SSD File Development Procedures
The following is an outline for your Paralegal to follow, under the direction of the Attorney, in order to ensure a successful outcome for your Social Security disability claim. The process can be quite complicated and the following is not an exhaustive list, but all of these steps are necessary to execute a successful Social Security disability claim on your behalf.
1. Forms That Are Required In Order to Begin the SSD Process:
- Two-Tier Fee Agreement
- Appointment of Representative – SSA 1696
- SSA-3288 Consent for Release of Information
- Request for Reconsideration – SSA 561
- Request for Hearing by Administrative Law Judge – HA 501
- Request for Review of Hearing or Decision/Order – HA 520
- Petition to Obtain Approval of a Fee for Representing a Claimant before the Social Security Administration – SSA 1560
- Authorization to Release Health Information – (2 copies)
- Authorizations to Disclose Information to the Social Security
- Administration SSA 827 – (need at least 4 copies, not dated)
- Statement of Claimant or Other Person – SSA 795
- Application to proceed in forma pauperis (A Pauper’s Affidavit)
- Signed document which allows family or guardians to discuss client’s case
2. Forms Provided to Client at the Start of the Social Security Disability Claim:
- Client handbook is provided along with the copy of the forms (listed above) including two-tier fee agreement;
- Copy of the SS Questionnaire. It is the client’s responsibility to fill it out COMPLETELY and return it as soon as possible. If not received follow up is needed to complete document.
- RFCs are provided to client for their physicians to complete; if the physician will not complete the form, then we will ask for a Physician’s Statement.
3. Information Obtained During Initial Interview
- Preliminary medical information is gathered along with a medications list. This list includes names, address, phone numbers and specialty of all medical providers.
- Determine at what appellate level within SSA appeals process the client’s Social Security disability claim currently is;
- Determine the date of the last denial;
- Determine the deadline for filing an appeal, if any;
- Gather multiple next of kin/friend/family contact info, including email.
4. Medical Records Request Procedures
- Processing of Medical Records for DDS:
- Medical Records are distributed to designated paralegal;
- Records are sent to DDS along with the DDS bar code;
- The bar code will have the doctor’s name and should be listed with the dates of treatment.
- Medical records sent to the DDS office using the bar code system
- Medical records are sent to the DDS office;
- We then receive confirmation of the fax transmission;
- The confirmation page is saved along with the records into the client’s file.
5. Initial Intake Process with SSD Paralegal
- Paralegal will collect all medical provider information (name, address, phone number);
- Paralegal will explain the importance of giving complete and accurate medical provider information on questionnaire.
- If the file does not have medical providers listed and it has been 30 days since the initial file setup, the paralegal will contact the client so that they can obtain this information. The medical records request file will be moved to the back until the medical providers are received.
6. Ordering SSD Medical Records
- First step is to create a Medical chart (T:SSD/Forms/Med-chart).
- No one is to alter the Medical Chart other than the Medical Records Specialist; if there is any information that needs to be on the chart it will be given to the Medical Records Specialist.
- Log each new provider into database.
- A copy of the chart is placed into the client’s file.
- A schedule is created in order to continually follow up with the client’s medical provider until the records are received.
- Items Included in the Request:
- Cover letter (T;/SSD/Forms/request medical records);
- Authorization to release Health information (in client Medical Record folder both physically and electronically);
- Appoint of Representation (1695) (in client Medical Record folder both physically and electronically)
7. Follow ups After Initial Request
- Medical records request is made when we receive an update form also known as FORM HA-4632. The Medical Records Specialist will contact medical providers 45 days after request has been made if records are not yet received.
- All records go directly to the Medical Records Specialist and are indicated as received on the client’s medical chart and then given to Paralegal within 2 days’ time.
- If a request is returned to the Medical Records Specialist, they will then notify the Paralegal, so the Paralegal can obtain correct contact information.
- Paralegal will follow up with client if the questionnaire is not received within 30-45 days.
- When the Paralegal receives notification that the case is ready to schedule they will contact the client and gather any new medical providers and forward the information to the Medical Records Specialist ASAP.
- When a hearing is scheduled, the Paralegal will notify the Medical Records Specialist if there are any additional providers or updates that are needed to complete file ASAP and at least 30 days prior to date of hearing.
- When records are re-requested, the Medical Records Specialist will highlight the request date on client’s medical file chart and follow up within 2 weeks and each week thereafter until records are received.
