I-1-2-16. Fee Agreements — Subsequent Application Is Filed While Request for Review Is Pending at the Appeals Council

Last Update: 9/9/04 (Transmittal I-1-47)

A. Introduction

A claimant may file a new application (“subsequent application”) while a request for review of an Administrative Law Judge's (ALJ's) decision in an earlier application (“prior application”) is pending at the Appeals Council (AC). This section addresses policy and procedure for cases in which the claimant is represented in connection with one or both applications and has entered into a fee agreement with one or more representatives in either the prior or the subsequent application, or both. Refer to I-5-3-17 for instructions for processing subsequent disability applications while a prior application, under the same or different title, is pending review at the AC.

In this section, the term “application” (rather than “claim”) applies to each of the two pending actions. This usage reflects the policy stated below that, for purposes of determining a fee for representation, SSA considers the two applications to be parts of a single claim process (see I-1-2-16 C.2. for policy on applying fee agreement rules). Accordingly, SSA will apply the fee agreement rules as if there were a single application or claim. (See I-1-2-16 C. for policy in applying the fee agreement rules.)

B. Subsequent Application Process Description

1. Request for Review in Prior Application Pending at the AC

When a claimant files a subsequent application while a request for review of a decision in a prior application is pending at the AC, the field office (FO) begins processing the subsequent application if there is a new issue (i.e., one that SSA has not already decided at some level of the administrative process), such as whether the claimant is disabled after the date of the hearing decision.

a. Subsequent Application Results in Favorable Initial or Reconsideration Determination

If the subsequent application results in a favorable initial or reconsideration determination, the FO or processing center (PC), as appropriate, effectuates the determination. In disability cases, after the Disability Determination Services (DDS) adjudicates a case and makes a favorable determination, the effectuating component (i.e., the PC or FO):

  • faxes a copy of the disability determination form, SSA-831-U3, to the subsequent claim coordinator in the Office of Appellate Operations (OAO) before it effectuates payment.

  • adds a Special Message to the MBR to identify the claim as a subsequent application with the prior application pending at the AC, with/without representative fee involvement;

  • releases the award notice in the subsequent application; and

  • routes the folder to OAO (or notifies OAO that there is an electronic folder). (I-5-3-17 III.B. describes the OAO process when a subsequent claim is allowed at the initial or reconsideration level.)

If the AC, or an ALJ on remand from the AC, later issues a fully or partially favorable decision in the prior application, the AC or ALJ also may affirm or reopen the favorable determination in the subsequent application, depending on the circumstances in the case.

b. Subsequent Application Does Not Result in Favorable Initial or Reconsideration Determination

If the subsequent application does not result in a favorable initial or reconsideration determination, and the claimant requests a hearing on the unfavorable determination, the hearing office (HO) does not schedule a hearing or issue a decision until the AC acts on the request for review in the prior application. (Refer to I-5-3-17 II.A. for HO procedures.)

2. Commissioner's Decision on Prior Disability Application Is Pending in Federal Court

If the claimant files a new disability application while the Commissioner's final decision on a prior application is pending in Federal court, an ALJ or the AC may issue a favorable decision establishing disability onset no earlier than the first day following the previously adjudicated period. If an ALJ or the AC issues a favorable decision on a subsequent application under these circumstances, the ALJ or AC will either approve or disapprove the fee agreement filed with that application. (Refer to I-2-8-16, Administrative Law Judge Decision When a Prior Claim Is Pending Judicial Review.)

C. Policy - Fee Agreements in Subsequent Application Cases

1. Cases This Policy Covers

The policy in this section applies to cases with the following profile:

2. Applying Fee Agreement Rules

When a case meets the profile in I-1-2-16 C.1., SSA will apply all fee agreement rules as if there were only one claim pending. (Refer to I-1-2-12 for fee agreement evaluation policy.)

  1. SSA will consider both applications to constitute one claim for purposes of approving or disapproving a fee agreement.

  2. When deciding whether exceptions to the fee agreement process apply, SSA will consider any representative appointed in connection with the prior or subsequent application to have been an appointed representative in the claim.

