SAMHSA SOAR

Reviewing Denial Notices and the Electronic Folder

To consider or prepare for an appeal after an SSI denial, reading and understanding SSA denial notices and forms is essential. SSA maintains an administrative folder for all claims that includes completed SSA forms regarding the child’s claim and other relevant medical and educational evidence.

About the Disability File

  • Understanding SSA’s rationale for denying SSI benefits is important when filing an appeal. It is important to assess whether SSA made any errors in the decision or if there is any medical documentation missing from the file. You can help by correcting these issues on appeal.
  • Even if you filed the applicant’s initial application, complete with medical records and other documents, other contents of the disability file are important to review.
  • A child applicant's parent/caregiver and authorized representatives (with a filed SSA-1696) have the authority to obtain relevant application information.

Requesting the Disability File

  • SSA keeps all new disability folders in an electronic format; paper folders are no longer generated.
  • The local SSA field office will provide one CD-ROM copy of the child’s case folder for free if the request is for “program purposes” (e.g. in connection with a claim for benefits).
  • Request the file by faxing a signed SSA-3288: Consent to Release Information to the attention of your local SSA field office. This form is co-signed by the parent/caregiver. Click here for a sample completed form (PDF).
Online access to SOAR applicants’ electronic folders or eFolders (EFs) is now available for Appointed Representatives (vis à vis SSA-1696) with ALJ hearing and Appeals Council level cases!  We strongly encourage you to enroll for online access to your applicant's eFolders. Read more about the benefits of enrollment and its multi-step process.

Opening the CD-ROM

  • No additional software is necessary to read the information on the encrypted CD.
  • The CD will be labeled with claimant’s last name and first 4 numbers of SSN.
  • For instructions on opening and decrypting the CD-ROM, read our article: Opening an Encrypted SSA CD-ROM.

Reviewing the File

Form SSA-831: Disability Determination and Transmittal

  • Form SSA-831: Disability Determination and Transmittal is the official disability determination document used by DDS to record the decision.
  • This form is helpful, especially when the denial notice is unclear. The form should contain the name of the DDS disability examiner and the DDS medical consultant who worked on the claim.
  • Separate forms are used for the initial and reconsideration determinations, and for each type of claim. 
  • One copy stays with the child’s folder, other copies go to other SSA offices; typically, the parent/caregiver or authorized representative does not automatically receive a copy.
  • Most of the information on the form are SSA codes; several key codes are highlighted below.
Important SSA Codes

  • Item 19 - States that the applicant is not disabled through the date of the determination (or other pertinent dates, such as expiration of insured status).

  • Item 22 - Citation to the Sequential Evaluation regulation under which a claim is denied.
  • Item 32B - This includes the specialty code for the doctor who signed the form.  Visit the SSA website to access the code translation chart.

Form SSA-4268: Explanation of Determination

  • This form states the “Disability Determination Rationale.” This is the technical rationale the DDS disability adjudicator used to make the disability determination.
  • This form may be attached to Form SSA-831, discussed above.
  • Although it may contain SSA technical language that you do not understand, it is in your best interest to look it over as it contains more detailed information than the personalized explanation rationale included in the denial notice.
  • By reviewing the technical rationale, you can see the step-by-step reasoning that SSA and DDS used to deny the child’s claim.
  • Generally, this form is not automatically mailed along with the Denial Notice. If not associated with the Denial Notice, you will need to request it from your local SSA field office.
How to Read Form SSA-4268
The technical rationale typically discusses the following: 
  • Symptoms and test results
  • Whether the impairment(s) meet the requirements of a Listing
  • Whether functional equivalency is met

Details

Type:
Child Course
Date:
April, 2018

Other Details

Topic
Appeals
Focus
Youth

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