is not easy – but under the Grid Rules you can still be legally “disabled” even if you have this capacity.

The grid rules are a great argument for anyone over 50 but especially those over age 55.

Not surprisingly there is a catch to using the grid rules. First you must have a physical impairment – you cannot use the grid rules for mental health issues or non-physical impairments.

Second, and this is critical – you must not have any skills that transfer to a lighter job.

The borderline age rule allows Social Security adjudicators and judges to apply the grid rules even if you have not yet celebrated a birthday that will put you into the next age category. If a person is “within a few days to a few months” of the next category, SSA does not apply the age limits strictly.

Example: How Borderline Age Can Unlock Thousands in Back Pay

Let’s say you are:

• 54 years and 7 months old at the time of onset
• Unable to perform your past relevant work
• Limited to a light residual functional capacity status due to one or more medical impairments
• Unable to use any skills you may have acquired because of distractions due to severe pain (i.e., no transferable skills)

Under a strict reading of the grid rules, you would fall within the “closely approaching advanced age” category at onset. A judge might find you disabled as of your 55th birthday but you would lose out on 5 months of past due benefits.

But if the judge applies borderline age rule and treats you as if you were age 55 then you would meet the grid rule and qualify for that extra 5 months of benefits. If your monthly payment is $2,000 per month, those extra 5 months would put another $10,000 in your pocket.

Further, the borderline age rule can keep you qualified for SSDI if your date last insured has run out. Continuing with our example from above, if your date last insured was 2 or 3 months prior to your 55th birthday, you would not meet the grids at light but applying the grids non-mechanically would mean that you could fit into the grids as of your date last insured, even before actually turning age 55.

In my experience disability adjudicators rarely invoke the borderline age rule independently. Judges sometimes do, but more often than not you have to ask. So if you are just under one of these important age categories, do not forget to argue that the borderline age rule should apply to your claim.

The post Unlock Thousands in Social Security Disability Back-Pay with the Borderline Age Rule appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

Anticipated Service Disruptions

SSA has furloughed about 6,200 employees out of roughly 51,800. However, about 88% of staff remain working on essential functions. This is higher than in prior shutdowns, which should limit disruption compared to 2013.

What we Expect:

Customer Service: Phone wait times will rise; many calls may go unanswered.

• Field Offices: Field offices will continue taking benefit applications and processing post-entitlement actions that impact payments, but with reduced staffing creating longer waits and limited walk-in availability.
• We are already having problems with field office personnel wrongly refusing to speak to us. NOSSCR (an advocacy group of which I am a member) has communicated this concern to SSA and I expect that this particular issue will be resolved within the next week or two.

Documentation Services: Benefit verification letters, replacement cards (except original and replacement Social Security cards, which will continue), and non-claims-related earnings record corrections will not be processed during the shutdown

Medicare Cards: Replacement Medicare cards will not be issued during the shutdown

Online Services: SSA’s online portal will remain operational, but technical support will be unavailable

Overpayment Processing: Suspended for the duration of the shutdown.

Here is a link to SSA’s contingency plan for the shutdown.

Thanks to my friend and colleague Karl Osterhout and to NOSSCR.org for providing up to date information about the impact of the shutdown on SSA operations.

The post What Does October 2025 Government Shutdown Mean for Social Security? appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

Can You Use SSA’s Blue Book of Listings to Win Your Lyme Disease Case?

Unfortunately, Lyme disease is not listed in SSA’s Blue Book of Listed Impairments. However, you can argue that your impairments equal a listed impairment. The listings I most frequently look to include:

• Listing 14.02 (Systemic Lupus Erythematosus)
• Listing 14.09 (Inflammatory Arthritis)
• Listing 11.17 (Neurodegenerative Disorders) –  if neurological involvement is well documented

In order to show that a Lyme case equals one of these listings, you would have to provide well-supported medical opinions which clearly explain how the combination of your symptoms is functionally equivalent in severity to the criteria of a listed impairment.

In my experience State Agency adjudicators are usually not very receptive to the argument that Lyme Disease equals one of these listings. While I have had some success making this argument to an Administrative Law Judge at a hearing most judges will decide Lyme cases under a functional capacity analysis.

