Search
 

Tips for Pending Applications and Appeals

Here are some tips from the SOAR TA Center on assisting an applicant with a pending application or an appeal.

Scenario #1:

Individual has applied and is pending initial decision.

Strategy:

  • 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.

Scenario #2:

Individual has applied, been denied and is awaiting hearing. No attorney is involved.

Strategy:

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

Scenario #3: 

Individual has applied, been denied and is awaiting hearing.  Attorney is involved.

Strategy: 

  • 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.

General Information:

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.