We are pleased to provide the revised Best Practices for Claimants' Representatives. It is our hope that all claimants’ representatives will use these best practices as an aid when advocating and appearing before the Office of Disability Adjudication and Review (ODAR).
ODAR is one of the largest administrative adjudicatory systems in the world. The claimants who appear before us may feel overwhelmed by the legal and administrative requirements associated with pursuing a Social Security claim. Therefore, it is important for those most closely associated with this effort to work together in a collegial and professional manner to make this process as efficient as possible. With those goals in mind, we share these best practices so that we can successfully fulfill our joint mission to provide the best possible service to the public.
Chief Administrative Law Judge
Social Security Administration
Office of Disability Adjudication and Review
Patricia A. Jonas
Social Security Administration
Office of Disability Adjudication and Review
1.01 Be familiar with and follow the rules of conduct and standards of responsibility for representatives.
All claimant representatives should be familiar with, and follow, the rules set forth at 20 CFR 404.1740 and 416.1540. These rules identify both the affirmative duties of a representative and the prohibited actions. See also Hearings, Appeals, and Litigation Law Manual (HALLEX) I-1-1-40.
1.02 Obtain as much information as possible from our website, http://www.ssa.gov/appeals/index.html
This practice is a general rule for all dealings with SSA. At the hearing level, the majority of claimants are represented, and we encourage our employees to cooperate as much as possible with requests for information or assistance from representatives. Every personal request for information from hearing office personnel, however, diverts the employee from performing responsibilities relating to other hearing requests. The time saved when representatives obtain information from the website can mean thousands of saved hours that can be devoted to processing other claims. Additional information is available on SSA’s website for representatives.
1.03 Timely and properly submit all necessary forms.
This practice should include forms SSA-1696 (Appointment of Representative) and SSA-827 (Authorization to Disclose Information to the Social Security Administration), as well as any fee agreement. If applicable, obtain and submit withdrawals and waivers from prior representatives to avoid possible delay in payment. Moreover, representatives must submit a form SSA-1695 (Identifying Information for Possible Direct Payment of Authorized Fees) to the SSA field office, not the hearing office, even if the case is pending at the hearing level.
1.04 Establish and maintain a good working relationship with hearing office staff and management.
Participate in periodic group meetings with the Hearing Office Chief Administrative Law Judge and Hearing Office Director in the offices in which you practice. Open dialogue allows both representatives and hearing offices to exchange suggestions as to how to improve service in the local area.
1.05 Timely notify the hearing office of any change of address or phone number for either yourself or the claimant.
This ensures that claimants and representatives receive timely notifications and limits the potential for a non-appearance at a scheduled hearing.
1.06 When withdrawing representation, provide sufficient written notice to the claimant as well as to the hearing office.
If you decide to withdraw as representative, please notify the hearing office and claimant as far in advance of the hearing date as possible. Use HALLEX I-2-4-25 C.1.c. and D.1., as well as section I-1-1-30, as a guide.
1.07 Ensure a fee agreement or a fee petition is consistent with Social Security law and policy.
Using the language contained in the sample fee agreement on our website reduces the chance of a fee agreement being disapproved by an administrative law judge (ALJ) for failing to meet the statutory requirements.
1.08 If the claimant decides to withdraw his or her Request for Hearing, provide timely and sufficient written notice of the withdrawal request to the hearing office.
Notifying the hearing office in a timely fashion, and preferably as far in advance of the hearing date as possible, may allow the hearing slot to be given to another claimant.
Under 20 CFR 404.935 and 416.1435, claimants have a duty to submit additional evidence or a summary of the evidence with a Request for Hearing or within 10 days after filing the request, if possible. Under 20 CFR 405.331, claimants in Region 1 (Maine, New Hampshire, Vermont, Massachusetts, Connecticut and Rhode Island) must submit any written evidence no later than five business days before the date of the scheduled hearing. Therefore, we encourage all representatives to review the file and submit evidence as early in the hearing process as possible. Do not wait until the case is scheduled to submit evidence.
2.01 Take advantage of your ability to access a claimant’s electronic folder.
Appointed representatives who have registered for the Appointed Representative Services and who request eFolder access can view and download documents in Sections A, B, D, E, and F of the Case Documents and Exhibit List tabs of their clients’ Certified Electronic Folders. Representatives can also download any digital hearing recordings in the electronic folder to their personal computers. Please remember that you must be the primary representative of record in order to access the electronic file.