Social Security Hearing Procedure
8. Prepping Claimant’s File for the Hearing:
The hearing file will be prepped a minimum 2 weeks prior to the hearing. The file is prepped and brought to the Attorney prior to the scheduled hearing. At this time, the Paralegal and Attorney will discuss if there are missing medical records or anything else that needs to be completed before the hearing.
The hearing file will contain the following information:
- Exhibits will be information, dates and types of benefits
- Exhibits will be denial letters, applications, notices and letters
- Eligibility Information also known as Quarter Information
- Activities of daily living forms and work history
- Medical records
9. Prepping Client for hearing:
The Paralegal will call client (no later than 2 mornings before the hearing) and give a brief overview of what to expect at the hearing including:
- The Courtroom Do’s and Don’ts (g., no flashy jewelry, plain comfortable dress with no logos, no hats);
- They will assist with directions and building description;
- They will schedule a prep conference for client with the Attorney (for day before hearing); Paralegal will ask client for any updated medical care visits.
10. Prepping Attorney for Hearing:
Paralegal will have an in depth meeting with the Attorney discussing the worked up file including:
- Any highlights or especially favorable evidence
- Any potential difficulties in the case
- Discussion of RFC’s in the hearing binder
11. What the Attorney Will Do to Prepare for Hearing
- Attorney will check to make sure our Notice of Rep (form 1696) and our fee contract are in the file.
- Attorney will check to make sure any recently submitted medical records are included in the hearing file.
- They will check for new medical records that we don’t have such as Consultive Exam’s. These aren’t normally sent to us. Also, check for reports from the Fraud Division (usually up front with a red cover, this is bad news and you may wish to ask for continuance to check this out).
- Attorney will check client’s earnings record to make sure no past relevant work after alleged onset date. If so, see below.
- They will also check to make sure client’s work history report has been filled out completely and will check to see if the work was done recently enough or long enough to count as PRW. The Attorney will see how client described the work, and see if the title client used matches the job description. See below.
- They will check to see what, if any, experts will be in hearing. They will know what ALJ (Administrative Law Judge), Medical Expert (including what type) and Vocational Expert client will be in front of. They will confirm with hearing monitor who will be in the hearing as often as possible to be ready in case there are last minute changes, even with the judge.
- Attorney will check to see if the client has a concurrent SSDI/SSI application or only one or the other. (Not enough quarters, spouse has too much income etc.) Administrative Law Judges always refer to them as either Title II (2), i.e. SSDI or Title XVI (16), i.e. SSI. Therefore the Attorney needs to know this and to be prepared.
- The Attorney will know before walking into a hearing the application date, client’s date last insured and alleged onset date of client’s disability. They will also be able to provide a reason for the proposed alleged onset date.
- They will check for prior applications to see if they can be reopened or if client has had a prior ALJ hearing which could be res judicata.
12. Day of the Hearing: Prehearing Client Preparation
Attorney will Discuss Client’s Onset Date:
- Why that Date?
- What Accident/Illness/Diagnostic Result/ Caused them to Stop Working?
- Why did they stop working?
The Attorney will explain that the client’s reason for not working needs to be because of an illness/injury, not because of layoff or termination (unless termination was related to client’s inability to work productively; they will also explain not to use the word “layoff” which implies multiple terminations, i.e. not because of the disability.)
- Attorney will ask client if they have worked since alleged onset date:
- SSA will check earnings record in the file to see if there were any reported earnings after the onset date.
- Be ready with an explanation if there is such as:
- Failed work attempt (needs to be short)
- Trial work period
- Part time work, LTD benefits, Workers Comp, Cash out of 401Ks
- Incorrect SS#
- Attorney will also discuss the possibility of amending the onset date, if necessary because of SGA work, no medical evidence until a later date, a birthday that may place client into a different Grid Rule. However, they will be careful not to amend onset date outside of the date last insured on Social Security disability claim unless there is no hope and client agrees. Note that benefits are only payable for full months, not partial months, therefore if the alleged onset date or the ALJ suggested onset date is say 5/4/05, Attorney will ask the ALJ for 5/1/05 and many will give it to you. It will gain you an entire months’ worth of benefits.
- Attorney will speak with client about considering asking for a Closed Period if client went back to work full-time.
- Attorney will also discuss claimant’s Past Relevant Work with them and how they are to describe their work during the hearing.
- Attorney will discuss Medical Evidence including:
- Theory of Disability/RFC Standards that are relevant
- Define the RFC standard that claimant must meet
- Client will also discuss Hearing Procedure with Attorney
- Attorney will go over Direct Exam Outline.
- They will emphasize claimant should not to go off subject, joke or make extraneous remarks.