How Do You Win a Disability Case When There are No Objective Tests to Assess the Severity of your Lyme Symptoms?

Lyme Disease cases pose a challenge because there are no objective tests like MRIs or CT scans to assess the severity of your symptoms. While there are tests to confirm that you have Lyme, these tests do not offer your doctors any insight as to the symptoms you might be experiencing.

By contrast, in a back pain case, an MRI showing a herniated disc with spinal cord compression can be associated with symptoms of back pain and radiating pain and numbness into the legs. There is no such test to assess Lyme symptoms.

Currently doctors identify symptoms based on what you report – in other words the evidence of your functional impairment is subjective, not objective. Social Security disability decision makers are much more comfortable approving cases where there is clear objective evidence of functional impairment.

SSA evaluates disability based not on your diagnosis, but on how symptoms impair your functional capacity. This is the essence of the residual functional capacity (RFC) determination under SSR 96-8p, which requires a function-by-function analysis of what the you can still do, despite your limitations.

For PTLDS, common limitations often include:

• Inability to sustain attention for extended periods
• Severe fatigue leading to frequent unscheduled breaks
• Sensory issues, like light or sound sensitivity
• Chronic pain interfering with manual dexterity or mobility

Under SSA law, disability judges are required to consider how symptoms of “invisible illnesses” like Lyme Disease wax and wane over time by reviewing the entire medical record. Further, Social Security Ruling 16-3p requires adjudicators and judges to assess the “intensity, persistence, and limiting effects” of symptoms based on the full record.”

This is why it is so important for you to visit your doctor regularly, seek treatment with a specialist, and follow all recommended treatment. While it may seem futile to continue to visit your doctor when there are no effective treatments for your Lyme symptoms, SSA expects to see a “paper trail” of treatment records if you hope to win.

What Can You Do About SSA Consultative Examinations that Cast Doubt on Your Credibility?

SSA often orders consultative exams (CEs), which may last only 15–30 minutes and lack access to long time treatment records. In years past, SSA was required to give more weight to the opinion of a treating physician over that of a CE doctor who saw you for less than an hour. However, SSA eliminated the “treating source” rule and now adjudicators and judges can deny a claim based on the report of a CE physician or even a non-examining medical consultant over the opinion of a doctor who has treated you for 15 years.

In my experience State Agency adjudicators will rarely approve an “invisible illness” case if there is a CE report that minimizes your symptoms. However disability judges usually recognize that a long time treating physician – and especially the opinion of a specialist – almost certainly has more value than the observations of a storefront industrial clinic doctor who saw you for a CE. Most judges also recognize the limitations associated with a 30 minute CE appointment.

In cases where I have to rebut the conclusions of a CE doctor I focus on

• CE’s failure to consider claimant’s full history
• Inadequate testing (e.g., no neurocognitive screening)
• Lack of familiarity with Lyme/PTLDS-specific functional effects

Arguing for Approval Under a Functional Capacity Theory of Disability

If you are under the age of 50, in order to win you have to prove that your “residual functional capacity” has been so eroded that even simple, unskilled entry-level sedentary work would not be possible because:

• You would be off-task more than 15% of the work day
• You would miss more than one to two work days per month
• The combined effect of your symptoms and medication side effects would not allow you to physically or cognitively perform the duties of a simple job.

At hearings, disability judges bring in vocational witnesses to answer hypothetical questions about your capacity to reliably perform a simple, entry-level, sit down job.

Since judges know what factors will prompt a vocational expert to identify jobs that exist for any set of factors included in a hypothetical question, it is easy for a judge who wants to deny your claim to create a hypothetical question that supports a denial.

In my experience it has been increasingly difficult for anyone under age 50 to win disability benefits and this is especially the case for those pursuing benefits based on subjective reporting of symptoms, which is the case in Lyme Disease. Therefore if you are under the age of 50 there needs to be extensive treatment records documenting truly severe symptoms. Further judges will expect to see evidence of visits with specialists and unsuccessful trials of various treatments.

If you are over the age of 50, and even more so if you are over the age of 55, the odds begin to shift in your favor.

Because Lyme Disease can and often does produce symptoms that limit you physically, you can argue for disability under the Grid Rules as well as a functional capacity argument.