2.02 Do not submit duplicative or illegible evidence.
Agency regulations require claimants and representatives to submit all evidence that relates to the claimant’s disability claim received from any source in its entirety, unless the same evidence was previously submitted to the Agency. See 20 CFR 404.1512(c) and 416.912(c).
These regulations also require the claimant’s representative to help the claimant obtain the information or evidence that we require the claimant to submit under our regulations. Submitting duplicative or illegible evidence significantly delays preparation of cases for hearing. Hearing office staff often spend several hours on any given case sorting out duplicate evidence. The sooner a case is prepared and exhibited, the sooner the hearing office can schedule the case. If a document is not readable because it is illegible or a poor copy, provide a typed and legible version or a clearer copy, when possible.
2.03 Submit or inform us about all known evidence relating to whether the claimant is disabled.
A claimant and representative must inform us about or submit all known evidence that relates to whether the claimant is disabled, subject to two narrow exceptions for privileged communications. These exceptions are oral and written communications protected by the attorney client privilege, and information subject to the attorney work-product doctrine. Failure to comply with the Rules of Conduct may lead to sanctions against a representative.
A representative may ask the hearing office for assistance in obtaining existing medical evidence from a medical source after he or she has made a good faith effort to obtain that evidence, or when the representative is unable to obtain the evidence for reasons beyond his or her control. See HALLEX I-2-5-14. These requests for assistance should be submitted no later than 30 days before the hearing, to allow time for the hearing office to request and receive the evidence in time for the hearing. Failure to do so could result in case processing delays.
2.04 Submit evidence as far in advance of the hearing as possible, using Electronic Records Express (ERE).
Representatives should provide sufficient time for hearing office staff to associate the evidence with the file. Please submit evidence via the ERE more than 15 working days before the hearing, as this practice allows hearing office personnel to exhibit the evidence and ensures that the claimant’s copy of the file includes a copy of all the evidence that has been received. It also gives the ALJ time to review all the evidence, and helps to ensure that all relevant evidence is timely provided to experts scheduled to appear at hearing. As noted above, in Region 1, evidence must be submitted no later than five days before the hearing.
2.05 Do not submit voluminous records as one document.
Up to 200 pages at one time can be faxed into the electronic folder using the fax number and bar code supplied with the Acknowledgment of Hearing notice. However, we recommend smaller submissions when possible. Instead of submitting new evidence into the record as one large exhibit, divide the evidence into separate exhibits containing the records from a single medical source, preferably less than 30 pages, for ease of processing and identification. This practice assists hearing office staff in reviewing the evidence for duplicates and exhibiting the records.
2.06 Before submitting evidence, check to ensure the evidence submitted belongs to the claimant.
This simple precaution significantly reduces the time hearing offices spend contacting representatives and re-associating evidence with the appropriate file.
2.07 When faxing evidence from different sources into the electronic folder, separate sources by placing a bar code as the first document for each source and submit in chronological order.
Submitting evidence separately by source is the most effective way to assist the hearing office in completing a timely and accurate review of the record, and allows the hearing office to associate new evidence with any previous medical or opinion evidence from the same source and helps the hearing office to review the claimant’s case faster. Organizing records by date of medical service, oldest to newest, likewise assists the hearing office in quickly and accurately reviewing the claimant’s course of treatment with a particular source. This practice also assists hearing office staff with reviewing the evidence for duplicates and in exhibiting the records.
Ensure that the barcode is the first item faxed in order to ensure proper identification of all records. If you do not have a barcode for a particular case, please ask the hearing office to provide you with one. Bar codes may be photocopied and used more than once, but only for the same claimant.
2.08 Submit a cover letter with the evidence identifying what is being submitted and the date of the evidence.
Submitting evidence with a cover letter and the dates of the evidence will assist hearing office staff in identifying duplicates and in exhibiting the records. Clearly label newly submitted evidence with the source’s name, the dates covered, and number of pages. For example: Attachment A – records from Mercy General Hospital, Topeka, KS, for the period 1/2012 through 6/2013, 16 pages; Attachment B – records from treating physician John Smith, M.D., Topeka, KS, for the period 12/2011 through 1/2013, 5 pages.