  3. SSA will approve no more than one fee agreement in the one claim and will authorize a maximum fee not to exceed the lesser of 25 percent of past-due benefits or $6,000 (or the statutory fee cap or a lesser cap specified in the fee agreement) for representation services in both applications (unless the fee is increased on administrative review).

  4. A representative who is dissatisfied with the fee authorized in a prior/subsequent application case may request administrative review. In such a case, SSA will find good cause for the late filing of a request for administrative review when either of the following situations exists:

    Non-court Case

    • SSA authorized an amount equal to the statutory cap (or a lesser cap specified in the agreement) in connection with the subsequent application;

    • SSA issues a favorable decision on the prior application that yields additional past-due benefits; and

    • a party to the agreement requests administrative review within 15 days of receiving the notice SSA issues when implementing the decision on the prior application.

    Court Case

    • SSA authorized an amount less than or equal to the statutory cap (or a lesser cap specified in the agreement) in connection with the subsequent application;

    • a Federal court issues a favorable decision on the prior application that yields additional past-due benefits; and

    • a party to the agreement requests administrative review within 15 days of receiving the award notice SSA issues when implementing the decision on the prior application.

    NOTE 1:

    A representative has the right to request administrative review in connection with any initial fee authorization. When a representative is authorized a fee amount that is less than the statutory cap (or a lower cap specified in the fee agreement) because 25 percent of the claimant's (and any auxiliary beneficiary's(ies') past-due benefits is less than the statutory or specified cap, and SSA issues a more favorable decision at a later date, that could yield an additional fee to the representative, the representative has another opportunity to file a timely request for administrative review of the authorized fee amount.

    NOTE 2:

    The decision maker who issues the second favorable administrative action (i.e., the decision on the prior application) will process the request for administrative review of the authorized fee, unless the only fee agreement submitted was in connection with the subsequent application. In that situation, the fee agreement decision maker for the subsequent application is the authorized fee reviewing official.

    NOTE 3:

    When a Federal court issues a decision on the prior application that is more favorable than the decision SSA issued on the subsequent application and, after the court issues its decision, the representative requests administrative review of the fee SSA authorized based on the fee agreement approved in connection with the subsequent application, the Attorney Fee Officer in the Office of Disability Adjudication and Review (ODAR) is the reviewer.

  5. If the fee agreement includes a provision that the representative is unwilling to accept the statutory cap if the claimant files a subsequent application, the decision maker will disapprove the fee agreement.

  6. If SSA disapproves a fee agreement, any representative appointed in the prior or subsequent application, who wishes to charge and collect a fee, must file a fee petition.

3. Documenting Appointment of a Representative and a Fee Agreement in the Subsequent Application

a. Claimant Represented

If a claimant is represented in the subsequent application, SSA must document the representation.

  • Claimant appoints the same representative as in the prior application:

    SSA will document the file with a new appointment of representative (Form SSA-1696-U4 (Appointment of Representative) or equivalent statement) or a copy of the appointment of representative submitted in the prior application, if any, signed and currently dated by the claimant and/or representative to indicate that the representation is continuing.

  • Claimant appoints a different representative or a representative for the first time:

    SSA will document the file with a new appointment of representative. In addition, SSA will inquire about any prior representation and document the subsequent application file accordingly.

SSA will accept any fee agreement filed with the subsequent application. SSA will accept a photocopy of a fee agreement, including a photocopy of a fee agreement filed in the prior application (refer to I-1-2-12 A.2.).

b. Claimant Not Represented

If SSA does not receive an annotated copy of a previous appointment or a new appointment, SSA will presume that the claimant is not represented in the subsequent application.

Therefore, SSA will NOT:

  • notify any representative, including any representative appointed in the prior application, of any decision made in the subsequent application;

  • withhold any past-due benefits based on the subsequent application; or

  • authorize a fee to any representative, including any representative appointed in the prior application, for work on the subsequent application.

