One thing that any new applicant for disability benefits will hear about shortly after submitting their application is the disability appeals process. It can sound like a daunting and difficult process filled with claimant participation and, occasionally, claimants can come to feel that they are doing more for their case than their representative is doing. Many times, however, these feelings come up because claimants are unaware of what is happening behind the scenes. This post will take readers through some brief descriptions of the steps in the appeals process and the roles of the claimant and representative are at each stop.
Requesting reconsideration is like asking SSA to redo the work it did during the initial application process. In doing this, SSA will send the application and supporting documents to a different decision maker to see if they come out with a different result. The claimant is allowed to submit additional information or request that SSA go out and get some additional records. This process usually works on the same 3-6 month timeline as the initial application, but can often be quicker since much of the case development was begun in the application stage.
For reconsideration, the claimant should have fewer responsibilities. The most major of these is providing his or her representative with information about recent doctor’s visits, new diagnoses, or new tests. The other important responsibility the claimant will have is completing some paperwork that SSA is going to send to the claimant. These papers can be filled out by the representative, however, most of what the claimant will receive will be questionnaires about their activities of daily living or symptoms they regularly experience making the claimant the best person to complete them.
At this stage, the representative will provide updated medical information to the agency, renew any requests for consultative examinations, respond to the examination reports, and likely add arguments to be presented to the new decision maker(s) reviewing the case. For more severe cases, the representative may also attempt to provide specialist opinions, medical source statements, or vocational opinions that refute the Agency’s reasons for denying at the application stage. Additionally, an attorney or advocate will also spend a good amount of time ironing out issues with medical record providers.
The Social Security Administration ultimately bears responsibility for collecting medical records during the initial application and reconsideration stages of the process. However, most providers are corporations and have requirements for being reimbursed for records. They also seem to assume that SSA is demanding the records for free (despite usually receiving a request for an invoice to be paid by the Administration). Depending upon the state, SSA (and disability lawyers) not only will require that the records be free of charge, but will do so because the state legislatures have enacted laws making it illegal to charge for records meant to support an SSI/SSDI claim. In this type of conflict between law and corporate policy, the law generally wins, but unless someone explains how the laws governing medical records works to a provider, or obtains a subpoena from an ALJ to require them to be released, the records may simply never be returned. Thus, this becomes a time consuming responsibility for your representative during the Reconsideration and hearing stages.