2.09 Do not submit medical evidence with non-medical evidence documents such as appointment of representative forms or fee agreements.
Because these documents are included in different sections of the folder, it requires more time to separate documents if they are submitted together.
2.10 Address employment (substantial gainful activity, unsuccessful work attempts, sheltered work environments, etc.) and earnings issues in a pre-hearing brief or at the hearing.
Be sure to distinguish long-term disability, vacation, or bonus pay, which may appear as earnings after alleged onset.
2.11 Address worker's compensation issues in a pre-hearing brief or at the hearing.
If there has been a settlement, provide appropriate proof.
2.12 Submit concise pre-hearing briefs whenever possible.
This practice assists an ALJ in preparing for the hearing and focusing on the issues or arguments you wish to raise.
2.13 Clearly label an OTR request "OTR Request," and submit as early as possible (but only when a request is appropriate).
OTR requests are not appropriate in every case, and you should only request an OTR when the evidence in the record unequivocally supports a favorable outcome.
2.14 Identify evidence that supports the OTR.
OTR requests should include a concise summary at the beginning of the brief outlining the argument, followed by a more detailed explanation specifically directing the reviewer's attention to evidence supporting a favorable decision.
2.15 Make sure the evidence supports the alleged onset date.
Onset issues are one of the most frequent reasons an OTR request cannot be granted.
2.16 When contacted, work with attorney advisors to expedite decisions.
Attorney advisors review and screen cases for an OTR, and some senior attorney advisors have the authority to issue a fully favorable OTR decision when it is warranted. If you are contacted by an attorney advisor regarding substantial gainful activity or onset issues in a particular case, discuss the matter with the attorney advisor to see if the issue can be resolved without a hearing.
2.17 Submit updated evidence with an OTR request.
With updated evidence, an ALJ may issue a fully favorable decision without a hearing in a case, which saves time and resources for both the claimant and the hearing office.
Submitting Dire Need and Terminal Illness requests, or
information regarding incarcerated individuals
2.18 Notify the hearing office when the claimant has a terminal condition, or is homeless or in dire need. Include appropriate documentation supporting these allegations.
If the allegation is supported, notifying a hearing office of these circumstances can expedite the processing of a case. You must provide sufficient documentation to support the request. The criteria for critical case processing are located in HALLEX I-2-1-40.
2.19 If the claimant is incarcerated, know our procedures and keep the hearing office informed.
It is very important that the hearing office be apprised of the status of an incarcerated claimant and the anticipated duration of the incarceration.
Scheduling, logistical and other issues arise when a claimant is incarcerated. These may include the manner of appearance available at the correctional facility, and issues with scheduling a consultative examination, among others. As stated in HALLEX I-2-3-10 A, a claimant’s confinement in a prison or other institution may require an ALJ to schedule the hearing at the place of confinement, by video teleconferencing (VTC), or by telephone when neither an in-person nor VTC hearing is possible.
2.20 Provide scheduling availability
Hearings require the participation of numerous individuals. These include the ALJ, the claimant, the hearing reporter, the expert witnesses, and possibly a claimant representative, other witnesses, or an interpreter. As requested by the hearing office or National Hearing Center, please provide your scheduling availability to ease the scheduling process for all involved.
2.21 Do not request postponements unless essential.
Be flexible when providing dates and times for hearings, and timely request postponements in writing whenever possible. When you have already agreed to the time of a scheduled hearing, avoid requesting a postponement for a conflict that arises later.
2.22 Consider appearing at the hearing by VTC.
We encourage you to appear at hearings by video teleconferencing (VTC). When a hearing is held by VTC, the claimant may appear at a field office, hearing office, or his or her representative’s office if the representative has signed up for the Representative Video Project (RVP). RVP allows a claimant and his or her representative to appear at the hearing from the representative’s office using the representative’s video equipment that has been certified by SSA’s Office of Systems. More information on RVP can be obtained at www.ssa.gov/appeals/odar_pubs/70-070.pdf. In addition, please see the pamphlet “Why You Should Have Your Hearing by Video Teleconference,” available at http://www.ssa.gov/appeals/odar_pubs/70-067.pdf, which discusses the advantages of having a hearing by video.
