Question: If an applicant wants to "fire" their attorney, will they have to pay them a fee?
Generally when an attorney is fired after the individual has signed the SSA-1696 (and possibly other binding documents with the attorney), the attorney has to file a fee petition with SSA defending their right to be paid. The attorney/representative must detail what services were performed while assisting the applicant. You can read more about the fee petition on the SSA website and see the form that is filed: http://www.ssa.gov/representation/fee_petitions.htm. SSA will determine whether or not the representative is granted the entire fee or a partial fee.
Question: Is the SOAR Online Application Tracking (OAT) Program HIPAA Compliant?
Yes, the SOAR Online Application Tracking (OAT) program is fully HIPAA compliant. The system does not collect any personally identifying information about applicants during any part of the process. When users add a new applicant to the database, they create a unique applicant ID. The use of this ID avoids the need for personally identifiable information and helps prevent case duplication.
The ID is a 10-digit alphanumeric in the following format: xx00xx0000 (2 letters/2numbers/2 letters/4 numbers). It can be any letters and numbers you choose - just be sure to note it in your hard copy records.
Additional demographic information collected about an applicant is limited to age (without birthdate) and gender.
Question: How do I become involved in SSI/SSDI cases that are already in process? What about cases that have been going on for a long time, such as those waiting for a hearing or appeal?
If the case is pending at the initial or reconsideration stage, you can become the applicant's representative via submission of the SSA-1696: Appointment of Representative form. You will then be able to communicate with SSA/DDS about the application and request access to the materials that have been submitted. After reviewing the person’s file, you'll know what needs to be addressed, just as when you are starting anew with someone. If the person isn't willing to have you be the representative, ask if they have one - if so, try to assist that person with what needs to be addressed.
If the person is waiting for an appeal hearing, it may be necessary for you to secure legal representation for them through agencies such as the state Protection and Advocacy organization, Legal Services, Legal Aid, or another kind of pro-bono legal service.
To help expedite a hearing, the applicant or their representative can submit a letter of "dire need" to the Office of Hearing Operations (OHO). The letter should describe the applicant's conditions, how they have worsened since the reconsideration was filed, and why they will worsen still if they are not granted an expedited hearing. You need to explain how the applicant is unable to get shelter, medical care, and/or food. Be as specific as possible and provide examples of the applicant's functional impairment. If you can reference medical records, that is very helpful. There is no guarantee that the administrative law judge will grant an expedited hearing, but it is worth trying.
Occasionally elected officials will send a form letter (a dire need letter of sorts) to OHO to inquire about the claim and to ask for an expedited process.
Question: Who do I contact to find out the status of a claim when the applicant is waiting for a hearing?
The second stage in the appeals process is when the applicant requests a hearing before the Administrative Law Judge (ALJ). These hearings are scheduled through the Office of Hearings Operations (OHO). Visit the SSA website to find the appropriate hearing office based on the applicant’s address or ask your local SSA field office.
Question: I am working with a person who has already applied for SSI and been denied. His request for reconsideration has also been denied. What can I do now to help? Is there anything I can do to speed up the process?
You can help the applicant file for a hearing before an administrative law judge. It is in the applicant's best interest to keep the appeals process going because if they are approved at the hearing level they will be eligible for back payments going back to the protective filing date of the initial application.
See our Appeals resources in the SOAR Library. Here you will find our Prior or Pending Applications document which outlines some of what you need to do at the hearing level. You'll want the applicant to sign the SSA-1696: Appointment of Representative form, if you haven’t already. Then, request their file from Social Security. Together, you'll need to complete the HA-501: Request for a Hearing and the SSA-3441: Disability Report- Appeal (available on SSA’s website). You'll also need to turn in a new SSA-827:Authorization to Release Information. Be sure to submit the Request for a Hearing within 65 days from the date of the denial letter. If you haven't already, request medical records, do the general and functional assessments, and write a Medical Summary Report (MSR) just as you would for an initial SOAR application.
The other thing we would recommend is to file for a review on record. This might help you to avoid a hearing and eliminate a long wait. People who are eligible for a review on record are those individuals who may have additional diagnoses/medical records that were not considered previously. This does not take them out of the line for a hearing. So, if they are denied at review on record, they are still eligible for a hearing.
Question: What is the rate of approval for applicants who do not use SOAR? The statistics appear positive but would be more useful if shown in comparison to the overall population of those applying and/or those who do not use SOAR.
Great question! Check out our most up-to-date National Outcomes to see how SOAR-assisted applications compare to those without SOAR assistance.
Question: What if a client is new to our program, and has already applied for and is in the appeal process for SSI? Can they still be considered for SOAR?
The SOAR process can definitely be used to assist applicants with appeals, as SOAR practitioners are often well positioned to assist given their relationships with applicants and knowledge of their impairments and related functional limitations. SOAR case managers can help by gathering additional medical records, writing a Medical Summary Report, and assisting with SSA forms specific to the appeal process. More information on assisting applicants with appeals, including a full issue brief with tips for practitioners, is available in the SOAR Library.
Question: Is it true that applicants always get denied initially and then win on appeal?
This is definitely something we hear quite a bit and a very pervasive rumor that an applicant has to be denied X number or times, or can only win on appeal. The truth is that if the evidence is in the initial filing showing that an applicant meets the criteria for SSI or SSDI, he/she will be approved at the initial stage. Using the SOAR model results in higher approval rates (see our national outcomes) because we focus on getting all of the information in the file from the beginning, whereas many people who are eligible for benefits are denied because they don’t have assistance in gathering this documentation.
Some lawyers who take fees for assisting with disability claims specialize in appeals and don’t provide the evidence in the initial stage – they wait for the application to be denied and then work on the appeal. For an application at the appeal stage to be successful, the vast majority of the time it requires new evidence that wasn’t originally presented (there are some cases that are overturned due to oversights at DDS). So, it’s not that DDS wants to deny the case from the beginning, they just didn’t have the right information. It doesn’t save them any money to automatically deny people and then send them to appeal (in fact, it actually costs them more money in adjudicator time, medical records requests, and consultative exams).
All of that said, we understand why people think this is true. The overall national approval rate for SSI/SSDI (without SOAR) is only 29%. So yes, that means 71% of people are denied. It's not possible to know how many applicants needed more evidence and how many just didn't meet the disability criteria, but it certainly leads to many myths about the process.
HALLEX (Hearings, Appeals and Litigation Law Manual) is a publication from the Social Security Administration's Office of Disability Adjudication and Review (ODAR). ODAR administers hearings and appeals for people seeking reviews of their applications for disability benefits. HALLEX contains policy statements from the SSA's Appeals Council, as well as procedures directed to lower levels of the SSA for carrying out the SSA's guiding principles