Introduction

We are pleased to publish the newly reformatted Best Practices Handbook for claimants' representatives. It is our hope that all claimants' representatives will use this handbook as a practice aid when advocating and appearing before the Office of Disability Adjudication and Review.

The Office of Disability Adjudication and Review is one of the largest administrative adjudicatory systems in the world. The claimants who appear before us may feel overwhelmed by the legal and administrative requirements associated with pursuing a Social Security claim. Therefore, it is important for those most closely associated with this effort to work together in a collegial and professional manner to make this process as efficient as possible. It is to this end that we publish this handbook so that we can successfully fulfill our joint mission to provide the best possible service to the public.

 

Frank A. Cristaudo
Associate Chief Administrative Law Judge
Social Security Administration
Office of Disability Adjudication and Review

 

January 2011

In General

1.01  Obtain as much information as possible from our website.

This is a general rule for all dealings with SSA. At the hearing level, the majority of claimants are represented, and we encourage our employees to cooperate as much as possible with requests for information or assistance from representatives. However, every personal contact with hearing office personnel precludes the employee from performing other responsibilities relating to other hearing requests. Every five minutes that is saved on individual claims converts to thousands of saved hours that can be devoted to processing other claims.

1.02  Timely submit the form SSA-1696 and fee agreement.

If applicable, obtain and submit withdrawals and waivers from prior representatives to avoid possible delay in payment.

1.03  Establish a good working relationship with hearing office staff and management.

You should participate in periodic group meetings with the Hearing Office Chief Administrative Law Judge and Hearing Office Director in the offices in which you practice. Open dialogue allows both representatives and hearing offices to exchange suggestions as to how to improve service in the local area.

1.04  Timely alert the hearing office of any change of address or phone number for either yourself of the claimant.

This would help reduce duplication of effort by hearing offices when notices are sent to either individual.

1.05  Submit updated form SSA-827 with the request for hearing.

If the hearing office needs to request information on short notice for a possible on-the-record (OTR) decision or a dire need review, or for any other reason, it is very helpful to have updated release forms already in the file.

1.06  Even if a case is pending at the hearing level, a form SSA-1695 should be submitted to the SSA field office, not the hearing office.

This form deals solely with payment to the representative and contains personal information, including a representative's Social Security number. If a SSA-1695 is received at a hearing office, it is immediately forwarded to the SSA field office for processing. Submitting this form to the SSA field office initially would significantly reduce the time hearing office staff spends forwarding documentation, and reduce the likelihood that the form will either be lost or improperly associated with the claimant's file.

Prior to an Administrative Law Judge Hearing

Under 20 CFR §§ 404.935 and 416.1435, claimants have an existing duty to submit additional evidence with a Request for Hearing or within 10 days of submitting the request. Therefore, we encourage all representatives to review the file and submit evidence as early in the hearing process as possible. Do not wait until the case is scheduled to submit evidence. ODAR is aggressively screening cases for potential "on the record" situations and updated evidence is helpful in identifying cases that may be reversed without the need for a hearing. At the same time, we also encourage representatives to be mindful of hearing office resources required to burn CDs, and ask that representatives not request excess copies of CDs.

Submitting Evidence

2.01  Do not submit duplicative evidence. 

This is a problematic and time consuming issue dealt with at the hearing level, and significantly delays preparation of cases for hearing. Hearing office staff often spend several hours on any given case sorting out duplicate evidence. The sooner a case is prepared and exhibited, the sooner the case can be scheduled.

2.02  Submit evidence as far in advance of the hearing as possible, using ELECTRONIC RECORDS EXPRESS.

Up to 200 pages at one time can be faxed into the electronic folder using the fax number and bar code supplied with the Acknowledgment of Hearing notice. However, we do recommend smaller submissions when possible (less than 30 pages), as smaller exhibits open more quickly. Early submission (more than 10 working days before hearing) allows hearing office personnel to exhibit the evidence and ensures that the claimant’s copy of the file includes a copy of all the evidence that has been received. It also gives the ALJ time to review all the evidence, and helps to ensure that all relevant evidence is timely provided to experts scheduled to appear at hearing.