2.23 When representing a child, have an adult available to care for the child during the entirety of the hearing.
A child claimant may not be able, or required, to remain present in the hearing room for the entire hearing. An adult must be present to care for the child outside of the hearing room. SSA staff will not provide care for the child.
2.24 Notify the hearing office in advance if any special accommodations or assistance is needed.
The agency will provide an interpreter free of charge, when requested, if a claimant has difficulty understanding or communicating in English. However, interpreters for some languages are more difficult to obtain. Please ensure that the request is submitted as far in advance as possible. Additionally, under Section 504 of the Rehabilitation Act, other accommodations may be possible to ensure that claimants are able to fully participate in the hearing. Make such requests as far in advance of the hearing as possible. For more information, see HALLEX I-2-0-8.
3.1 Submit post-hearing evidence as soon as possible, and include a written brief identifying how the evidence supports a favorable decision.
This practice will assist the ALJ in reviewing the records and appropriately focus attention on the information supporting your arguments, resulting in the issuance of a timely decision. If you are unable to submit evidence within the time period allotted by the ALJ, timely advise the hearing office of the circumstances, including whether you are requesting additional time, or if you need our assistance in obtaining the evidence (see information in 2.03).
3.2 Submit fee petitions within 60 days of a decision or as soon as possible after your services have been terminated or withdrawn.
Submitting fee documents within this period will have a significant impact on the time a representative waits for payment. This practice reduces the number of follow-ups necessary to determine if a fee petition will be submitted, allowing the ALJ to act on the fee authorization at an earlier date. It reduces the likelihood that funds withheld for direct payment will be released to the claimant, and reduces the wait time if administrative review of an authorized fee is requested.
Requests for Review
4.1 Requests for review must be in writing.
We make available Form HA-520, Request for Review of Hearing Decision/Order, for this purpose, but a written request in any form is acceptable.
4.2 A request for review cannot be submitted via the Internet.
This Appointed Representative Guide to Requesting Appeals Council Review chart describes the three best methods to submit a request for review.
Using any other method, including submission by Electronic Records Express or by fax with a barcode can cause significant delays in processing because Appeals Council (AC) staff does not receive an alert that a request was filed.
4.3 Candor and truthfulness is necessary in any submission to the AC, including the request for review.
Please note that submissions to the AC, including the request for review, additional arguments, and any additional evidence, are governed by 18 USC §§ 1001 and 1621. These statutes, as well as our regulations, require representatives to be forthright in their dealings with us and prohibit a representative from knowingly making false or misleading oral or written statements, assertions, or representations to us about a material fact or law (20 CFR 404.1740 and 416.1540).
Requesting Critical/Terminal Illness (TERI) Case Status
4.4 If a claimant’s case is critical, let us know when you file the request for review.
If you believe a claimant’s case qualifies for expedited processing under our critical case procedures in Hearings, Appeals, and Litigation Law (HALLEX) manual I-3-1-5, clearly state this in the request for review. Point to or provide evidence to support your request. You can follow up on the request by calling the Congressional and Public Affairs Branch (CPAB) at 1-877-670-2722.
4.5 If you later learn that a claimant’s situation is critical, contact us immediately.
If you believe a claimant’s medical condition or financial situation becomes critical after you file the request for review, fax a brief statement and supporting documents to CPAB staff at (703) 605-8021. You can also contact the CPAB staff by phone at 1-877-670-2722. A specialist on the CPAB staff will evaluate the claimant’s situation under HALLEX I-3-1-5 and take appropriate action.
4.6 If you are requesting a copy of the record, submit a clear request.
If you wish to receive a copy of exhibits or the hearing recording in a case, please clearly state this request at the beginning of your correspondence to facilitate support staff screening and action on your request. Our letter responding to your request will grant you a 25-day extension of time and will include two AC level barcodes that you can use to submit additional evidence or arguments.
4.7 Be specific in requesting an extension of time.
Requests for an extension of time should explain how much additional time you need and why the AC should grant the request. For second requests, or requests for more than 40 days, the AC will consider the particular set of circumstances in each case. The AC does not grant extensions automatically and will grant additional time only if there are extenuating circumstances present in the case. If the AC grants an extension of time, we will provide you with barcodes to submit additional evidence or arguments.
