The Five Steps Of The Sequential Evaluation
The Social Security Administration uses a sequential evaluation process with five steps when determining whether an applicant qualifies to receive disability benefits. Accordingly, it is often a good idea to specifically address each of the five steps in the prehearing brief, although if a particular step presents no major issues, the discussion of that step may be kept to a minimum.
Depending on the situation, it may be important to focus more on one step than on others. For instance, if an applicants conditions align with one of the SSAs listed medical conditions, information related to this correlation should be highlighted. Likewise, if an applicant has work extensive experience in the one field and is unable to return to that field, then step four should be given substantial attention in the brief.
How To Appeal To Federal Court
You have 60 days from the date of the Appeals Council decision to appeal. This is done by filing a civil complaint with the United States District Court in your area. A civil complaint is a brief statement of facts and allegations that tell the court what your case is about.
Under federal law, you cannot sue the Social Security Administration directly. The defendant in a complaint against the SSA is whoever the current Social Security commissioner happens to be when the complaint is filed.
Once you have written your complaint, it must be filed with the proper court. Use the federal district court locator to find the court for your area.
The SSA cannot help you with a complaint for a federal appeal. You can either file the complaint yourself or hire an attorney who is experienced in appealing disability denials at the federal level to assist you.
If you choose to appeal the denial on your own, you must follow the federal court rules or you risk having your complaint dismissed. For more information about the procedural rules for filing a federal complaint, you can visit the United States Courts website.
The Structure Of The Letter
The structure of the document is also important. Write the brief as you would a letter. Respectful, clear and concise wording allies you with the Appeals Council members.
The Heading: Begin with a formal opening such as Dear Appeals Council Member. Including your name, date of birth, Social Security number and claim number in the heading clearly identifies the case. It helps reconnect your letter and case should they become separated.
The Body: Your arguments and evidence make up the body of the letter. Thoroughly reading your explanation of determination gives you an accurate picture of the factors the SSA considered and their reasons for denial. It includes:
a) A medical condition descriptionb) The impairments evaluatedc) Any medical and non medical sources used in the evaluationd) And, the reasons for denial;
Using this information, craft a well-supported argument. Missing documentation, inaccurate medical descriptions or mistakes in education or work history give you reason to appeal. Look for evidence of these issues in the explanation of determination.
Referencing these specific exhibits with page numbers allows the AC to follow your trail of evidence. Furthermore, gather and submit documentation to support your points and strengthen your claim. Send:
a) Medical records not listed as considered b) New medical records which indicate a change in your conditionc) Medical doctor statementsd) Any new test resultse) Other documents which support your claim;
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Asking The Right People
Social Security wants to hear from people who have first-handknowledge of your condition and how it limits your ability to function. Lettersfrom friends and family can be helpful if they see you often and can describeconcrete examples of your impairment. For example, a friend who comes over tohelp you organize your medication every week because you cannot remember whichpills to take on which day could write a useful letter describing how yourmemory problem keeps you from being able to take your medication. In contrast,a letter from a friend repeating what you have told her about your memoryproblem will not be helpful.
Representative Access To Electronic Folders
4.09 Take advantage of your ability to access a claimants electronic folder.
Appointed representatives who have registered with SSA for ARS 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 CEF 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 principal representative will have access to the CEF. If a claimants principal 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 CEF:
If our records indicate that you have access to the CEF, we will not send you copies of a claimants 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 CEF.
If a claimant has more than one claim pending at the same time , representatives will not have access to the CEF of either claim. A CD will be burned for these specific cases.
What Happens After The Briefs Are Filed
Once the Opening Brief is filed, the SSA then has the opportunity to file a Response Brief. A Response Brief is the SSA’s chance to explain why you are wrong and why the ALJ’s decision was correct. After you may file a Reply Brief, which is one last chance to defend your position and point out weaknesses in the SSA’s argument. Sometimes the court will schedule oral arguments, but this is rare.
