I-1-2-14.Subsequent Decision and Fee Agreement Determination

Last Update: 6/22/09 (Transmittal I-1-58)

A. Fee Agreement Submitted After First Favorable Decision

To obtain the Social Security Administration's (SSA's) approval to charge and collect a fee under the fee agreement process in a claim resulting in more than one favorable decision, the representative or the claimant must have filed the agreement with SSA before the date of the first favorable decision SSA made after the representative's involvement began.

  • SSA generally considers the representative involved in a claim when SSA receives the claimant's written appointment of that person as representative.

  • Unless the representative or the claimant files the fee agreement before the date of the first favorable decision SSA made after the representative's appointment, SSA presumes he/she will either waive a fee or use the fee petition process to obtain SSA's approval to charge and collect a fee.

  • If the representative or claimant does not file a fee agreement before SSA makes a favorable decision on a claim with which the representative is involved, yet files a fee agreement before SSA makes another favorable decision in that claim, the decision maker will disapprove the fee agreement for the following reason:

    The Social Security Administration did not receive the written agreement before making the first favorable decision that the representative worked toward achieving in this claim.

    Examples:

    1. SSA initially decided that the claimant was not disabled. The claimant appointed a representative, who requested reconsideration. On July 2, 2009, SSA notified the claimant that she had been found disabled as of a date later than she alleged. The representative requested a hearing and, for the first time, presented a fee agreement specifying a fee equal to the lesser of 25 percent of past-due benefits or $6,000. After a hearing, the Administrative Law Judge (ALJ) found the claimant disabled as of the onset date alleged. In this case, the ALJ should disapprove the agreement because the first favorable decision SSA made after the representative's involvement began is dated July 2, 2009. Neither the representative nor the claimant filed the fee agreement before the date of that determination. Therefore, the representative must file a fee petition to obtain SSA's approval to charge and collect a fee for services provided in connection with the claim.

    2. SSA initially decided that the claimant was entitled to a period of disability and disability insurance benefits for a closed period. The claimant disagreed that her disability had ended, and appointed a representative to assist her in appealing. The representative filed a request for hearing, the Form SSA-1696-U4 (Appointment of Representative), and a copy of the fee agreement specifying a fee equal to the lesser of 25 percent of past-due benefits or $6,000. The ALJ decided that the claimant's disability did not cease, but continued through the date of the decision. Assuming the fee agreement meets the other requirements for approval, the ALJ should approve the fee agreement because the representative filed it before the date of the first favorable decision SSA made after the representative became involved in the claim.

    3. Based on an application filed on July 9, 2009, SSA decided that the unrepresented claimant became disabled on January 1, 2007, and was entitled to a period of disability and disability insurance benefits. After the claimant received that determination, he appointed a representative. In addition, he submitted a fee agreement and requested that SSA reopen the unfavorable hearing decision dated March 15, 2009, issued on the application he had filed on December 12, 2007. The ALJ reopened the hearing decision and found the claimant entitled to benefits based on the 2007 application. If the agreement meets the other requirements for approval, the ALJ should approve the fee agreement because the representative filed it before the date of the first favorable decision SSA made after the representative became involved in the claim.

B. Fee Agreement Submitted Before First Favorable Decision

The decision maker's approval of a fee agreement can remain in effect for any subsequent favorable decision SSA may issue on the same issue or issues, if there has been no change in pertinent circumstances and if the approval was proper. Accordingly, if a fee agreement was approved in connection with a favorable initial or reconsideration determination or a hearing decision, and an ALJ or the Appeals Council (AC) issues a subsequent favorable decision on the same issue or issues, no further action is required on the fee agreement unless the initial fee agreement approval was improper. The component that effectuates the subsequent decision will determine if the representative(s) is due any additional fee based on the subsequent decision.

Example:

If an ALJ has properly approved a fee agreement and the AC issues a subsequent decision that is either more or less favorable than the ALJ's, the fee agreement will not require a second approval by an Administrative Appeals Judge (AAJ). However, if the ALJ's approval was improper under the statute and the exceptions listed in I-1-2-12, or if there was a change in circumstances subsequent to the approval such that an exception applies, the AAJ should rescind approval of the fee agreement.