Using SOAR in the Appeals
Process
Will Connelly
SAMHSA SOAR TA Center
September 13, 2011
Welcome

Welcome to today’s webinar

Today we will provide an overview
of the SSA appeals process and
discuss strategies about how
SOAR can be used to facilitate a
timely review
Webinar Instructions

Recording availability

Q&A segment and chat function

Muting
Agenda
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Overview of the appeals process
– Will Connelly, SAMHSA SOAR TA Center, Delmar, NY

Reconsideration
– Paul Berry, Ph.D., St. Paul, MN

Review on Record
– Vicki Dunham, Eckman/Freeman & Associates, Nashville, TN

Administrative Law Judge (ALJ) Hearings

Bill Doub, Genesee County Community Mental Health, Flint, MI
Levels of Appeal

Reconsideration
– Note: 10 States do not have this level– AL, AK, CA
(Los Angeles North and West areas), CO, LA, MI,
MS, NH, NY (Brooklyn and Albany), and PA

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Review on Record
Hearing before an Administrative
Law Judge (ALJ)
Appeals Council
Federal Court
Useful Information

SSA website information on
appeals
http://www.ssa.gov/pubs/10041.html#Reconsideration

Tips on Appeals
http://www.prainc.com/SOAR/training/pdfs/TipsforPendingAp
psandAppeals.pdf
Reconsideration
Paul Berry, Ph.D.
Overview


File within 60 days of SSA denial
If possible allege
– Worsening condition and/or
– New evidence and/or
– New impairment

Case is reviewed at DDS by
different examiner than original
claim
Overview con’t


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Nationally 15% are reversed on
recon
Many case managers file recon as
quickly as possible to move to
ODAR
Consider carefully before filing a
recon for a partially favorable SSDI
decision
Reconsider Recon!
There are opportunities at recon level
 Steps
– Obtain and READ the decision from
DDS thoroughly
– Gather information that will counter
DDS’s original denial
– Become familiar with Process
Unification regulations
Timing Is Everything


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Become familiar with your state’s
guidelines on waiting period before
reconfirming denial
Make DDS aware that there may be
some delay in providing new
evidence.
Don’t be afraid to ask them to wait.
Timing con’t


Know how long DDS must wait for
new medical evidence. In MN it’s
30 days
Wait period may be different for
non-medical/ADL data. In MN it’s
10 days
Delay Filing for Recon

If you know you have new
evidence, consider delaying filing
the application – until you have the
new data

Ensure that your new information
arrives prior to the deadline
Amended MSR



Submit a revised Medical Summary
Report (MSR) on recon
Be sure to address the issues
raised by DDS in the denial
Make sure that the new evidence is
easy for the new adjudicator to find
Contact Information
Paul Berry
Email: plb.maine@gmail.com
Office: 952 432 1091
Cell: 952 412 0794
On-The-Record
Favorable Decision
Vicki Dunham
Eckman/Freeman and Associates
The Steps
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Know the reason for denial
File the appeal with supporting rationale on SSA Form
501
Prehearing Review based on advanced age and Dire
Need Processing
Identify and Resolve Issue
Obtain additional supporting evidence
Research and identify corresponding Impairment Listing,
Medical-Vocational Rule, and/or Social Security
Ruling(s)
Request an On-the-Record Favorable Decision
Know the Denial Reason(s)

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Request the electronic folder from the
Social Security office or ODAR
Review the CD to ascertain evidence
on file and rationale for denial
Review earnings record to make sure
there are no SGA earnings
Make note of errors,omissions, and
plan your strategy
File a Hearing Request
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File online within 60 days of
decision
Cite supporting rationale on Form
HA-501-U5
State that you have additional
evidence
Plan to attend the hearing
Pre-Hearing Based on Age

If claimant is 55 or over
– Generally flagged by ODAR for prehearing review
– If unfairly denied by DDS, can be
approved here

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Submit new evidence immediately
Follow up on status
Dire Need

Submit proof of homelessness

Other dire need situations
– Terminal illness
– Eviction/foreclosure
– Suicidal/homicidal tendencies
Common Issues

Wages on the earnings record after
disability onset

Alleged disability onset date does
not match the evidence

Substance abuse...material vs. nonmaterial
Suggested Strategies
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Contact past employers for clarification
of earnings, special conditions, etc.
Consider amending alleged disability
onset date to a date where the proof is
clear
Compare functioning during periods of
use and abstinence
Clarifying letter from treatment provider
Creating the OTR Request
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Summarize the evidence, cite proof,
and propose consideration of an
on-the-record decision
Submit the brief with a bar code or
through Electronic Records Express
Follow up with ODAR to be sure the
case is pulled for prehearing review
Resources

Medical-Vocational Guidelines: 20 CFR Appendix 2 to
Subpart P of Part 404

SSR 96-2p: Policy Interpretation Ruling Titles II and XVI:
Giving Controlling Weight to Treating Source Opinions
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SSR 96-9p: Policy Interpretation Ruling Titles II and XVI:
Determining Capability To Do Other Work
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SSR 06-03p: Titles II and XVI: Considering Opinions and
Other Evidence from Sources Who Are Not “Acceptable
Medical Sources” in Disability Claims
Contact Information
Vicki Dunham, CDMS
Eckman/Freeman and Associates
Social Security Disability Services
Email:VDunham@eckmanfreeman.com
Phone (615) 889-1221
Fax (615) 889-4206
SOAR Appeals & Hearings
William A. Doub
Genesee County Community Mental Health
Before the Hearing

Find out when the hearing is
scheduled

Begin to prepare your client for
what’s likely to happen

Determine who is going to be
conducting the hearing on behalf of
the claimant
Preparing for the Hearing

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Request a copy of the Client’s
Record Disc from the Hearing
Office
Review the claim, including the
evidence used to deny the claim
Submit new evidence if applicable
Use SSA Disability Criteria and
apply the evidence
Hearing Mechanics

Respond immediately to hearing
announcement

Find out the location for the hearing

Contact the judge’s office for the
timetable to introduce evidence
Other People at Hearing

A Hearing Monitor and a Vocational
Expert are assigned to be present

Pay close attention to the testimony
given by the Vocational Expert
What the ALJ Looks For

Is all the evidence in the file,
including any new evidence

Does your Medical Summary
Report reflect any new evidence

Judges will look at your MSR and
consider it a legal framework to
review the claim
Evidence During the Hearing
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Be prepared to make an opening
statement showing how claim
meets Listings with new evidence
Judge wants you to present your
client’s case and not give testimony
You may be asked to question your
client about his/her conditions
causing them to be disabled
Closing Statements
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You may be asked to provide a
closing statement, summarizing key
points
Be ready to ‘connect the dots’ and
make your client’s case
The ALJ may ask for your
recommendations for the client
Final Comments
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Don’t panic! There are trainers who
can help you get ready for the
hearing
Get your client ready for the hearing
by meeting with him/her frequently
Be supportive and a source of
encouragement.
Contact Information
William A. Doub, MAUP
Community Housing Supervisor
Genesee County Community Mental
Health
WDoub@gencmh.org
Phone: (810) 257-3662
Fax (810) 257-3665