Section 5: Ethical Responsibilities of Representatives-Advance Cards Flashcards
Scenario:
Susan, a representative, agrees to charge her client $7,500 for her services, arguing that the fee exceeds SSA’s cap because the case involved extraordinary effort.
Question:
Is Susan allowed to charge a fee above the SSA cap without SSA approval?
Answer:
No, all fees, even those exceeding the cap, must be approved by SSA. Fee agreements exceeding the maximum limit require a detailed fee petition.
Explanation:
SSA regulates fees to protect claimants. Representatives must obtain SSA approval for any fee exceeding the cap, demonstrating extraordinary circumstances.
Key Resource: CFR §404.1725 – Fee petition process.
Key Takeaway:
Representatives cannot charge fees exceeding SSA’s cap without prior SSA approval through a fee petition.
Scenario:
Tom, a representative, learns about new medical evidence favorable to his client’s case but decides not to submit it because it would delay the ALJ hearing.
Question:
Does withholding favorable evidence to expedite a hearing violate ethical rules?
Answer:
Yes, representatives have an ethical duty to submit all known evidence that may affect the outcome of the case, regardless of its potential impact on timing.
Explanation:
Representatives must ensure the SSA has a complete record to make a fully informed decision.
Key Resource: CFR §404.1740(b)(3) – Duty to submit evidence.
Key Takeaway:
Representatives must submit all relevant evidence, even if it may delay proceedings.
Scenario:
Maria, a representative, accepts appointment for two clients who are siblings and have competing claims for SSI benefits from the same trust.
Question:
Can Maria represent both clients under SSA’s ethical rules?
Answer:
No, representing both clients constitutes a conflict of interest, as their claims are competing.
Explanation:
SSA prohibits representatives from taking on cases where conflicts of interest prevent unbiased advocacy for each client.
Key Resource: CFR §404.1740(b)(5) – Avoiding conflicts of interest.
Key Takeaway:
Representatives must avoid conflicts of interest and cannot represent clients with competing claims.
Scenario:
Lisa, a representative, charges her client a flat fee for services and refuses to disclose the fee structure to SSA.
Question:
Does failing to disclose fee arrangements violate SSA rules?
Answer:
Yes, all fee arrangements must be disclosed and approved by SSA to ensure compliance with its fee cap and regulations.
Explanation:
SSA requires transparency in fee arrangements to protect claimants from excessive charges.
Key Resource: CFR §404.1720 – Fee disclosure requirements.
Key Takeaway:
All fee arrangements must be disclosed and approved by SSA.
Scenario:
What is the maximum fee representatives can charge under a standard fee agreement in 2025?
Question:
What is the SSA fee cap?
Answer:
$7,200 or 25% of past-due benefits, whichever is less.
Explanation:
The fee cap ensures claimants are not overcharged.
Key Resource: CFR §404.1730(b) – Fee caps.
Key Takeaway:
The SSA fee cap in 2025 is $7,200 or 25% of past-due benefits, whichever is less.
Scenario:
What is the representative’s primary ethical duty to the client?
Question:
What is the representative’s overarching ethical responsibility?
Answer:
To provide competent, diligent, and professional representation.
Explanation:
Representatives must act in the claimant’s best interest while adhering to SSA rules and ethical standards.
Key Resource: CFR §404.1740(a)(1) – Duty of competent representation.
Key Takeaway:
Representatives must provide competent and diligent representation to their clients.
Scenario:
David, a representative, charges a fee for services rendered but fails to provide an invoice or itemized statement to his client. The client files a complaint with SSA.
Question:
Does David’s failure to provide an itemized statement violate ethical rules?
Answer:
Yes, representatives must provide clients with an itemized statement of services rendered when charging fees.
Explanation:
Transparency in fee structures ensures claimants understand the basis of charges and prevents overcharging.
Key Resource: CFR §404.1740(c)(1) – Requirement for itemized statements.
Key Takeaway:
Representatives must provide itemized statements to clients when charging fees.
Scenario:
Emma, a representative, encourages her client to agree to a backdated fee agreement after the case is adjudicated, claiming it’s common practice.
Question:
Is backdating fee agreements after adjudication allowed under SSA rules?
Answer:
No, fee agreements must be submitted to SSA for approval before the claim is adjudicated.
Explanation:
Backdating agreements violates SSA rules designed to ensure transparency and claimant protection.
Key Resource: CFR §404.1720(e) – Timing requirements for fee agreements.
Key Takeaway:
Fee agreements must be submitted for SSA approval before claim adjudication.
