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Find answers to frequently asked questions.

Question:
How long does a medical provider have to provide information to a patient? Is it a federal mandate or do individual states have a different timeline?

HIPAA requires medical providers to release the patient's records within 30 days after the request is received (https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/ind…). Some states have laws that require the release of medical records in fewer than 30 days.

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Question:
Should I actually include information from the Listings and Grids in the MSR, or should I wait until the applicant is denied?

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.

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Question:
Should I file a SSI/SSDI claim when there are no medical records available?

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.

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Question:
How do we find out why a client was previously denied?

You can obtain valuable insight into the reason an applicant was previously denied by reviewing the applicant’s electronic folder, or at minimum, obtaining the “Disability Determination Explanation” or denial notice. Most likely, you will have easy access to the denial notice from the applicant or, if you are the authorized representative, SSA should have mailed a copy to you. You can also request reason for denial by contacting your local SSA office. Learn more at Reviewing Denial Notices.

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Question:
I have a client that has already applied for SSI, SSDI, and supplied his medical records to the SSA. Am I still able to help him with a MSR?

We recommend contacting the DDS examiner assigned to the case to find out where they are in the decision making process. If they have just been assigned the case and are starting to process it, then you have time to write and submit a Medical Summary Report. You could let the DDS examiner know that you have additional evidence to submit. If you do not have an SSA-1696 on file, the claimant will need to be with you when you call. 

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Question:
My client's SOAR case has been denied and I would like to ask for another representative to review the case. How do I ask for reconsideration and which forms do I use to request this?
The first level of appeal is the reconsideration. It is an opportunity to have the application reviewed by different staff at DDS and to add new or additional information.
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Question:
Can I submit a 3368 on line?

Yes! We actually suggest that you submit both the SSA-3368: Adult Disability Report and the SSA 16: Application for SSDI online as part of a complete SOAR-assisted SSI/SSDI application packet. You can use the paper forms as worksheets and then transfer to the Online Disability Benefit Application and Adult Disability Report

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Question:
Must the client be present when the SSA-1696 Appointment of Representative form is submitted to SSA?

No, the claimant does not need to present when you turn in the signed SSA-1696. We do recommend submitting an original copy with a "wet-signature." Be sure to keep a copy for your records.

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Question:
Is there any guidance or training on assisting with the appeal process?

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.

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Question:
If someone has a pending claim for SSDI under appeal with an attorney involved, should/can a SOAR application be submitted?

SSA does not allow an applicant to have multiple applications pending at the same time.  If the applicant chooses to have a new initial SOAR-assisted application for SSDI benefits submitted, then the applicant would need to withdraw their current application.  It is important that the applicant understands that the new application would create a new application date which may result in the loss of retroactive 'back' benefits based on withdrawing the current pending application.

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