FAQ

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.

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.

At the hearing level, many Administrative Law Judges (ALJs) will invoke ‘Rule 3.7: Lawyer/Advocate as Witness’.  Under the advocate-witness rule, you cannot serve as both advocate (via the SSA-1696) and witness.  The ‘witness’ is required to testify on the basis of personal knowledge, while an advocate is expected to explain and comment on evidence given by others. This dual role can give rise to a conflict of interest.

In your case, the ALJ viewed the 3^rd Party Function Report you completed as ‘providing witness testimony’ which can prejudice the ALJ’s decision. Often, the ALJ will recognize that the SOAR case worker is not familiar with this rule, and educate them on their options.  When there is other evidence in the file and the SOAR case worker does not need to testify themselves, they will remain the official 1696 representative. By doing so, they are able to cross examine expert witnesses and directly examine the applicant (i.e. ask them questions in front of the judge during the hearing).

"Questions for Direct Examination at SSA Administrative Law Judge (ALJ) Hearing," along with other helpful resources, can be accessed on the webinar "Hearing Tips for SOAR Practitioners."

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.

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.

• 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

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.

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.

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.