4. Approving or Disapproving a Fee Agreement When Making a Favorable Determination in the Subsequent Application

The FO or PC decision maker will approve or disapprove a fee agreement when SSA makes a favorable initial or reconsideration determination on the subsequent application, if the fee agreement was filed during the subsequent application process. The decision maker will approve or disapprove the fee agreement based on whether it:

The FO or PC decision maker will take no action on a fee agreement filed only in connection with the prior application.

5. ODAR Decision Maker Responsibilities Regarding Fee Agreement Approval or Disapproval

a. ODAR Decision Maker Issues Favorable Decision in Prior Application

Because SSA considers the prior and subsequent applications to be one claim for purposes of authorizing a fee for representation services under the fee agreement process, SSA will approve no more than one fee agreement. Therefore, SSA must consider any appointment(s) of representative and any fee agreement(s) filed in both the prior and subsequent application(s) to arrive at one overall fee agreement action.

If an ODAR decision maker, as defined in I-1-2-13, issues a favorable decision in a prior application after SSA has issued a favorable determination in a subsequent application, the ODAR decision maker who issues the decision in the prior application is responsible for ensuring that the correct action is taken on the fee agreement(s) in the claim (i.e., both the prior and subsequent applications).

In these situations, the ODAR decision maker will:

  • Consolidate information about representation and any fee agreement(s) the parties filed in the prior and subsequent applications.

  • Determine whether he/she must act on any fee agreement filed in the prior application, considering the determination in the subsequent application and the approval or disapproval of a fee agreement filed in the subsequent application (if applicable).

  • Rescind any approval of the fee agreement SSA issued in connection with the subsequent application, if the ODAR decision maker determines that the approval action was incorrect. Refer to the sample rescission language in I-1-2-119.

  • If necessary, approve or disapprove the fee agreement(s).

NOTE:

In determining whether the fee agreement is excepted from the fee agreement process, the decision maker will consider any representative appointed in connection with the prior or the subsequent application to have been an appointed representative in the claim.

For more detailed guidance concerning ODAR decision maker actions in specific situations, see I-1-2-16 D..

b. ODAR Decision Maker Does Not Issue a Favorable Decision in Prior Application

If an ODAR decision maker issues an unfavorable decision in a prior application, or does not issue a decision, the ODAR decision maker will not act on a fee agreement or review any action the decision maker in the subsequent application took on a fee agreement.

6. Jurisdiction to Authorize Fees Under the Fee Petition Process If Fee Agreement Is Disapproved

a. Representative Appointed in Prior Application

If, under the policy in this section, SSA disapproves a fee agreement, initially or after rescinding approval of the fee agreement, and the representative(s) appointed in connection with only the prior application or the prior and subsequent applications, later requests a fee through the fee petition process, the ODAR component that took the last action on the prior application will evaluate any fee petition(s) and authorize a fee(s). If the FO or PC decision maker disapproves the fee agreement in connection with the subsequent application while the prior application is pending at the AC, the FO or PC will advise the representative to file the fee petition with the Attorney Fee Branch (AFB), Office of Appellate Operations, when he/she has completed the services he/she provided in pursuing the claimant's benefit rights in proceedings before SSA.

b. Representative Appointed in Only Subsequent Application

If the FO or PC disapproved the fee agreement or the FO or PC fee agreement approval is rescinded, and the representative was appointed only in the subsequent application, the appropriate reviewer in the PC will evaluate that representative's fee petition and authorize that representative's fee.

D. Policy Applied to Specific Situations

These guidelines are for ODAR decision makers to follow when acting on a fee agreement in the situations described below.

In all of the following scenarios, these assumptions apply:

1. ODAR Reopens Determination in Subsequent Application and Issues Favorable Decision

When the AC or ALJ reopens the favorable determination in the subsequent application, any approval of a fee agreement based on that favorable determination is vacated (see I-1-2-11). If an ODAR decision maker issues a favorable decision after reopening the favorable determination in the subsequent application, the AAJ or ALJ who issues the favorable decision will approve or disapprove the latest-dated fee agreement filed in connection with either application, from each representative (whether or not the decision maker in the subsequent application previously acted on it). Because ODAR's decision supplants the favorable determination in the subsequent application, the AAJ or ALJ is the sole decision maker in the claim for purposes of approving or disapproving the fee agreement. When deciding whether any exceptions to the fee agreement process apply, the decision maker will consider any representative appointed in the prior or the subsequent application to have been an appointed representative in the claim.

