FAQ

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

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.

The Medical Summary Report (MSR) Interview Guide and Template is a great tool for writing the MSR. The Interview Guide portion contains key questions to ask applicants when gathering evidence for the application. The Template contains main headings that may be used when formatting the MSR. Be sure to remove the Interview Guide and guidance under the Template headings before turning the MSR in to DDS. It is also important to put the MSR on your agency's letterhead whenever possible.

This guide and template can be found on the SOAR Tools and Worksheets page.

The expectation is that providers involved with SOAR do not charge persons applying for SSA disability benefits for their services. We work closely with providers to identify alternative sources of funding for their programs. All 50 states and the District of Columbia have identified various methods to fund SOAR activities that do not involve charging the applicant or collecting a fee from the applicant’s back pay. Resources related to SOAR funding and sustainability can be found in the SOAR Library.

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.

Great question! Check out our most up-to-date National Outcomes to see how SOAR-assisted applications compare to those without SOAR assistance.

We recommend using headings throughout the MSR to divide information so that DDS can quickly find the evidence they are looking for. These headings typically include: personal history, employment, physical health, psychiatric health, and functional information. You can include sub-headings in these categories to further organize the information if you’d like.

Naturally, information may overlap in some of the sections. For instance, in legal history you may talk about how an applicant’s incarceration was related to their symptoms and then add extra information about symptoms in medical history. In these areas of overlap, there’s no need to repeat information you have already provided. By avoiding excessive repetition in the MSR and grouping the information using broad headings, we can help walk DDS through the documentation of how the applicant meets the disability criteria.

The SOAR TA Center is available to review Medical Summary Reports from SOAR practitioners. To submit your MSR for review, email soar@prainc.com and attach your MSR with the applicant’s name, birthdate, and Social Security number removed for HIPAA compliance.

Trying to write the Medical Summary Report (MSR), a key component of the SOAR approach, can seem challenging at first. Everyone is going to have a different approach to writing that works for them.

We recommend starting with the Medical Summary Report Worksheet as a template.  Work on only one section in each sitting.  Breaking it up into smaller chunks can take some of the pressure off of writing a long report. It may also help if you don't set a target length. Think about just writing a letter that tells all you know about someone's Personal History, Psychiatric History, or Functional Information. If you can get a couple sections complete and then put them together, you will likely see that the MSR comes together easier than you anticipated.

For more information about Medical Summary Reports, see the SOAR Library.

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.

The SOAR TA Center does not have funds available to pay for SOAR in local organizations and there is no dedicated source of funding for SOAR programs. And yet, all 50 states participate in SOAR at some level by reallocating existing resources; by securing funding through federal and state grants or foundation funding; or by establishing collaborations with hospitals and criminal justice systems.

To support local organizations, the SOAR TA Center developed resources and tools for funding and sustainability, based on best practices from SOAR programs around the country. The SOAR TA Center also maintains a webpage dedicated to upcoming funding opportunities, which is updated frequently with new resources.