4.8 If you want barcodes, request an extension of time.
Since the AC only sends barcodes when specifically asked, the best way to ensure that you get AC level barcodes is to request an extension of time when you submit the request for review.
Representative Access to Electronic Folders
4.9 Take advantage of your ability to access a claimant’s electronic folder.
Appointed representatives who have registered with the Social Security Administration (SSA) for the Appointed Representative Services and who request eFolder access are able to view and download documents in Sections A, B, D, E, and F of the Case Documents and Exhibit List tabs of their clients’ certified electronic folders. As long as the case is pending before the AC, representatives can also download any digital hearing recordings in the electronic folder to their personal computers.
4.10 Make the AC aware of any changes in representation.
If a claimant has appointed more than one representative, only the main representative (as indicated on the Form SSA-1696 with the most recent date) will have access to the electronic folder. If a claimant’s main representative changes, it is very important that you notify the AC right away so we can update our records.
4.11 Other issues to note about access to the electronic folder:
- If our records indicate that you have access to the electronic folder, we will not send you copies of a claimant’s hearing recording or exhibited evidence on compact discs. We will grant you an extension of time and notify you in our letter that our records indicate you have access to the electronic folder.
- If a claimant has more than one claim pending at the same time (e.g., a claimant has a claim pending at the hearing level and at the AC), representatives will not have access to the electronic folder of either claim.
- A representative has access to a claimant’s electronic folder for 90 days after the AC completes its action in a case. During the 90 days, only the representative recorded in our case control system at the time the case was closed has access to the electronic folder. If the claimant obtains a new representative to file a civil action, the new representative will not have access to the claimant’s electronic folder.
4.12 Submit any additional evidence or comments with the request for review.
For internal review and association purposes, it is very helpful if you submit the request for review and all evidence at the same time. Claimants must inform the agency about or submit to the agency all evidence, in its entirety, known to him or her that relates to whether he or she is blind or disabled. Representatives must help the claimant obtain the information or evidence that the claimant must submit. This duty applies at the AC level if the evidence relates to the period on or before the date of the administrative law judge (ALJ) decision.
4.13 If you have additional evidence, explain how it is material to the period at issue.
In regard to new evidence, the AC applies 20 CFR 404.970 and 416.1470. For disability claims filed in the Social Security Administration’s Region I (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), the AC applies 20 CFR 405.401 to new evidence submissions.
4.14 Avoid submitting duplicate evidence.
The AC has access to the entire record present at prior levels of adjudication, including the hearing level. Please do not resubmit information that is already available to the AC.
4.15 There are three ways to submit evidence to the AC.
You can submit evidence directly to the electronic folder by mail or fax, via the Electronic Records Express website, or by paper fax directly to the AC. Please see this Appointed Representative Guide to Requesting Appeals Council Review chart for a detailed explanation of each method. Please note, as discussed in section 4.2 above, you should never submit a request for review by the Electronic Records Express website.
4.16 When submitting evidence, organizing it chronologically and by source greatly aids case processing.
The AC reviews all evidence presented at prior levels of adjudication as well as evidence submitted while a claim is pending with the AC. Submitting evidence separately by source is the most effective way to assist the AC in completing a timely and accurate review of the record. Instead of submitting all new evidence into the record as one large exhibit, divide the evidence into separate exhibits containing the records from a single medical source. This allows the AC to associate new evidence with any previous medical or opinion evidence from the same source and helps the AC to review the claimant’s case faster. Organizing records by date of medical service, oldest to newest, assists the AC in quickly and accurately reviewing the claimant’s course of treatment with a particular source.
Clearly label newly submitted evidence with the source’s name, the dates covered, and number of pages. For example: Attachment A – records from Mercy General Hospital, Topeka, KS, for the period 1/2012 through 6/2013, 16 pages; Attachment B – records from treating physician John Smith, M.D., Topeka, KS, for the period 12/2011 through 1/2013, 5 pages.
4.17 Contentions should be specific.
The AC appreciates receiving concise, focused arguments. We recommend using 2,000 words or less if possible.
4.18 Contentions need not include a recitation of the jurisdictional history or evidence generally, unless related to a specific point of contention.
As the record is already before the AC and the AC reviews the entire record in each claim, a summary of the evidence is not necessary. There is also no need to send us a copy of the administrative law judge’s decision or a copy of the hearing recording.
