For Attorneys: The Phases Of An SSDI Claim

When you help a client apply for Social Security Disability Insurance (SSDI), you both may begin what can become a very lengthy and complicated process. At the practice of James Ratchford Law, PLLC, we’ve laid out a step-by-step breakdown of all of the actions that you, as a qualified Social Security attorney, and your client will take to process a claim. As a diligent Social Security Disability Insurance attorney, you need to prepare for most of these steps and advocate at no cost until your client is granted benefits.

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 the 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 the local office. At the 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 10 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 website using above information
3. Advise client to complete and return forms sent by DDS. Assist client as necessary
4. Prepare client for a 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 the decision

Phase two: The hearing

1. File request for a 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 the scheduling office to schedule hearing
13. Advise client of scheduled hearing
14. Update treatment information
15. Obtain updated medical records, verifying the 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 client and advise them of an unfavorable decision. Present options for appeal, withdrawal 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 the 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

1. Review AC denial and ALJ denial. Identify viable legal arguments
2. Advise client of appeal rights and option of new applications
3. Prepare retainer paperwork, including fee waiver application
4. Simultaneously start new SSD or SSI application
5. File lawsuit with Federal District Court electronically within 60 days of Appeals Council denial (file complaint, retainer forms and $400 filing fee or fee waiver petition)
6. Verify receipt of lawsuit by the court
7. Prepare administrative record collaboratively with assigned U.S. attorney
8. Await U.S. attorney’s answer to complaint and docket calendar from court
9. Prepare legal arguments and case summary as a written brief (20-30 attorney hours)
10. Submit brief before deadline
11. Confirm receipt of brief with the court
12. Confer with U.S. attorney to request voluntary remand
13. Await U.S. attorney’s reply brief
14. Prepare reply to U.S. attorney’s reply
15. Await decision from magistrate judge
16. Review court’s decision and order
17. If claim is granted, file Petition for EAJA fees with fee assignment document
18. If claim is granted, inform client and prepare for subsequent ALJ hearing. Return to Hearing steps above
19. If denied, inform client and advise of next steps
20. If appropriate, consider appeals to U.S. Court of Appeals. Note: This level of appeal is rarely pursued

Upon grant, regardless of level:

1. Advise and congratulate the client
2. File form SSA-1695 with the local SSA office
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 closeout 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

Need More Education? Call Today

As an extensively experienced SSDI attorney from New York now based in West Virginia, I can help educate you on the stages of a Social Security disability claim. Contact me in Morgantown at 304-974-0523 or request an appointment via this convenient email.