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 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 Review on Record Hearing before an Administrative Law Judge (ALJ) Appeals Council Federal Court

Useful Information SSA website information on appeals Tips on Appeals psandAppeals.pdf 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 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 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 Office: Cell:

On-The-Record Favorable Decision Vicki Dunham Eckman/Freeman and Associates

The Steps 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) 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 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 pre- hearing review –If unfairly denied by DDS, can be approved here 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. non- material

Suggested Strategies 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 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 SSR 96-9p: Policy Interpretation Ruling Titles II and XVI: Determining Capability To Do Other Work 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 Phone (615) Fax (615)

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 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 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 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 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 Phone: (810) Fax (810)