A step-by-step overview of the SSD application and appeal process

It occurred to me this morning that while I know how to run a Social Security case from beginning to end, I don't actually use a comprehensive written step-by-step checklist or task list.  I am working on improving the efficiency and accountability of my practice as well as providing instructional information to other practitioners.  Additionally, clients sometimes ask what is involved in an attorney's representation of a claim.  What follows is a step-by-step listing of the actions that must be taken to prepare a Social Security claim through all levels of administrative appeal, excluding Federal Court appeals which I do not presently represent.  

Note that each step is merely listed.  Some of these steps are straightforward and self-explanatory, while others are fairly involved and require multiple specific expertise and sub-steps to complete.  

Here is the list of steps:

Firm intake/retention (insert before whichever phase the client comes in to the firm and before taking any other official action):

  1. Input client data to case management system. 
  2. Prepare representation forms (SSA-1696 and fee agreement) and medical authorization documents (SSA-827, HIPAA release, source-specific authorization forms)
  3. Have client and attorney sign all forms. 
  4. Submit representation forms. At IA, submit by mail or fax to local office. At hearing, submit by fax, mail, or barcode to hearing office. At AC, submit by mail or fax to AC. 

Phase one: the initial application

  1. Prepare client to have the following information available: contact and identifying information; diagnosis and limitations causing disability; information on every marriage within the last ten years; date disability began and/or work ended; contact information and treatment dates for all medical sources since AOD; list of medications identified by prescribing source and condition treating; recent medical tests by date and body part; wage and hour information for past five jobs; contact information of last five employers
  2. Complete SSD application online at SSA.gov using above information. 
  3. Advise client to complete and return forms sent by DDS. Assist client as necessary. 
  4. Prepare client for consultative examination. 
  5. Reach out to a treating source for a functional capacity opinion. 
  6. Submit representation forms to local office
  7. Receive decision
  8. Advise client of decision. 

 

Phase two: the hearing

  1. File request for hearing. 
  2. Identify known medical sources. 
  3. Submit representation forms if not already done. 
  4. Verify receipt of appeal. 
  5. View and download initial exhibit file. 
  6. Review exhibit file. 
  7. Obtain a relevant treating source opinion. 
  8. Obtain updated records from supportive treating source. 
  9. Prepare and submit OTR if opinion and supporting records are sufficient. 
  10. Advise client to complete and return incidental forms sent by ODAR. 
  11. Wait for scheduling of hearing. 
  12. Communicate with scheduling office to schedule hearing. 
  13. Advise client of scheduled hearing. 
  14. Update treatment information. 
  15. Obtain updated medical records, verifying date range of records already received and submitted to avoid duplication. 
  16. Obtain updated medical opinion. 
  17. Review received medical records. 
  18. Submit received medical records. 
  19. Review opinions for support. If supportive, submit. If unsupportive, evaluate for next steps.
  20. Prepare and submit five-day notice letter as relevant. 
  21. Prepare and submit brief as relevant. 
  22. Contact client to prepare for hearing testimony. 
  23. Attend hearing. 
  24. Debrief client. 
  25. Complete any required post-hearing follow up. 
  26. Await decision. 
  27. Check status report for case status. 
  28. If inordinately delayed, write to ODAR to expedite. 
  29. Download or receive decision. 
  30. Review decision. 
  31. If favorable, advise client and proceed as below. If unfavorable, proceed to next phase. 
  32. Call client and advise of favorable decision. 
  33. Submit SSA-1695 to local office.
  34. Follow up on payment. 
  35. Deposit payment. 
  36. Send client completion of case letter. 
  37. Scan and shred paper file; archive electronic file. 

 

Phase three: Appeals Council appeals

  1. Review unfavorable decision to identify viable issues for appeal. 
  2. Call cl and advise them of unfavorable decision. Present options for appeal, withdraw, or new application with relevant recommendation. 
  3. If appeal is agreed to, prepare appeal letter or HA-501 form and mail to Appeals Council. 
  4. Follow up with AC/status report to confirm receipt of appeal and ERE access. 
  5. Download exhibit file. 
  6. Review exhibit file. 
  7. Obtain updated supportive opinion or medical clarification as relevant. 
  8. Obtain updated medical documentation to the extent provably relevant. 
  9. Submit new material evidence, if any. 
  10. Submit written argument. 
  11. Await decision. 
  12. If remand is granted, return to step 5 of hearing level and proceed. 
  13. If denied, proceed to federal court or new application as appropriate. 

 

Phase four: Federal Court appeals (referred out)

  1. Review AC denial. 
  2. Advise client of appeal rights and option of new application. 
  3. Refer out. 
  4. Simultaneously start new application. 

 

Upon grant, regardless of level:

  1. Advise and congratulate client. 
  2. File 1695. 
  3. If relevant, prepare and file fee petition. 
  4. Wait for payment. 
  5. If necessary, follow up on fee petition approval and/or payment. 
  6. Deposit check. 
  7. Submit withdrawal as representative to local office. 
  8. Sent client close-out letter
  9. Scan, shred, and archive file, returning to client any papers they desire. 
  10. Present to client a digital copy of the case file.