In several recent Lyme cases I have successfully argued that Grid Rule 202.06 applies because Lyme, especially cases where treatment was delayed, can cause both physical and cognitive limitations and negate any transferable skills.

While it is always helpful to have treatment records from specialists in the file of a 50+ claimant, there is an unspoken bias in the SSD system in favor of older claimants. Although the grid rules only apply to cases where there are physical (exertional) impairments, your over 50 status will help you even if your primary Lyme impairments are cognitive or fatigue based. SSA recognizes that claimants over the age of 50 with a significant medical issue will have a very difficult time finding a new job.

Use Non-Medical Evidence to Strengthen Your Case

Lay evidence from family, friends, or (especially) former coworkers—submitted via the SSA-3380 form or narrative statements using form SSA-795 can strengthen your case.

These third-party statements are particularly effective in documenting:

• Daily fatigue and need for rest
• Difficulty with memory, attention, or completing tasks
• Mood changes or social withdrawal
• Changes in personal hygiene, routine, or mobility

Without question, SSA makes it difficult to win disability benefits because of symptoms associated with Lyme Disease. However, it has also been my experience disability judges uniformly recognize that Lyme Disease is a real and legitimate ailment so the challenge is to prove that your symptoms create a work preclusive level of impairment.

So if you are struggling with symptoms associated with chronic Lyme Disease and do not have the stamina or mental capacity to hold a job, the disability option may be a viable path forward.

The post Winning Social Security Disability Claims for Lyme Disease: What Works for Me appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

What Is a Continuing Disability Review (CDR)?

• The passage of a designated review period (SSA puts a code on every claim classifying it as one where medical improvement is likely, possible, or not likely at all. If your claim is coded as “medical improvement is likely’ you will be reviewed often.
• Your age – in my experience claimants over age 50 generally face fewer reviews than those under 50
• A tip or report suggesting medical improvement.
• Your return to work (remember that the IRS shares earnings record information with SSA).

SSA uses two types of reviews:

1. Long Form Review: This involves collecting and evaluating updated medical records. SSA may send you forms like the SSA-454 (Continuing Disability Review Report) and SSA-827 (Authorization to Release Medical Information)*.

2. Short Form Review: A less intensive review using the SSA-455 (Disability Update Report). Based on your responses, SSA may decide to continue benefits without a full review.

What Happens If SSA Moves to Terminate Your Benefits?

If SSA determines that you are no longer disabled, they will issue a Notice of Cessation, which is letter explaining the termination of your benefits. From the date of the notice, you have:

• 60 days to appeal** by filing a Request for Reconsideration of the cessation.
• If you file your appeal within 10 days, you can elect to have your benefits continue during the appeal process by completing form SSA 792.

This decision – whether to continue benefits during appeal or not –  is perhaps the most crucial choice you’ll face in the CDR process.

Should You Elect to Continue Benefits During Your Appeal?

Pros of Continuing Benefits:

Ongoing income: Disability benefits often cover essential living expenses like rent, food, and medical care. Electing to continue benefits can provide a financial lifeline while your appeal is pending.

Cons of Continuing Benefits:

No past-due benefits: If you win your appeal after electing continued benefits, there will be no “past due” lump sum for an attorney to receive as a fee. This creates a significant barrier to hiring a lawyer under a traditional 25% contingency fee. More specifically you would have to pay a lawyer several thousand dollars up front to represent you in an overpayment case

Risk of overpayment: If you lose your appeal, you will be responsible for repaying all benefits paid during the appeal period which can add up to tens of thousands of dollars over one to two years. Currently this type of overpayment is dischargeable in bankruptcy but that is not an ideal solution for many people.

Medical Treatment: Your Best Defense Against a CDR Termination

The most effective defense against losing benefits during a CDR is consistent, documented medical treatment. SSA’s decision to continue or terminate benefits is based on whether your condition has medically improved and they need medical records to evaluate that question.

Here’s Why Ongoing Medical Care Is So Important:

1. Creates a Strong Paper Trail: Regular treatment generates continuous, dated records.

SSA uses the term “longitudinal treatment record” when it refers to on-going assessments and treatments of chronic and worsening symptoms, treatment resistance, or permanent limitations.

