FAQ

Yes, we have a number of resources on the SOAR website to help provide information and guidance through the appeals process. They can all be found in the SOAR Library. I recommend starting with the article About Appeals and then checking out the Appeals Toolkit.

Most states have laws that regulate what health care providers can charge individuals for copies of their medical records. However, these rules do not necessarily apply to providers requesting records. In addition, some states provide an exception for records needed to apply for a disability benefits program and stipulate that they be provided at no-cost. For more information on state statutes and regulations regarding the collection of fees for medical records, click here.

If your state does not require a fee-waiver, we recommend contacting the director of the medical records department and advocating for or negotiating one. Explain that the individual is homeless and that you, as a mutual provider, are unable to pay for the records. Let the director know that the records will be used for a disability application and that, upon approval, the individual will likely be eligible for Medicaid and/or Medicare benefits that will pay for uncompensated care that the provider has given as well as future care that is provided. Therefore, it is in the provider’s best interest for the individual’s application to be well supported and documented as an approval may lead to retroactive and future reimbursements.

In addition, offer to the director of the medical records department that you would be happy to write a letter to the administrator of his/her agency regarding how helpful the director has been as well as the potential financial recoupment that such collaboration will mean to the provider.

If they are unwilling to waive the fees, try contacting United Way or other community action agencies that may be able to pay all or part of the bill.

You should definitely send all of the medical records. SSA has a rule called the “All Evidence Rule” which requires applicants (through their representative) to submit all medical information known, which includes knowledge of impairment and/or treatment sources. 

• The appeal must be filed within 60 days of receipt of the initial denial notice.
• The applicant must submit the following forms:
  • SSA-561: Request for Reconsideration
  • SSA-3441: Disability Report- Appeal
  • SSA-827: Authorization to Disclose Information to SSA
• Additional medical records and evidence can be submitted
• The application will be assigned to a different disability examiner and reviewing physician at DDS

The SAMHSA SOAR TA Center recommends that you don’t cite the Listing and Grid numbers, e.g.) Ms. Jones meets Listing 12.04, and the alternative Grid rule 203.03. Rather, at the DDS level (initial and reconsideration) we suggest providing a description of how the applicant meets a particular Listing(s) or Grid rule through specific examples from the medical records, applicant quotes, and other collateral sources.

Yes, you should file a SOAR-assisted application because even if you don’t have access to the medical evidence, DDS will request directly from prior treating sources and/or schedule appropriate Consultative Examinations (CE) to obtain diagnoses. Remember, SSA needs a diagnosis to make a disability determination. Remember, to write in the “Remarks Section” on SSA forms, about your efforts to obtain medical information so that DDS will know what they need to do to medically develop the claim.

This is a great question! While DDS does not have a way to process records received via disk, this sounds like a good opportunity to speak with them about signing up for Electronic Records Express, which allows you to upload medical records directly into an applicant’s file from your computer without having to print them. I recommend reaching out to your DDS Professional Relations Officer, or your local SOAR contact, for details on how to register.  This should be a quick process, allowing you to upload these records without delaying your current case.

ALJ hearings may be conducted using video teleconferencing (VTC) equipment, rather than in-person, if there is equipment available to conduct a VTC hearing and if this would be more efficient than conducting an appearance in person. Applicants have a right to object to a VTC hearing if using the VTC model would cause undue hardship or for other reasons specified in HALLEX regulations. 

Here is a link to SSA data on length of time it takes to get a hearing, by hearing office:  https://www.ssa.gov/appeals/DataSets/01_NetStat_Report.html.   You can also see how many video vs. in person hearings a particular office does, though there is much local variation on how cases are assigned to in-person vs. video dockets. While VTC hearings generally come up quicker, this is in the context of long wait times for hearing scheduling generally.  

It is our opinion that all applicants at the hearing level should be represented by someone who is knowledgeable about preparing and presenting claims at the ALJ level.  ODAR will have a staffer who will assist with the equipment, but not much more than that. An advocate will be able to directly examine the applicant and cross examine any experts that are present, e.g. vocational and/or medical experts.

To meet SSA’s definition of disability, the applicant’s diagnosis must be documented in medical records, laboratory reports, or other clinical findings of a physician or psychologist. DDS prefers that medical evidence come from an ongoing treatment provider. If this medical documentation is not available because the applicant has not received treatment for these conditions, we recommend that SOAR practitioners try to arrange for a physician or psychologist to conduct assessments, including documenting the applicant’s diagnosis and functioning, before submitting the SSI/SSDI application.

If it is not possible to arrange an evaluation before submitting the application, DDS may arrange for a consultative exam (CE) for the applicant, including physical or psychiatric testing based on the applicant’s alleged conditions. More information about CEs can be found here. In these instances, it is especially important that the SOAR practitioner provides comprehensive information about the applicant’s impairments in functioning through the Medical Summary Report. Collateral information from caseworkers, family members, and former employers can also be helpful in supporting an application with limited medical documentation.

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