2.03  Before faxing evidence, check to ensure the evidence you are submitting matches the claimant.

This simple precaution would significantly reduce the time hearing offices spend contacting representatives and re-associating evidence with the appropriate file.

2.04  Make sure the barcode is the first item faxed in order to ensure proper identification of all records.

If you do not have a barcode for a particular case, please ask the hearing office to provide you with one. Bar codes may be photocopied and used more than once.

2.05  Submit a cover letter with the evidence identifying what is being submitted and the date of the evidence.

Submitting evidence with a cover letter and the dates of the evidence will assist hearing office staff in identifying duplicates and in exhibiting the records.

2.06  Avoid submitting voluminous evidence at the last minute.

This does not provide sufficient time for hearing office staff to associate the evidence with the file, or provide the ALJ and experts adequate time to review the evidence.

2.07  When faxing evidence from different sources into the electronic folder, separate sources by placing a bar code as the first document for each source and submit in chronological order.

This assists hearing office staff in reviewing the evidence for duplicates and in exhibiting the records.

2.08  Do not submit medical evidence with non-medical evidence documents such as appointment of representative forms or fee agreements.

Medical and non-medical documents should be submitted separately. Because these documents are included in different sections of the folder, it requires more time to separate documents if they are submitted together.

Issues to Address and Supporting Evidence

2.09  When Possible, obtain a medical source statement from a treating source which identifies the limitations imposed by the claimant's impairments.

Submit with supporting evidence or direct attention to supporting evidence already in the file. Treating source statements can greatly assist an ALJ in assessing Step 3 of the sequential evaluation and the claimant's residual functional capacity.

2.10  Deal with employment (substantial gainful activity, unsuccessful work attempts, sheltered work environments, etc.) and earnings issues in a pre-hearing memorandum or at the hearing.

Be sure to distinguish long term disability, vacation, or bonus pay which may appear as earnings after alleged onset.

2.11  Deal with worker's compensation issues in a pre-hearing memorandum or at the hearing.

If there has been a settlement, provide appropriate proof.

2.12  Submit concise pre-hearing briefs whenever possible.

This assists an ALJ in preparing for the hearing.

Submitting On-The-Record (OTR) Requests

2.13  Clearly label an OTR request "OTR Request," and submit as early as possible (but only when a request is appropriate).

OTR requests are not appropriate in every case, and should be requested only when a favorable outcome is supported by the evidence in the record.

2.14  Identify evidence that supports the OTR.

OTR requests should include a concise summary at the beginning of the brief outlining the argument, followed by a more detailed explanation specifically directing the reviewer's attention to evidence supporting a favorable decision.

2.15  Make sure evidence supports onset date.

Onset issues are the most frequent reason an OTR request cannot be granted.

2.16  Use FIT templates to submit OTR requests.

A CD of these templates is available from hearing office personnel.

Working with Attorney Adjudicators

2.17  When contacted, work with attorney adjudicators to expedite decisions in appropriate cases.

Attorney adjudicators review and screen cases for an OTR. Currently, attorney adjudicators have the authority to issue a fully favorable decision OTR when it is warranted. If you are contacted by a hearing office attorney regarding substantial gainful activity or onset issues in a particular case, discuss the matter with the attorney to see if the issue can be resolved without the need of a hearing.

Submitting Dire Need, Terminal Illness requests, or
information regarding incarcerated individuals

2.18  Notify the hearing office when the claimant has a terminal condition, is homeless, or is in dire need, and include appropriate documentation supporting these these allegations.

Notifying a hearing office of these circumstances can significantly expedite the processing of a case, if the allegation is supported. The criteria and reference links for critical case processing can be found in our provisions in HALLEX I-2-1-40 (Critical Cases).

2.19  With the request and documentation supporting the allegation, submit updated evidence supporting the claim for an OTR review.

If a dire need case can be awarded without the need of a hearing, this works to the advantage of the claimant and the hearing office.

2.20  If claimant is incarcerated, provide the hearing office with the address of the facility and the release date.

There are many difficulties that arise when an individual who has requested a hearing is incarcerated. For example, if an in-person hearing must be conducted, there are varying rules and procedures depending on the facility in which the claimant is incarcerated. Some claimants are transferred after a hearing has been scheduled but before the hearing has been held. For these types of reasons, it is very important that the hearing office is apprised at all times of the status of an incarcerated claimant.