2. Supports Functional Limitations:

Doctors’ notes, physical therapy evaluations, pain management reports, and mental health notes can all document how your impairments limit your daily functioning.

3. Demonstrates Credibility:

In my experience, SSA is more likely to believe a claimant who actively seeks care than one who goes months or years without treatment. My experience has been that Social Security equates no treatment with no problems. SSA does not care that you can’t afford treatment or that there is nothing that a doctor can do for you – if you do not go to the doctor, SSA will assume that you are not going because your medical problems have resolved.

4. Refutes “Medical Improvement”:

To terminate benefits, SSA must find that there has been medical improvement related to your ability to work.  A detailed and thorough medical record showing ongoing or worsening impairments undercuts this conclusion.

5. What You Must Do:

• Don’t skip appointments: Missing care, even for understandable reasons like lack of transportation or money, weakens your case.
• See specialists: The more qualified the provider, the more weight SSA gives their opinions.
• Keep a treatment journal: Note your symptoms, how your conditions affect your activities, and any medication side effects. This information can be shared with your providers and SSA.
• Ask your doctors to complete functional capacity forms. These forms identify specific activity limitations associated with your medical condition and can be very persuasive to SSA. Here are two sources of free FCE forms you can use:
  • Mike Murburg’s FCE forms
  • HowToGetOn FCE forms

Practical Tips for Dealing with a Notice of a Continuing Review

1. Respond Promptly: Whether you receive a mail-in form or full CDR paperwork, respond quickly and accurately. Failure to respond can result in an automatic cessation.

2. Organize Your Records: Keep copies of all medical visits, test results, prescriptions, and therapy sessions. Being proactive helps your attorney (if you have one) prepare a strong defense.

3. Be Honest: Exaggerating your symptoms can backfire. SSA reviews your activities and may use surveillance or social media to challenge your statements.

4. Understand the Timeline: Reconsideration decisions can take 6 to 12 months. If denied, the appeal proceeds to a hearing before an administrative law judge, which can take another 12 to 18 months. Be prepared for a long process.

How Can an Attorney Help You Avoid CDR Problems?

If you have been approved for disability benefits and SSA has not contacted you about a possible CDR, there is really no need hire a lawyer. As noted above your best course of action would be to continue going to the doctor, keeping a symptom/pain journal and keeping copies of your medical records.

If you are thinking about trying to return to work full time or part time, your attorney can be a good resource for understanding SSA’s trial work period and substantial gainful activity income limits.

I am happy to answer questions from my past clients about post-approval work activity at no charge. This is part of my on-going responsibility to my client base.

I also sometimes hear from disability claimants who I did not previously represent who have questions about CDRs. I try to answer questions from non-clients in blog posts or on my weekly livestream, and I am available for consultations for a nominal fee.

Final Thoughts: Plan Ahead and Stay Vigilant

A Continuing Disability Review is not something to take lightly. SSA may only review your case every few years, but when they do, the consequences of not being prepared can be severe. Choosing whether to continue benefits during appeal and ensuring ongoing medical care are two pivotal factors that can determine the outcome of your case.

If you are receiving disability benefits, the best time to prepare for a CDR is now. Stay engaged with your medical treatment, document your limitations, and keep your contact information current with SSA. If you do receive a CDR notice, act quickly and contact your lawyer for help navigating this complex process.

The post Continuing Disability Reviews – What You Need to Know appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

You Do Not Get to Keep Your Social Security Disability Lump Sum Payment

Unfortunately this offset also applies to the lump sum payment that SSA will send you for past due benefits. Assuming that the onset date for Social Security disability was after the start date of your LTD payments, the insurance company will require you to turn over your lump sum payment when you receive it.

Needless to say, it is very upsetting to receive a check in the mail from SSA in the amount of $30,000 for past due benefits, only to have the LTD carrier demand that you turn that payment over to them.

Their argument, by the way, is that your monthly premiums were kept low by the expectation that your Social Security disability payment would reduce the insurance company’s obligations.

The Insurance Company Will Pay Your Legal Costs in Your Social Security Disability Case

The only positive element to this arrangement is that the LTD carrier will not require you to repay the portion of your lump sum that was used to pay your Social Security attorney. You will not have to pay back money you never received.