4.19 Cite to the record.
Citing specific exhibits and the pertinent page numbers of cited exhibits in support of a specific point of contention helps us review the record more efficiently.
4.20 Do not make automatic, multiple requests for the status of a request for review.
You can verify that the AC has received the request for review through the online status report available in the Social Security Administration’s (SSA) Appointed Representative Services (ARS), by contacting your local Social Security office or local hearing office, or by calling our Congressional and Public Affairs Branch at 703-605-8000 and toll free at 1-877-670-2722.
4.21 Requirements to view the online AC status reports.
On August 26, 2013, SSA expanded ARS to include an online status report for cases pending at the AC. To have access to the AC status report, representatives must register with SSA for ARS. Additionally, the case must be pending before the AC with a record in our case control system, and the representative attempting to access the report must be shown as the claimant’s representative in our case control system.
If you attempt to access ARS, are denied access, and the error message says, "Our system cannot accept the Social Security Number you entered" (see screenshot below):
- You may have entered the wrong Social Security Number (SSN); or
- You may not be shown as the appointed representative for this case in the Case Processing and Management System (CPMS) or the Appeals Review Processing System (ARPS).
If you are denied access and the error message says, “Your ability to use the Access Claimant’s Electronic Folder service has been suspended” (see screenshot below), please call the telephone number provided in the message to reinstate your access. If you have already called to reinstate access and the problem persists, send your REP ID and contact information to ^ODAR HQ ARS and request that they contact you to restore access to the electronic folder.
If you receive an error message saying “Unable to Process Your Request” (see screenshot below), it could be the result of one of the following problems:
- The case is not electronic;
- The case was closed more than 90 days ago;
- The case is not at the hearing office (HO) or AC level;
- The case has been remanded; or
- There are multiple pending cases at the HO or AC levels.
4.22 Representatives have three options for viewing their cases in real-time:
- Search for individual cases by SSN. (Cases must be active or closed within the last 90 days.)
- View a list of up to 100 of the oldest cases for all AC offices. (Cases must be active or closed within the last 90 days.)
- Download all cases for all AC offices in a spreadsheet file. (Cases must be active or closed within the last 90 days.)
4.23 The view only status report will display the following information:
- Claimant Name (Last, First)
- Last 4 of SSN
- Case Status/Status Date
- Appeals Office with Jurisdiction
- Transfer Information
- Electronic Case (Yes or No)
- Request Date
- Expedited (Yes or No)
4.24 The downloaded status report will display the following information:
- Claimant Name (Last, First)
- Last 4 of SSN
- Case Status/Status Date
- Claim Type
- Appeals Office with Jurisdiction
- Transfer Information
- Electronic Case (Yes or No)
- Request Date
- Expedited (Yes or No)
- Fee Agreement (Yes or No)
- Fee Petition (Yes or No)
- Title II and Title XVI (T2 & T16, respectively) Decision
NOTE: The Fee Agreement field displayed in the downloaded AC Status Report will always contain a NO unless the AC issues a favorable decision.
4.25 What it means if the T2 or T16 Decision field shows “Other”.
The AC status report only provides detailed status information for the request for review workload. Therefore, the T2 & T16 Decision field will include denials, dismissals, favorables, unfavorables, and remands.
The workload types below will display the T2 & T16 disposition code “Other” when one of the following types of cases is closed.
4.26 Further descriptions of the “Case Status” field:
- New case – New request entered in control system pending further screening
- Case workup – Screening or case preparation actions (e.g., responses to claimant or rep initiated requests for extensions, file material, timeliness of filing)
- Pending analyst assignment – Preparation actions completed; in assignment queue
- Assigned to analyst – Assigned to analyst for workup and referral to adjudicator
- Assigned to adjudicator – With AC for disposition
- Document preparation – AC notice prepared for release
4.27 Other issues to note about the AC online status report:
- Only the representative recorded in the AC’s case control system will have access to the status report. If a claimant’s main representative changes, it is very important that you notify the AC right away so we can update our records. (The AC recognizes as the representative of record the person designated as the main representative on the Form SSA-1696 with the most recent date.)
- The AC online status report only provides information for active cases or cases closed within the last 90 days. Only the representative recorded in our case control system at the time the case was closed has access to the online status report.
- Federal court cases are excluded from the AC status report.