- They will emphasize that claimant should not to overstate their ability to perform daily activities.
- Attorney will ask client if they have brought anything/ or any document with them that we don’t already have.
- If claimant has brought a witness to the Hearing:
- Attorney will question the witness to see if they would be helpful to testify.
- Attorney will check the witness’s background and relation to claimant.
- Once the hearing is over, Attorney will go through a post hearing debriefing with client.
13. Attorney Will Explain the Five Step Sequential Evaluation – Claimant Will Need to Understand This Process
FLOW CHART OF THE FIVE STEP SEQUENTIAL EVALUATION
ANY CONTRARY ANSWER WILL LEAD TO A FINDING OF NOT DISABLED.
14. The Following Listing Categories Will Be Evaluated By Attorney
SSA Adult Listing Categories:
1.00 Musculoskeletal System
2.00 Special Senses and Speech
3.00 Respiratory System
4.00 Cardiovascular System
5.00 Digestive System
6.00 Genitourinary System
7.00 Hemic and Lymphatic System
9.00 Endocrine System
10.00 Multiple Body Systems
12.00 Mental Disorders
13.00 Neoplastic Diseases
14.00 Immune System
15. Medical/Vocational Rules (Grid Rules) will be Evaluated by Attorney
|Age||Education||Previous work experience||Max. RFC||Rule|
|60-64||6th grade or less||Unskilled||Medium||203.01|
|7th to 11th grade||Unskilled||Light||202.01|
|11th grade or less||None||Medium||203.02|
|11th grade or less||Skilled/semiskilled. Skills not transferable||Light||202.02|
|High school grad or more. Does not provide for direct entry into skilled work||Unskilled or none||Light||202.04|
|High School grad or more. Does not provide for direct entry into skilled work||Skilled/semiskilled. Skills not transferable||Light||202.06|
|55-59||11th grade or less||None||Medium||203.10|
|11th grade or less||Unskilled||Light||202.01|
|11th grade or less||Skilled/semiskilled. Skill not transferable||Light||202.02|
|High school graduate or more does not provide for direct entry into skilled work||Unskilled or none||Light||202.04|
|High school graduate or more does not provide for direct entry into skilled work||Skilled or semiskilled. Skills not transferable||Light||202.06|
|50-54||Illiterate or unable to communicate in English||Unskilled or none||Light||202.09|
|11th grade or less – at least literate and able to communication in English||Unskilled or none||Sedentary||201.09|
|High school graduate or more, does not provide for direct entry into skilled work||Unskilled or none||Sedentary||201.12|
|High school graduate or more does not provide for direct entry into skilled work||skilled/semiskilled Skills not transferrable||Sedentary||201.14|
|45-49||Illiterate or unable to communicate in English||Unskilled or none||Sedentary||201.17|
|All education levels, Literate and able to communicate in English||Unskilled, none, or skilled or semiskilled – skills not transferable||Sedentary occupational base must be significantly eroded.||201.00(h)|
|18-44||All educational levels including illiterate or unable to communicate in English||Unskilled, none, or skilled or semiskilled – skills not transferable||Sedentary occupational base must be significantly eroded.||201.00(h)|
16. Post Hearing Process with Attorney and Paralegal:
Paralegal will have a detailed conversation with Attorney regarding the Attorney’s impression of claimant’s case. Paralegal will enter any notes or impressions discussed in client’s file and scan any handwritten notes from Attorney in anticipation of decision to appeal the case further.
Paralegal will then execute any post-hearing instructions given by Attorney regarding actions on client’s case (e.g., getting additional medical records, submitting financial records, helping claimant file follow proper procedure or instructions). Paralegal will then schedule an event for the time allowed by judge to submit necessary document and double check that this is completed.
17. Appeals Council Request for Review
Appeals Council; Request for Review must be filed in writing; they are not filing these by electronic filing yet.
- Request for Review:
- Letter for the Request for Review is created
- Appeal is mailed via certified mail
- An original copy and one copy are sent to the Appeals Council
- Copy of the Request for Review placed into claimant’s file
- Letter will ask for extension of time to file Appeals Brief
- A copy of the hearing tapes will also be requested
- If necessary, a copy of the ODAR file will be requested at this time
- Notations with tracking number placed in claimant’s file
- When the Appeals Council is ready to review the file:
- A letter will be sent out with a deadline to file any new and material evidence along with an Appeals Brief.
- You are usually only given 25 days from the date of their letter.
- The Appeals Council will grant extension if you give advance notice of the need for an extension.
- In Most cases they will only grant one or two extensions.