Scheduling Hearings

2.21  Do not request postponements unless essential.

Be flexible with providing dates and times for hearings, and request postponements in writing in a timely fashion wherever possible. When you have already agreed to the time of a scheduled hearing, avoid requesting a postponement for a conflict that arises later.

2.22  When representing a child, be prepared to have someone available to look after the child, if possible, after he or she testifies or if he or she does not testify.

Representatives should avoid keeping the child in the hearing room when it will disrupt the hearing process or is otherwise not appropriate.

After an Administrative Law Judge Hearing

3.1  Submit post hearing evidence as soon as possible, with a written brief identifying how the evidence supports a favorable decision.

This will assist the ALJ in reviewing the records and appropriately focus attention on the information supporting your arguments, resulting in the issuance of a timely decision.

3.2  Whenever possible, submit fee petitions within 60 days of a decision or as soon as possible after services have been terminated or withdrawn.

Submitting fee documents within this time frame will have a significant impact on the time a representative waits for payment. This reduces the number of follow ups necessary to determine if a fee petition is going to be submitted, allowing the ALJ to act on the fee authorization at an earlier date. It reduces the likelihood that funds withheld for direct payment will be released to the claimant, and reduces the wait time if administrative review of an authorized fee is requested.

Actions Before the Appeals Council

Requests for Review

4.1  Requests for review must be in writing.

We make available Form HA-520, Request for Review of Hearing Decision/Order, for this purpose, but a written request in any form is acceptable.

4.2  A request for review cannot be submitted via the Internet.

This Appointed Representative Guide to Requesting Appeals Council Review chart describes the three best methods to submit a request for review.

Using any other method, including submission by Electronic Records Express or by fax with a bar code can cause significant delays in processing because Appeals Council (AC) staff does not receive an alert that a request was filed.

4.3  Candor and truthfulness is necessary in any submission to the AC, including the request for review.

Please note that submissions to the AC, including the request for review, additional arguments, and any additional evidence, are governed by 18 USC §§ 1001 and 1621. These statutes, as well as our regulations, require representatives to be forthright in their dealings with us and prohibit a representative from knowingly making false or misleading oral or written statements, assertions, or representations to us about a material fact or law (20 CFR 404.1740 and 416.1540).

Requesting Critical/TERI Case Status

4.4  If a claimant’s case is critical, let us know when you file the request for review.

If you believe a claimant’s case qualifies for expedited processing under our critical case procedures at Hearings, Appeals, and Litigation Law Manual (HALLEX) I-3-1-51, clearly state this in the request for review. Point to or provide evidence to support your request. You can follow up on the request by calling the Congressional and Public Affairs Branch (CPAB) at 1-877-670-2722.

4.5  If you later learn that a claimant’s situation is critical, contact us immediately.

If you believe a claimant’s medical condition or financial situation becomes critical after you file the request for review, fax a brief statement and supporting documents to CPAB staff at (703) 605-8021. You can also contact the CPAB staff by phone at 1 877-670-2722. A specialist on the CPAB staff will evaluate the claimant’s situation under HALLEX I-3-1-51 and take appropriate action.

Procedural Requests

4.6  If you are requesting a copy of the record, submit a clear request.

If you wish to receive a copy of exhibits or the hearing recording in a case, please clearly state this request at the beginning of your correspondence to facilitate support staff screening and action on your request. Our letter responding to your request will grant you a 25-day extension of time and will include two Appeals Council (AC) level bar codes that you can use to submit additional evidence or arguments.

4.7  Be specific in requesting an extension of time.

Requests for an extension of time should explain how much additional time you need and why the AC should grant the request. For second requests, or requests for more than 40 days, the AC will consider the particular set of circumstances in each case. The AC does not grant extensions automatically and will grant additional time only if there are extenuating circumstances present in the case. If the AC grants an extension of time, we will provide you with barcodes to submit additional evidence or arguments.

4.8  If you want bar codes, request an extension of time.

Since the AC only sends bar codes if specifically asked, the best way to ensure that you get AC level bar codes is to request an extension of time when you submit the request for review.

