Last Update: 1/28/03 (Transmittal I-1-44)
Only the parties to a fee authorization, or individuals appointed to act on the parties' behalf, have a right to request administrative review.
If the spouse of a claimant or an individual in the office of the appointed representative protests a fee when neither is a party to the fee authorization, assume that the individual is acting at the request of the proper party (i.e., the claimant or the appointed representative).
Send the acknowledgment letter and any request for more information to the proper party. However, in the letter, explain to the party that:
the Social Security Administration (SSA) has received a request for administrative review from (the name of the person) on his/her behalf; and
he/she must let SSA know, within 15 days, whether to proceed with the review.
If the party does not verify that the request was filed on his/her behalf, deny administrative review. Notify the individual who protested the fee that he/she is not a proper party. Send a copy of the notice to the proper parties.
If a representative who did not participate in the initial fee authorization protests the fee, determine whether SSA paid the fee to the correct person. If more than one individual from the same office is involved in a claim, SSA may have paid the wrong person.
If the request for administrative review is filed more than 30 days after the date of the notice of SSA's initial fee authorization, the requester must state, in writing, why it was not filed on time. In such cases, the reviewing official will conduct an administrative review only if he/she determines that there was good cause for not filing the request on time. Examples of good cause are provided at 20 CFR 404.1720(d)(2)(ii) and 416.1520(d)(2)(ii).
The reviewing official must acknowledge receipt of the request for administrative review. He/she must also notify all other parties of the request for administrative review and afford them 15 days to submit written information responding to the request. (See I-1-2-64 for guidance on issuing the acknowledgment letter.)
If the request is untimely and good cause is not found, notify the claimant, affected auxiliary beneficiary(ies) and the representative that the prior fee authorization is final and not subject to further review.
Based on the review of the documents listed in I-1-2-62, the reviewing official will:
determine if more information is needed to make the administrative review decision; and
identify issues, if any, that SSA did not resolve when it initially authorized the fee.
Situations in which additional actions must be undertaken before acting on the request for administrative review include, but are not limited to the following.
If the claimant discharged one representative and another representative accepted an appointment to represent the claimant, the prior representative retains the right to request a fee. The reviewing official should ask the representative to file either a fee waiver or a fee request. If the first representative files a fee petition:
Send the fee request to the office that authorized the fee being protested. (That office will process the second fee request.) Advise that office of the pending request for administrative review and ask them to send you a copy of the fee authorization.
Do not conduct the administrative review until the time limit for requesting administrative review has expired on the second fee authorization.
If there are multiple representatives involved in the claim, SSA authorized more than one fee, and one party filed a request for administrative review:
review the services of all the representatives, and
recognize that the services of the representatives are generally interrelated.
However, do not:
conduct an administrative review on any unprotested fee authorization, or
consider modifying any fee except the one being protested.
If the contents of the original fee petition are insufficient, the reviewing official should contact the representative for clarification. Information most frequently omitted, but essential to the evaluation of the services pertain to:
the date the services ended, and
the itemization of the representative's services.
If there is an indication that the representative charged, received or collected money from the claimant, as a fee, in excess of the amount SSA authorized, then:
ask the representative for more information about the disposition of the funds (do not ask for a refund until the issue is resolved);
resolve the issue in the administrative review decision;
notify the representative that he/she she must immediately refund to the claimant any funds collected as fees in excess of the amount SSA finally authorized (refer to I-1-1-40 for rules governing the conduct of representatives); and
notify the claimant that he/she should inform SSA if the representative does not refund the excess funds.
If the claimant advises SSA that the representative did not refund the excess funds, refer to I-1-2-81.
After receipt of any additional information or comments in response to the acknowledgment/interim letters, and following resolution of any issues(s) that may have been identified, the reviewer must review the initial fee authorization in light of all the information in file. The reviewing official will determine whether the fee initially authorized is a reasonable fee for the services provided the claimant based on the factors outlined in I-1-2-57. The reviewing official will increase, decrease or affirm the fee initially authorized.
During this evaluation, the reviewing official will:
examine the authorization to identify the factual elements (e.g., the time spent and services performed by the representative, the results achieved by the representative, and the level at which the representative entered the case), rationale and conclusions reached;
identify what issues, if any, pertinent to the representative's services, had a bearing on the conclusion and decide if these issues have been resolved fully; and
obtain further clarification from the parties if the factual elements critical to the authorization are based on assumptions not supported by evidence in the claim file.