Individual has applied and is pending initial decision.
- Find out from SSA if the applicant has an authorized representative. If not, have the applicant sign the SSA-1696:Appointment of Representative.
- Contact the assigned DDS examiner to determine what information is there, what is needed, and how you might assist.
- Proceed as you would if it’s an initial claim. That is, collect any additional information and write a Medical Summary Report.
- Maintain communication with the DDS examiner.
Individual has applied, been denied and is awaiting hearing. No attorney is involved.
Hearings, scheduled through the Office of Hearings Operations (OHO), (formerly the Office of Disability Adjudication and Review (ODAR)), can take months to schedule. The SOAR service provider should:
- Become the individual’s representative by completing the SSA-1696: Appointment of Representative.
- Contact the hearings office and ask for a copy of the record or a compilation of the record. Send the SSA:1696 to the hearings office.
- If the applicant has additional information/diagnoses that were not known at the time of the earlier decision, request a review on record from the hearings office. Compile the new information and write/update a Medical Summary Report. This review on record enables a decision at the hearings office without waiting for an in-person hearing.
- Requesting a review on record does not deny a person a hearing. If the person is denied in this review, he/she simply waits for a hearing to be scheduled.
- If the person is scheduled for a hearing and does not have an attorney, contact Legal Aid, Legal Services or another pro bono legal service for representation
Individual has applied, been denied and is awaiting hearing. Attorney is involved.
Ask the applicant to sign a release of information so you can talk with the attorney about the case.
- If the applicant is homeless or has received an eviction notice, inform the attorney of this and ask that he/she request an expedited hearing.
- If there are concerns about the attorney representation, contact your local protection and advocacy agency to discuss these concerns.
- If additional information/diagnoses are available, ask the attorney to request a review on record and notify him/her that you will send the new/additional information to the attorney with permission from the applicant.
Appeals generally must be filed within 65 days of the denial letter. A request for an appeal may be accepted beyond the limit for “good cause.” For instance, an individual who is homeless, in a hospital, or incarcerated may not have received a denial letter. A letter to SSA from the service provider requesting that the appeal be accepted for “good cause” and explaining the reason why is required.
Levels of Appeal:
- RECONSIDERATION: Available in most states. This is a paper review done at the DDS by a different examiner. The forms to request a reconsideration are SSA-561 (Request for Reconsideration) and SSA-3441 (Reconsideration Disability Report). Any new sources identified at the reconsideration level should be noted on the Reconsideration Disability Report and a release of information (SSA:827) completed to address these new sources.
- HEARING: Done before an Administrative Law Judge. These can take a long time to schedule.
- APPEALS COUNCIL: If the person is denied at a hearing, he/she may appeal to the Appeals Council, a reviewing body of SSA.
- FEDERAL COURT: This is the last appeal level, not typically used.