Representative Access to Electronic Folders

4.9  Take advantage of your ability to access a claimant’s electronic folder.

Appointed representatives who have registered with the Social Security Administration (SSA) for the Appointed Representative Services and who request eFolder access are able to view and download documents in Sections A, B, D, E, and F of the Case Documents and Exhibit List tabs of their clients’ Certified Electronic Folders. As long as the case is pending before the Appeals Council (AC), representatives can also download any digital hearing recordings in the electronic folder to their personal computers.

4.10  Make the AC aware of any changes in representation.

If a claimant has appointed more than one representative, only the main representative (as indicated on the Form SSA-1696 with the most recent date) will have access to the electronic folder. If a claimant’s main representative changes, it is very important that you notify the AC right away so we can update our records.

4.11  Other issues to note about access to the electronic folder:
  • If our records indicate that you have access to the electronic folder, we will not send you copies of a claimant’s hearing recording or exhibited evidence on compact discs. We will grant you an extension of time and notify you in our letter that our records indicate you have access to the electronic folder.
  • If a claimant has more than one claim pending at the same time (e.g., a claimant has a claim pending at the hearing level and at the AC), representatives will not have access to the electronic folder of either claim.
  • A representative has access to a claimant’s electronic folder for 90 days after the AC completes its action in a case. During the 90 days, only the representative recorded in our case control system at the time the case was closed has access to the electronic folder. If the claimant obtains a new representative to file a civil action, the new representative will not have access to the claimant’s electronic folder.

Evidence Submissions

4.12  Submit any additional evidence or comments with the request for review.

For internal review and association purposes, it is very helpful if you submit the request for review and all evidence at the same time.

4.13  If you have additional evidence, explain how it is material to the period at issue.

In regard to new evidence, the Appeals Council (AC) applies 20 CFR 404.970 and 416.1470. For disability claims filed in the Social Security Administration’s Region I (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), the AC applies 20 CFR 405.401 to new evidence submissions.

4.14  Avoid submitting duplicative evidence.

The AC has access to the entire record present at prior levels of adjudication, including the hearing level. Please do not resubmit information that is already available to the AC.

4.15  There are three ways to submit evidence to the AC.

You can submit evidence directly to the electronic folder by mail or fax, via the Electronic Records Express website, or by paper fax directly to the AC. Please see this Appointed Representative Guide to Requesting Appeals Council Review chart for a detailed explanation of each method. Please note, as discussed in section 4.2 above, you should never submit a request for review by the Electronic Records Express website.

4.16  When submitting evidence, organizing it chronologically and by source greatly aids case processing.

The AC reviews all evidence presented at prior levels of adjudication as well as evidence submitted while a claim is pending with the AC. Submitting evidence separately by source is the most effective way to assist the AC in completing a timely and accurate review of the record. Instead of submitting all new evidence into the record as one large exhibit, divide the evidence into separate exhibits containing the records from a single medical source. This allows the AC to associate new evidence with any previous medical or opinion evidence from the same source and helps the AC to review the claimant’s case faster. Organizing records by date of medical service, oldest to newest, assists the AC in quickly and accurately reviewing the claimant’s course of treatment with a particular source.

Clearly label newly submitted evidence with the source’s name, the dates covered, and number of pages. For example: Attachment A – records from Mercy General Hospital, Topeka, KS, for the period 1/2012 through 6/2013, 16 pages; Attachment B – records from treating physician John Smith, M.D., Topeka, KS, for the period 12/2011 through 1/2013, 5 pages.

Contentions

4.17  Contentions should be specific.

The Appeals Council (AC) appreciates receiving concise, focused arguments. We recommend using 2,000 words or less if possible.

4.18  Contentions need not include a recitation of the jurisdictional history or evidence generally, unless related to a specific point of contention.

As the record is already before the AC and the AC reviews the entire record in each claim, a summary of the evidence is not necessary. There is also no need to send us a copy of the administrative law judge’s decision or a copy of the hearing recording.

4.19  Cite to the record.

Citing specific exhibits and the pertinent page numbers of cited exhibits in support of a specific point of contention helps us review the record more efficiently.