Once the briefs have been filed and the oral argument has been held, the federal judge who heard your case will make a decision and issue a written opinion. This process can take at least a year.
When To Send An On The Record Request
After your disability application has been denied at the initial application and reconsideration level, you have 60 days to request a hearing in front of an administrative law judge . When you file your appeal , your claim is transferred from your state’s Disability Determination Services office to the Social Security Office of Hearings Operations, or OHO . After a few months, your case is assigned to a particular ALJ and several months after that, your hearing is scheduled.
Probably the best time to submit an OTR request is after your case has been assigned to an ALJ but before you’ve received a hearing date. Because the judge is the one responsible for deciding your claim, there’s little point in asking for an OTR decision before the judge has been named. On the other hand, if you wait until your hearing has been scheduled, it may be too late for the OHO office to use your time slot for another claimant’s hearing. Keep in mind that OTR decisions are intended to increase the efficiency of an ALJ and reduce the amount of time he or she spends conducting hearings.
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Writing A Social Security Disability Appeal Letter
Living with a disability can be overwhelming. The ability to not be able to work and provide for a family is devastating for most.;
While the Social Security Administration does provide payments for those who are approved under the disability clause of the government system, it can be a chore to get an approval letter.
General Factors To Keep In Mind About A Prehearing Brief
It is wise to prepare a prehearing brief far enough in advance of the Social Security disability hearing so that it can be part of the applicants file at the time the judge begins to review it. After all, even the most well-crafted brief would fail to fulfill its intended purpose if the judge never reads it.
It is also important to note that the word brief can be somewhat deceiving. While it is wise to state matters in a clear and concise manner, there are many components to be included. As such, while a brief should contain material that is to the point, it will not necessarily be short in length.
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Example Of A Letter From A Relative/caregiver
Here is an example of a letter written about Nancy, a claimant who has applied for disability for depression.
My name is Patricia W. I am Nancy’s sister, and have known her all her life. Nancy currently lives with me and my husband in our house. I am retired, so I see her every day. Ever since her husband left her two years ago, Nancy has gotten really depressed. She used to help her husband with managing rental properties, but has not worked for the past few years.
Nancy has few friends and rarely leaves the house. I ask her if she wants to go out dancing or for a night out with the girls, and she says no. I take Nancy out grocery shopping twice per week and to her doctor appointments. She prefers going in the evening because she likes less people in the store. She often says she thinks people are staring at her, but I tell her it is just in her head.
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How To Appeal A Denial
The Social Security Administration provides several ways to appeal. Whichever way you choose to appeal, it is a good idea to obtain proof that you appealed on time .
Go to your local Social Security office to file your appeal. You can find the address in your denial letter. Take along the denial letter, a list of current medications and a list of names and addresses of all medical care providers you have seen since you last updated SSA – since you filed your claim or last appealed – so that you can complete all appeal papers at the Social Security office with the help of a claims representative. Be sure the SSA claims representative gives you a copy of everything you submit and a receipt for your appeal.
Appeal by phone and mail. Telephone SSA at 1-800-772-1213 and explain that you want to appeal. You will be sent the appropriate appeal form, a Disability Report – Appeal, and an Authorization to Disclose Information to the Social Security Administration . Your appeal is not complete until you have mailed the appropriate appeal form back to SSA. Mail the appeal papers back by certified mail that requests a return receipt for merchandise.
Summary Of Medical Evidence
A disability claim file can contain hundreds of pages of medical records over a period of many years. Your goal in your prehearing brief should be to highlight the most significant medical evidence for the judge, particularly the results of objective tests and opinions from your treating physicians that support your claim. It is critical that you provide citations to exhibits in your claim file.
An MRI of the brain performed on August 21, 2015 revealed multiple lesions consistent with a diagnosis of relapsing-remitting multiple sclerosis.