2. Decision Maker in Subsequent Application Approved Fee Agreement - ODAR Issues a Favorable Decision on Prior Application - ODAR Does Not Reopen Determination in Subsequent Application

If an ODAR decision maker issues a favorable decision in the prior application without reopening the determination in the subsequent application, the ODAR decision maker will review any fee agreement approval issued in connection with the subsequent application to determine whether it is still correct, considering the information regarding representation in both the prior and subsequent application files.

a. Same Representative(s) in Both Applications

The ODAR decision maker will take no action on the fee agreement if:

  • the claimant appointed the same representative(s) who signed the fee agreement approved in the subsequent application, to represent him/her in the prior application; and

  • the claimant appointed no other representative(s) in the prior application.

NOTE:

The fee authorized for services in both applications stems from the fee agreement approved in the subsequent application. No further action on the fee agreement is necessary.

b. Different Representatives in Prior and Subsequent Applications

If the AC plans to act favorably in the prior application or to remand the prior application to an ALJ, ODAR generally obtains the subsequent application file (see I-5-3-17 III. B.). The ODAR decision maker is then in a position to evaluate information regarding representation in both the prior and subsequent applications. If at least one representative appointed in connection with the prior application did not sign the fee agreement approved in the subsequent application, the ODAR decision maker will:

  • rescind the previous approval of the fee agreement in the subsequent application; and,

  • disapprove any fee agreement filed in connection with the subsequent application, and if applicable, disapprove any fee agreement filed in connection with the prior application. Refer to I-1-2-119 for sample rescission and disapproval language.

EXCEPTION:

If the representative who did not sign the fee agreement approved in the subsequent application later waived charging and collecting a fee and there is no other basis for rescission, the ODAR decision maker will take no action on the fee agreement.

When approving or disapproving the fee agreement, the ODAR decision maker must consider whether the agreement meets the statutory requirements before disapproving the fee agreement solely on the grounds that an exception applies. If the ODAR decision maker disapproves a fee agreement in this scenario, the following order of priority determines the order for listing the bases for disapproval, if there is more than one:

  • The fee agreement does not meet one of the statutory criteria for approval (e.g., provides for a fee that exceeds the lesser of 25 percent of past-due benefits or $6,000).

  • One or more of the “multiple representative” exceptions apply:

    • the representatives appointed in the prior and subsequent applications are all members of the same firm, partnership, or legal corporation and all did not sign a single fee agreement (refer to I-1-2-12 B.1.);

    • the representatives appointed in the prior and subsequent applications are not members of a single firm, partnership, or legal corporation (refer to I-1-2-12 B.2.); or

    • the claimant discharged a representative or a representative withdrew in either the prior or subsequent application (refer to I-1-2-12 B.3.).

NOTE:

If, considering all representatives appointed in the prior and the subsequent applications, one of the “multiple representative” exceptions to the fee agreement process applies, SSA may not use the fee agreement process to authorize fees to any representative in the claim. In this situation, all representatives, including any representative whose fee agreement was previously approved, must file a fee petition to obtain authorization to charge and collect a fee. Therefore, if the information in the prior application file that indicates that a fee agreement should be excepted was not known to the decision maker in the subsequent application, and that decision maker approved a fee agreement, rescission of the approval and then disapproval of the fee agreement is necessary.

3. Decision Maker in Subsequent Application Correctly Disapproved Fee Agreement - ODAR Issues a Favorable Decision - ODAR Does Not Reopen Determination in Subsequent Application

If an ODAR decision maker issues a favorable decision in the prior application without reopening the determination in the subsequent application, the ODAR decision maker will review any fee agreement disapproval in the subsequent application to determine whether he/she must take additional action on the fee agreement in the prior application.

a. Same Representative(s) in Both Applications

The ODAR decision maker will take no action on the fee agreement if the claimant appointed the same representative(s) in both applications, and no other representative in the prior application. In this situation, the representative already has received notice of the determination on the fee agreement.

b. Different Representatives in Prior and Subsequent Applications

The ODAR decision maker will disapprove any fee agreement filed in the prior application if the representative(s) appointed in the prior application did not sign the fee agreement disapproved in the subsequent application. (See I-1-2-16 D.2.b. for the basis for disapproval.) The decision maker will notify the representative(s) in the prior application of the disposition of his/her fee agreement and of his/her right to file a fee petition to request fee authorization.

