HEARINGS AND APPEALS Flashcards
SSA FORMS: SSA-3441
DISABILITY REPORT - APPEAL
SSA FORMS: SSA - 827
AUTHORIZATION TO DISCLOSE INFORMATION
SSA FORMS: SSA - 561
REQUEST FOR RECONSIDERATION
SSA FORMS: HA - 501
REQUEST FOR HEARING BY ADMINISTRATIVE LAW JUDGE
SSA NOTICES
Notices are primarily used to communicate with claimants. The SSA must send a written notice to a claimant on any determination or decision in the case. SSA must also send a notification if there are going to be any adverse actions in a case. The most widely sed notice is the PDN or Personalized Denial Notice that explains the reason a case was denied. most notice forms have some identifier that begins with the letter L as in SSA-L 1675-U2.
NOTICE OF RECONSIDERATION
In addition to regular notices, the SSA sometimes sends out advance predetermination notices to SSDI claimants.
These Advance Notices:
- Inform you of action the SSA plans to take, such as a termination of benefits because you are performing Substantial Gainful Activity
- Summarize the evidence in your fi9le that supports the proposed determination.
- Advise you how to present evidence that may change the planned action, and
-Tell you how long you have to respond to the notice.
RATIONALS:
A Rationale is a formal explanation of an SSA decision with greater detail than the PDN. There are two types of rationales: (1) Personalized and (2) Technical.
Personalized Rational: The personalized rational is sent to the claimant in the form of a notice. The personalized notice (SSA Form 4268) explains the reason or rational behind the final decision. If the decision were a denial, then the rational would be referred to as a Personalized Denial Notice.
Technical Rational: An SSA Technical Rationale is an internal document used to explain case details with professional SSA staff. The Technical Rational is far more detailed than the PDN. The Technical Rational provides SSA with a case review strategy that can be re-engaged if the decision is appealed.
The purposes of the disability determination/hearing decision rationales are to:
- identify the medical and non-medical factors that have been considered
- explain the process the SSA used to arrive at the determination
- provide a permanent record for the underlying conclusion
A representative uses a Rational to understand what went wrong and provide the basis for an appeal strategy.
APPEAL TIME LINE:
Enclosed with the notice from the SSA denying or termination a claimant’s benefits will be information on how to appeal the decision. The claimant or his representative must appeal in writing within 60 days of the date that the claimant received the notice.
MISSED APPEAL DEADLINE
If a deadline for an appeal is missed, you can:
a) Start over from the initial level
b) Ask for an extension or waiver of 60 days for a good cause.
Generally, SSA will accept a good cause argument and allow you to pursue the appeal.
FORMS USED TO REQUEST AN INITIAL APPEAL:
Forms SSA - 561-US, SSA-3441-BK, and SSA-827. This starts you first level of appeal. Depending on your state, the reconsideration appeal process can range from traditional recon review to a hearing structure outlined under the DSIP.
FORMS USED TO REQUEST A RECONSIDERATION APPEAL:
To appeal a denial of a reconsideration claim, you must file Forms HA-501-US, SSA-3443-BK, and SSA-827. This starts your appeal to an Administrative Law Judge (ALJ).
FORM USED TO REQUEST AN ALJ APPEAL:
To appeal a denial of an ALJ claim, you must file Forms HA-520-US. This will start the Appeal Council review.
FORM SIGNATURE:
All SSA forms must be properly completed and signed. The claimant, legal guardian of a child claimant, or the legal representative must sign and date the SSA form in the appropriate form bloc indicated. It is also important to collect data and signatures of witnesses. If the claimant is not signing his own form, specify the relationship of the person who is signing – such as a parent or legal representative.
ELECTRONIC RECORD EXCHANGE
Claimants and their representatives can complete an application and other operations online. When client data is exchanged, that information goes into a highly secure and confidential electronic folder (EF) assigned to your name and SSN.
When applying and interviewing at an SSA Field Office, the official will scan client information not their EF, even if the claimant completes a paper form. Also, medical evidence in a paper format is scanned into the claimant’s electronic folder either by the FO or the DDS.
Physical records submitted to SSA are still retained, but the SSA no longer keeps its own decisional documents in the paper file. The authorized representative does have direct access to the client’s EF and can copy files as need.
REPRESENTATIVE RECORD REVIEW
During an appeal, the representative should acquire access to:
Claimant’s PDN, Technical Rational, medial evidence, vocational data, RFC and/or PRTF Form SSA-2506-BK Psychiatric Review Technique Form (PRTF) if a claimant has a mental condition.
Prior to a Hearing, it is wise for the representative to review:
Claimant’s medical documents
Claimant’s work history
Claimant’s RFC
SSA Correspondence
Decision Notice
Disability Hearing Officer (DHO)
Disability Hearing Officers are not medical doctors or psychologists and do not need to have any formal medical training. Some DHO’s are experienced disability examiners or examiner supervisors promoted into a DHO position and give administrative training on conducting hearings.
When the DHO receives an appeal, the DHO may allow a claim for continued benefits without requiring a hearing. If so, the claimant will receive a notice to that effect.
Otherwise, the DHO will send the claimant an his representative notice of hearing date and location.
Before the hearing, the DHO will send a notice asking for a list of the people the claimant expects to attend the hearing, including witnesses or a representative.