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What If I Am Overwhelmed
The SSDI appeals process and writing an appeals brief leaves many a claimant overwhelmed. As mentioned, a sample disability appeals letter gives you an example to follow. However, attorneys specializing in SSDI cases offer the most support. These experienced professionals know what to look for in the explanation of determination and the evidence needed to get a denial reversed.
Write An Appeals Letter
The Social Security forms for appealing a decision give you only a few lines to write your explanation on why you think the decision was wrong, but you should feel free to write the phrase “see attached page” on the form and submit a letter along with the form that carefully outlines the problems you see with the decision.
The denial letter you received from the SSA that denied your eligibility for benefits will include an “explanation of determination,” which is sometimes called the “disability determination rationale.”
This explanation of determination will include issues such as what sources the SSA used to evaluate your claim, why the SSA denied your claim, what impairments the SSA evaluated, and a description of your medical condition. If anything is incorrect or missing in your explanation of determination, include this in your letter to the SSA. Also submit any statements, records, or other information that makes your claim stronger.
For more on appeals letters, see How to Write a Successful Disability Appeal Letter, on Nolo.com.
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How To Write To The Disability Appeals Council
How do you write disability appeals? Is it the same as a disability appeal letter? Yes, they are the same. And, a denied Maryland Social Security disability insurance claim may lead to this step, depending on how far you pursue an appeal.
The SSDI process proves confusing enough with the fill-in-the-blank applications and documentation gathering. But, if you need to write disability appeals, it takes the complexities to a new level. Of course, you retain the right to draft the letter on your own. But, the insight of a disability representative clears the confusion.
;But, let us break it down for you today.
Talk To A Disability Lawyer
Need a lawyer? Start here.
Here Are Instructions On How To Write A Brief For Your Social Security Disability Hearing
By Aaron Hotfelder, J.D., University of Missouri School of Law
A single disability claim file can contain many hundreds or even a thousand pages of evidence, including vast quantities of medical records. Submitting a written “brief” to the Administrative Law Judge prior to your hearing allows you to highlight the most important evidence, clarify the issues, and present your theory of the case. When done well, a hearing brief reassures the judge that you have a strong claim that is well-supported by medical evidence and consistent with Social Security regulations.
Usually disability claimants hire a lawyer to write a prehearing brief, but if you have good writing skills, you can try to write your own.
How Does A Person Qualify For Ssi
In addition to meeting the disability criteria , an SSI enrollee must meet several non-medical criteria, including having a low income. SSA has complex rules for determining financial eligibility. In general, income is anything received in cash, earned or unearned, that can be used to meet a persons need for food or shelter.17 Income is countable except for some limited amounts that are disregarded.18 Income also includes in kind support, such as any food or shelter provided or paid by another person. In kind support generally is valued at one-third of the maximum federal benefit amount.19 SSA also deems a portion of income from a persons spouse or parent/step-parent as countable income.20 To financially qualify for SSI, a persons countable income cannot exceed the maximum federal benefit rate , and the amount of SSI that a person actually receives is the maximum federal rate reduced by the amount of their countable income.21 These rules apply to SSI enrollees of all ages.
Figure 4: SSI Disability Determination Process for Adults
Figure 5: Disability and SSI Status of Nonelderly Adults with Medicaid, 2019
Figure 6: SSI Application Allowance Rate for Medical Decisions by Adjudicative Level, 2018
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Reference Page Numbers And Exhibits In The Evidence
Social Security should provide you with a CD containing the evidence used to decide your case. The CD will include your medical records and the ALJ’s decision on your case. In your brief, you should provide citations to the particular exhibit and page number that supports your arguments. For example, you might say:
The ALJ erroneously stated that the claimant’s cane was not prescribed by a doctor. In fact, the evidence shows that the claimant’s treating physician wrote a prescription for the cane on August 13, 2012.
You may also cite parts of the audio recording of the hearing if, as often happens, the ALJ mischaracterized your hearing testimony in his or her decision. Social Security will provide you with the hearing audio upon request.