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Find answers to frequently asked questions.

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. 

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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.

Read more at Prior or Pending Applications.

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Question:
How can you expedite a hearing?

To help expedite a hearing, the applicant or their representative can submit a letter of "dire need" to the hearing office (ODAR).  The letter should describe the applicant's conditions, how s/he has worsened since the reconsideration was filed and why s/he will worsen still if s/he is 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 the hearing office (ODAR) to inquire about the claim and to ask for an expedited process.  

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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. 

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

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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.

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Question:
My agency received a bill for medical records. What should we do if we do not have funding available to pay the bill?

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.

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Question:
Are there trainings available for physicians to help improve medical record documentation?

The Documenting Disabilities training from the National Health Care for the Homeless Council is a great way to train doctors in the community on creating medical records and documentation that can help assist with SSI/SSDI applications. It clarifies the myths and helps develop a better understanding and support of what SOAR case managers are doing. The online curriculum is approximately 3-4 hours and has 2 basic parts: An introduction to the SSA disability determination process and then explanations and examples of how to document a person's physical (less emphasis on mental illness) impairments in a letter to be submitted to SSA. It is a great draw for physicians because NHCHC offers free CMEs. The training is now offered online at no-cost. The link to their website: http://www.nhchc.org/training-technical-assistance/online-courses/dd-101/.  You can download and read the manual and/or watch the online videos for the course.

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Question:
What are your recommendations if the client does not have enough medical documentation to support their illness ?

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.

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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.

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Question:
I already have medical records from another provider in my chart/file. Can I send those to SSA now that I am helping this individual apply for SSI/SSDI benefits?

Most states prohibit the re-release or “further release” of records once they have been released to an entity that originally requested them. However, if you send a request for records using the SOAR Process, which includes (1) a signed SSA-827 Authorization to Disclose Information and (2) a signed Agency Authorization to Release Information (either using the sample on the SOAR Tools & Worksheets page or your agency’s HIPAA compliant release), you will be able to send those records on to SSA.

Also included on the SOAR Tools & Worksheets page is a Medical Records Request Letter, which explains the purpose of the records request. This process of sending two releases is permitted under the HIPAA Privacy Rule as a “compound authorization.” The regulation can be found in the Code of Federal Regulations: Title 45 Part 164 Section 164.508. Source: Code of Federal Regulations: Title 45

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