So if your total past due payment was $24,000, and SSA paid your attorney 25% ($6,000), the insurance company will ask you to pay them back $18,000, since that is all that you actually received.

In essence, therefore, the LTD carrier ends up paying your legal fees to win your Social Security disability claim.

Why Bother Filing for Social Security Disability at All?

Why, you may ask, should you even bother filing for Social Security disability if winning will not change what you receive each month?

There are two answers to this question.

First, you don’t really have a choice – the LTD insurance company will require you to file for Social Security disability. If you refuse they can cut you off completely.

Second, winning Social Security disability does give you a margin of safety. LTD companies can be aggressive when it comes to finding a reason to cut you off. They may claim medical improvement. They may base a termination on an absence of medical treatment. Further, many LTD policies change how they define “disability” after one or two years.

I have seen policies that define disability in terms of your inability to perform the duties of your own occupation for the first two years, then it changes to “any occupation” thereafter. I have also seen policies that limit payment to one year or two years if the underlying medical issue is mental health.

If you have Social Security disability in the “background” you are protected from arbitrary decisions by the LTD carrier.

Further, your Social Security disability payment will include cost of living increases and you will become eligible for Medicare.

So, while the advantage to you in winning Social Security disability may not seem important now, it actually can a vital safety net be down the road.

Should You Let the Insurance Company Choose Your Social Security Representative?

Finally, what should you do if the insurance company offers to provide you with a representative to assist with your Social Security disability claim? Should you agree to use their representative or choose your own?

In my experience, the companies that LTD carriers make available to LTD claimants are non-attorney representative companies who employ case managers to process your claim along with hundreds of others. The biggest complaint I hear about these non-attorney rep firms has to do with communication – you will typically have to go through a voice mail tree to reach a live person.

Further, to my knowledge, none of these non-attorney rep firms actually try cases. They hire contract lawyers to appear at hearings – I know this because in the past I did contract hearing work for several of these companies. At that time, the non-attorney rep firm would pay around $450 to $500 for a hearing. Typically I would get a file two or three weeks prior to the hearing and I would review the file and appear at the hearing.

I think that the bigger concern is one of confidentiality. Remember that the LTD company will be looking for a way to cut you off. By hiring one of their agents (remember these are non-attorneys who are not subject to rules about client confidentiality) you are making available to the insurance company all of your medical records. Further, any communication you make to the non-attorney rep firm becomes part of your file and can be used against you.

The good news is that every LTD insurance company I have dealt with has no objection if you choose your own attorney. Further, if you sign up with a non-attorney rep firm but later choose your own attorney the non-attorney rep firm will withdraw.

In my opinion any representative working on your disability case should be focused on one thing – helping you, and not serving the interest of an insurance company. This is my opinion – others may disagree.

Takeaways…

• So, what you can takeaway from this post is as follows:
  most long term disability policies require to you file for Social Security disability
• if you win your Social Security disability case you will almost certainly have to repay any lump sum you receive back to the insurance company
• the long term disability company will not make you repay the portion of your lump sum used to pay your Social Security disability attorney, so, in essence, they will be paying your legal fees
• you are not bound to use the non-attorney rep firm that your LTD carrier may offer you

The post Why Your Long Term Disability Insurance Company Can Demand That You Turn Over Your Social Security Disability Lump Sum Payment appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.”

With very limited exception, workers’ compensation offsets Social Security disability dollar for dollar.

If you are receiving $500 per week from workers’ compensation (equal to around $2,150 per month) and your Social Security disability benefit is $2,000 per month, you will be subject a complete offset. (You can go to ssa.gov/myaccount to learn what your SSD benefit would be.) As long as you are receiving workers’ compensation, you will not be eligible for Social Security disability.

Because of this dollar for dollar offset, you will have a difficult time finding a Social Security disability lawyer to take your case under a “no fee unless you win” contingency fee contract. If there are no past due benefits payable to you because of a workers’ compensation offset, there would be no past due benefits to pay a lawyer.

What Happens if You Settle or are About to Settle Your Workers’ Compensation Case?

Once you settle your workers’ compensation case the offset can go away, but only if your settlement paperwork contains what is known as a “Hartman provision.” A Hartman provision says that for Social Security disability purposes your workers’ compensation settlement will be treated as if it was being paid out over your expected lifetime.