4. No Fee Agreement in Subsequent Application - ODAR Issues a Favorable Decision; ODAR Does Not Reopen Determination in Subsequent Application

If an ODAR decision maker issues a favorable decision in the prior application without reopening the determination in the subsequent application, and there was no fee agreement submitted in connection with the subsequent application, the ODAR decision maker will approve or disapprove the fee agreement filed in connection with the prior application. When deciding whether any exceptions to the fee agreement process apply, the decision maker will consider any representative appointed in connection with the prior or the subsequent application to have been an appointed representative in the claim.

NOTE:

In this scenario, ODAR is responsible for approving or disapproving the fee agreement and notifying the parties. Although there was no fee agreement in the subsequent application, the ODAR decision maker must consider whether a representative was appointed in the subsequent application and, if so, whether that representative is a signatory to any fee agreement filed in the prior application.

5. Two-tiered Fee Agreement

An ALJ or AAJ evaluates a two-tiered fee agreement (see I-1-2-15, Two-tiered Fee Agreements) like any other fee agreement in the situations described in I-1-2-16 D.1. through I-1-2-16 D.4. When the circumstances, such as described in I-1-2-16 D.1.I-1-2-16 D.4., require the ODAR decision maker:

E. Procedure - OAO Branch Actions on Fee Agreement in Prior Application

If the DDS allows a subsequent application, the FO faxes OAO a copy of the Form SSA-831 completed in the case. OAO distributes the SSA-831 under the procedures in I-5-3-17 III. B.1.

When recommending that the AC issue a fully or partially favorable decision, the OAO hearings and appeals analyst routes the case to the AFB if there is a fee agreement in file (I-1-2-31 C.). When SSA has issued a favorable determination on a subsequent application and the AC has obtained the subsequent application file, the OAO hearings and appeals analyst also routes the prior and subsequent application files to the AFB.

F. Procedure - AFB or HO Support Staff Actions on Fee Agreement in Prior Application

The support staff:

1. ODAR Decision Maker to Take No Action on the Fee Agreement

AFB or HO support staff prepares section I of the recommendation form at I-1-2-117 for the AC or ALJ, stating why no action is needed on the fee agreement in the prior application.

2. ODAR Decision Maker to Approve or Disapprove Fee Agreement - Favorable Determination in Subsequent Application Not Reopened

AFB support staff follows the recommendation, order preparation, and file routing and release instructions in I-1-2-32 (Fee Agreement — Appeals Council Level — Attorney Fee Branch Procedures). HO support staff follows the order preparation and file routing and release instructions in I-1-2-21 (Fee Agreement — Hearing Office Procedures). AFB and HO support staff substitute forms as follows:

3. ODAR Decision Maker to Approve or Disapprove the Fee Agreement; Favorable Determination in Subsequent Application Reopened

AFB support staff follows the recommendation, order preparation and file routing and release instructions in I-1-2-32 (Fee Agreement — Appeals Council Level — Attorney Fee Branch Procedures). HO support staff follows the order preparation and file routing and release instructions in I-1-2-21 (Fee Agreement — Hearing Office Procedures). AFB and HO support staff substitute forms as follows:

G. Examples

The following examples of ODAR decision maker action on a fee agreement illustrate the application of the policy statements in this section.

1. Fee Agreement Approved in Subsequent Application - Same Representative Filed the Same Fee Agreement In Prior Application - Determination in Subsequent Application Not Reopened

2. Fee Agreement Approved in Subsequent Application - Different Representative Was Appointed In Prior Application - Determination in Subsequent Application Not Reopened