- Attorney will draft a brief and send it to the Appeals Council.
- When a Decision is received from the Appeals Council:Remands:
- We will receive notice from the Appeals Council that a remand has been issued.
- Paralegal will send client a letter explaining the remand.
- Claimant file will be moved from Appeals Council files and back to hearing level.
- We will receive another letter from the ODAR that they have received the remand from the Appeals Council and ODAR will notify us of the hearing date. Hearing process starts over again.
- Appeals Council denial is given to Attorney along with copy of the ALJ and hearing notes and Appeals Council brief.
- Attorney will decide with client if they wish to file in Federal Court.
- If a decision not to file an appeal is made, a letter of contract completion will be sent to client via regular and certified mail.
- A copy of this letter will be added to claimant’s file.
- The contract completion letter will include the claimant’s deadline to file their lawsuit, should they choose to do so.
- If the Attorney Decides to File:
- There are only 60 days to file.
- Attorney will determine if the claimant is eligible for A Paupers Affidavit or if a filing fee required.
- This determination will be made at least 30 days after the Appeals Council denial letter was issued.
18. Federal Court Review
- Attorney will prepare the complaint; when filing SSA cases, claimants can use a Pauper’s Affidavit if they do not have income or assets.
- The complaint should include the following:
- Original Complaint
- Completed Pauper Affidavit
- Completed Summons for the following people:
- Social Security Commissioner
- United States Attorney
- Unites States Attorney General
- The Federal Judge will approve or deny the affidavit.
- If the Pauper’s Affidavit is denied by the Federal Judge:
- We will have 10 days to pay the filing fee of $350.00 or the case is dismissed.
- Once the filing fee is paid, we will receive a receipt.
- It is the Attorney’s job to serve the Defendant’s by certified mail.
- Attorney will call or go to the Court House to get certified copies of the summons. Two copies of the summons are required for the Defendant to be served.
- We will send one copy of the summons to each defendant by certified mail.
- Once we receive the certified confirmation of receipt for each defendant, we will complete the other copy of the summons and file it electronically with the court. There are 120 days from the date of filing to get the defendants served.
- If the Pauper’s Affidavit is approved by the Federal Judge:
- The Court is responsible for filing the Summons and serving the Defendant.
- The Defendant has 60 days from the date they are served to file an Answer.
- The Defendant (Office of General Council, or OCG) will file their Answer electronically.
- Defendant will file transcripts electronic and may mail a hard copy.
- The Federal Judge will issue an Order to file Motions for Summary Judgment.
- Attorney will receive the OGC transcripts.
- A copy of the Order will be placed into claimant’s file.
- The process for electronic filing of Motion for Summary Judgment:
- Document filing;
- Login and password;
- Enter in the case number, push find this case;
- find summary judgment;
- Client name;
- Find client information; select the Plaintiff Motion for Summary;
- “Yes” for attachments;
- Find your document;
- Choose your category – ORDER –
- Add to list;
19. Attorney Will Create Federal Court Review
- Attorney will Examine claimant’s Earning’s Summary to determine client’s Earnings History
- Attorney Will compare the Earnings History to claimant’s Work History Form
- Attorney will prepare Argument for any discrepancy
- Attorney will examine the Medical Records in claimants’ SSA file
- Attorney will summarize all medically determinable severe impairments
- Attorney will identify the Exhibit number and page for the Judge
- Attorney will identify all Listings of Impairments that apply to client’s case
- Attorney will identify the most likely Residual Functional Capacity (RFC) level the claimant is at currently, based on the medical summary
- Attorney will compare claimant’s RFC Estimate to their Past Relevant Work (PRW) to determine the jobs mostly likely to be identified by the Judge that client could still do
- Attorney will prepare arguments to rebut the judge’s assumptions
- Attorney will prepare Arguments to prove claimant can’t do PRW
- Attorney will determine which grid rules may apply
20. If Claimant Receives an Unfavorable Decision:
- The letter “Denial by Administrative Law Judge will be sent to client.
- The Unfavorable decision will be placed in client’s file.
- Attorney will review and initial the decision and decide next step.
- Attorney’s decision will be noted in the claimant’s file.
21. If Claimant Receives a Fully Favorable Decision:
- We will receive the Award Letter
- Attorney will double check the letter for proper benefits calculation.
- The letter explaining the Award Benefits will be mailed to client.
- A check with for the Awarded Benefits will be mailed to client by the Social Security Administration.
- Attorney will add the award information to claimant’s file;
- Close out claimant’s file;
- And send client a contract completion letter via regular mail and certified mail.