For example if your portion of a workers’ compensation settlement is $50,000 and you have an expected life expectancy of 35 years (420 months), the $50,000 will be treated as if it was payable to you at the rate of $119 per month. Since most SSD payments are around $2,000 per month, this offset is small enough such that you should be able to find a lawyer.

If there is no Hartman language in your workers’ compensation stipulation then the $50,000 settlement would offset the first $50,000 of Social Security payments, which in most cases would totally offset any past due benefit and leave nothing to pay a lawyer.

So, if I get a call or email from a potential client who is currently receiving workers’ compensation benefits, my most likely response would be to tell that person that I cannot help them now, but to call me back when their case is about to be settled. I would also tell that person to download their MySocialSecurity statement to look at their earnings record. Your eligibility for Social Security disability runs out when your earnings credits run out – usually about 5 years after you stop working.

As you can see, there are a lot of moving parts here. State law determines how much you can receive in workers’ compensation benefits and what your settlement options may be. There is the earnings credit/date last insured issue for Social Security disability. There is your expected lifespan calculation. There is the Hartman language issue for settlements. There is also a potential issue with Medicare if funds from your settlement are not set aside in your workers’ compensation case.

Because there are so many potential areas of trouble, you should avoid filing for Social Security on your own without speaking to both your workers’ compensation lawyer and a Social Security disability attorney.

Why Does the Offset Exist?

One final point – you may wonder why federal law calls for a workers’ compensation offset. Apparently our lawmakers think that an injured worker who now has a total disability would receive too much money if that person received both workers’ compensation and Social Security disability. Those who are in this situation would recognize the absurdity of this reasoning but this is how the law is written.

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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.

The post Comedian John Oliver Explores the Social Security Disability Mess appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

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.

Consider the job of photocopying machine operator. In the D.O.T., this job is classified as unskilled. 15 years ago, it was unskilled. You stood at a copy machine, loaded documents into the feeder and pressed “copy.”

Now, most offices (including mine) use their copiers as high speed scanners. Occasionally we make paper copies but most of the time, a person whose job it is to scan documents has to choose a destination, then go to a computer terminal to confirm the scan came through, then rename the document and save it in a particular directory.

Instead of being a one step process, making copies (scans) may involve 4 or 5 steps, computer skills and more intensive training. Rather than being an unskilled job, a copy machine operator is, in reality, a semi-skilled job.

Similarly, if you performed a job that would be considered semi-skilled or skilled 15 years ago, the skills needed for those jobs have most likely evolved as well.

Recently, in two separate cases, I represented clients at hearings who had been ultrasound techs. Both of them told me that this job has become significantly more physical over the past 15 years. 15 years ago the machines were less portable and many of their patients would come to them. Now, almost all of the patients they evaluated are bedridden. Further, both reported that the ultrasound tech job was much more physical because so many of the patients were obese. The ultrasound tech often has to push and hold a immobile, bedridden patient on his/her side while performing the ultrasound scan.

The D.O.T. classifies “ultrasound technologist” as a light job (lifting 20 lbs. occasionally) but it is now a heavy to very heavy job. One of my clients told me a job requirement for ultrasound techs in most hospitals requires a minimum of 50 lbs. lifting/carrying.

Further, ultrasound techs need to be computer savvy and well versed in software programs used by hospitals. So, a person who worked as an ultrasound tech in 2010 would almost certainly find that this job is significantly different in 2024 requiring both more skills and more lifting capacity. It is beyond time that SSA realizes this as well for many jobs.

The change in the past relevant work look back will make it more difficult for a disability judge to conclude that work you did 10 or 15 years ago is relevant to what you might be able to do now. If there are fewer jobs that might fit your vocational profile, then the more likely it is that the judge will find out disabled.

The post June 2024 Change in Past Work Look Back Benefits Claimants appeared first on Social Security Disability | Expert Help | Free Case Evaluation.

This is the 2023 Social Security disability “waterfall chart.”  It shows the approval/denial rates at all stages of the SSD process.  Compared to 2022, hearing approvals are down by around 6% (45% approval in 2023 vs. 51% approval rate in 2022).

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