Status Inquiries

4.20  Do not make automatic, multiple requests for the status of a request for review.

You can verify that the Appeals Council (AC) has received the request for review through the online status report available in the Social Security Administration’s (SSA) Appointed Representative Services (ARS), by contacting your local Social Security office or local hearing office, or by calling our Congressional and Public Affairs Branch staff at 1-877-670-2722 or SSA’s National 800 Number staff at 1-800-772-1213.

4.21  Requirements to view the online AC status reports.

On August 26, 2013, SSA expanded ARS to include an online status report for cases pending at the AC. To have access to the AC status report, representatives must register with SSA for ARS. Additionally, the case must be pending before the AC with a record in our case control system, and the representative attempting to access the report must be shown as the claimant’s representative in our case control system.

If you attempt to access ARS, are denied access, and the error message says, "Our system cannot accept the Social Security Number you entered" (see screenshot below):

  • You may have entered the wrong Social Security Number (SSN); or
  • You may not be shown as the appointed representative for this case in the Case Processing and Management System (CPMS) or the Appeals Review Processing System (ARPS).

 

If you are denied access and the error message says, “Your ability to use the Access Claimant’s Electronic Folder service has been suspended” (see screenshot below), please call the telephone number provided in the message to reinstate your access. If you have already called to reinstate access and the problem persists, send your REP ID and contact information to ^ODAR HQ ARS and request that they contact you to restore access to the electronic folder.

If the you receive an error message saying “Unable to Process Your Request” (see screenshot below), it could be the result of one of the following problems:

  • The case is not electronic;
  • The case was closed more than 90 days ago;
  • The case is not at the Hearing Office (HO) or AC level;
  • The case has been remanded; or
  • There are multiple pending cases at the HO or AC levels.
4.22  Representatives have three options for viewing their cases in real-time:
  • Search for individual cases by SSN. (Cases must be active or closed within the last 90 days.)
  • View a list of up to 100 of the oldest cases for all AC offices. (Cases must be active or closed within the last 90 days.)
  • Download all cases for all AC offices in a spreadsheet file. (Cases must be active or closed within the last 90 days.)
4.23  The view only status report will display the following information:
  • Claimant Name (Last, First)
  • Last 4 of SSN
  • Case Status/Status Date
  • Appeals Office with Jurisdiction
  • Transfer Information
  • Electronic Case (Yes or No)
  • Request Date
  • Expedited (Yes or No)
4.24  The downloaded status report will display the following information:
  • Claimant Name (Last, First)
  • Last 4 of SSN
  • Case Status/Status Date
  • Claim Type
  • Appeals Office with Jurisdiction
  • Transfer Information
  • Electronic Case (Yes or No)
  • Request Date
  • Expedited (Yes or No)
  • Fee Agreement (Yes or No)
  • Fee Petition (Yes or No)
  • Title II and Title XVI (T2 & T16, respectively) Decision

NOTE:  The Fee Agreement field displayed in the downloaded Appeals Council Status Report will always contain a NO unless the AC issues a favorable decision.

4.25  What it means if the T2 or T16 Decision field shows “Other”

The AC status report only provides detailed status information for the request for review workload. Therefore, the T2 & T16 Decision field will include denials, dismissals, favorables, unfavorables, and remands

The workload types below will display the T2 & T16 disposition code “Other” when one of the following types of cases is closed.

4.26  Further descriptions of the “Case Status” field
  • New case – New request entered in control system pending further screening
  • Case workup – Screening or case preparation actions (e.g. responses to claimant or rep initiated requests for extensions, file material, timeliness of filing etc.)
  • Pending analyst assignment – Preparation actions completed; in assignment queue
  • Assigned to analyst – Assigned to analyst for workup and referral to adjudicator
  • Assigned to adjudicator – With AC for disposition
  • Document preparation – AC notice prepared for release
4.27  Other issues to note about the AC online status report:
  • Only the representative recorded in the AC’s case control system will have access to the status report. If a claimant’s main representative changes, it is very important that you notify the AC right away so we can update our records. (The AC recognizes as the representative of record the person designated as the main representative on the Form SSA-1696 with the most recent date.)
  • The AC online status report only provides information for active cases or cases closed within the last 90 days. Only the representative recorded in our case control system at the time the case was closed has access to the online status report.
  • Federal court cases are excluded from the AC status report.