FAQ

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.

Most SOAR programs that have a hospital collaboration will work with the hospital’s billing department to collect information on reimbursed expenses for each SOAR applicant approved. Some are able to separate out Medicaid and Medicare reimbursements; others have just a total for all reimbursements. The information isn't any more complicated than: "We helped 100 individuals get approved for SSI/SSDI and the hospital has been reimbursed $500,000 in the past year in Medicaid/Medicare expenses for these individuals."  It can be helpful to also collect the totals for unreimbursed expenses for those same individuals for the year prior to approval to use as a comparison.  One SOAR provider looked at emergency room usage for the year prior and the year after approval to see if there was a reduction. They found a 24 percent reduction in ER usage and 52 percent reduction in psychiatric ER usage.

Some SOAR providers will meet monthly with the billing department and collect reimbursement data, others will do it quarterly.  We would recommend doing whatever works best for the staff at the hospital and the SOAR staff.  

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. 

You can also take a look at Prior or Pending Applications and other Appeals resources in the SOAR Library.

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.  

SSA considers any life insurance policy with a face value of $1,500 or higher. The face value is how much insurance you're buying, (e.g., $5,000, $10,000, etc.). The cash value is what you'd get for the policy if you cashed it in.  Since this person’s policies are valued at $3,700, they are over the resource limit for an individual ($2,000). In order to fall below the resource limit, they would need to cash in one (or more) of the policies depending on what other resources they have.  They would need to use/spend that money to live on before becoming eligible for SSI.  

If he is eligible for unemployment and the amount is more than the Federal Benefit Rate (FBR)*, then he should take the higher amount (unemployment) as long as he can.  The medical approval for SSI will last for 12 months, so if the unemployment only lasts a few months, he can always reapply for SSI (the non-medical application) and SSA will use the medical decision from his last application. 

*This figure is updated annually and can be found at SSA Annual Updates.

Generally, SSA will not count the retroactive (back-pay) SSI or Social Security benefits for up to nine months after the person receives them. This includes payments received in installments.

When the individual receives his/her award letter it should spell out the exact length of time s/he has to spend down the retroactive payments. If there is any confusion, definitely check with the local SSA office for specifics on the individual's case.  

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.

Read more at Prior or Pending Applications.

In certain circumstances, someone can get both SSI and SSDI. This happens when someone is approved for SSDI, but their monthly check is lower than the full SSI Federal Benefit Rate (FBR)*. This could be due to earning low wages throughout the employment history or limited recent work. In this case, the individual will receive SSI to supplement the payment to bring them up to the FBR. Since the Social Security Administration (SSA) discounts the first $20 of earned or unearned income an individual receives when calculating the SSI amount, a concurrent beneficiary will receive $20 above the SSI FBR.

*The Federal Benefit Rate changes annually and can be found at SSA Annual Updates.

If an individual becomes disabled before the age of 22 and one of his/her parents is either deceased or receives disability or retirement benefits, the "Disabled Adult Child" may receive benefits based on their parent's earnings record. SSA has an easy to use FAQ page about this topic: https://www.ssa.gov/planners/disability/qualify.html