Those who contact you for an assistance typically fall into one of three categories:

1.      People who have never applied for disability benefits before

2.      People who have applied and either received no decision or were
   denied

3.      People who have applied and are now on appeal 

Category 1:  Claimant Has Never Applied for Benefits Before

Even if the case is strong you are in for a lot of Case Development work which may not result in an allowance determination.  In some states, the denial rate is up to 75% at the Initial Level.

Many Advocates avoid these high work, low potential profit situations altogether. We don’t agree!  Yes, an Initial Level case takes more work.  But if you get in on the ground floor you can control the strategic direction of the case right from the start.  This makes it far easier to win on appeal. 

It is OK to avoid Initial Level cases as long as you maintain a connection with the applicant.  You still want to direct him/her at the Initial Level, but without doing a lot of work for zero pay.  Your guidance should be mostly hands-off and indirect.  Disability Associates designed our Guidance Package marketing approach for situations where you don’t want to accept a case now but want to keep your options open for the future. 

This guidance approach makes the Initial Level applicant feel that you’ll be there for him/her in the event SSA rejects the case.  This forms a bond of trust between you and the client that will all but assure that he/she will sign on with you if the case is denied.  The applicant knows that if he/she becomes a member of your Guidance Support Program he/she will have free and continuous help during the application process, which is reassuring for him/her and is also good business for you.  The approach is simple: 

1.      Interview the claimant and assess the case

2.      If you give the case a high score – over 70% - consider accepting the case.   If you don’t want to do cases at the Initial Level, encourage the applicant to try it on his/her own and send a Guidance Package to help him/her through the process.  At this point, you’re acting not as a representative but as a free coach.  The Guidance Package keeps the claimant connected to you and sharing his/her case progress with you.  You can then easily decide to jump in or stay out until appeal.   

3.     If the case is weak - below 70% for an inexperienced Advocate - tell the claimant that you would like SSA to make a decision before you officially enter the case.  Assure him/her that you’ll support him/her throughout the Initial application process at no charge and send him/her a Guidance Package.  If the case is denied, you will know its weaknesses from the PDN and can prepare a strategy for the Reconsideration Appeal.  

The purpose of the Guidance Package is two fold:

1.      It guides the claimant through the disability application process, telling him/her how to prepare the case and what to expect as he/she proceeds. 

2.      It acts as a marketing kit for your Advocacy service.  The suggestions you provide in the packet should lead the applicant directly back to your doorstep if the case is denied. 

Our Guidance Package approach has proven to be one of the most effective techniques we have for assuring the long term growth of your Advocacy service.  Anyone who calls you will become an advertiser for your business if he/she feels good about the contact.  Receiving a tangible product in the ( mail or via our new Olivia software) helps create that feeling.  If the interviewee later becomes a client, he/she will be pre-trained by the materials in the package.  If he/she is someone you don’t want to represent, he/she goes away feeling supported.

The package can contain anything you want, but should always include:

·        Cover letter on company letterhead introducing your firm and welcoming the applicant to your Guidance Support Program

·        Brochure explaining your service

·        Explanation of the disability application process

·        Instructions on how to complete SSA forms

·        Schedule for communication and follow-up

Cover Letter:  Present the Guidance Package as part of your “Guidance Support Program” for people who are applying for benefits for the first time.  Make it clear that the program is free and does not signify representation by your firm.  Indicate that you’re not going to act on the case unless there is an initial denial of benefits.  If the claimant follows the instructions in the Guidance Package, you’ll be ready to spring into action on his/her behalf the moment he/she receives a denial notice. 

Brochure:  Explain your Guidance Support Program and your company’s basic services.  Be sure to mention that services are free until the case is won.  Explain your basic fee structure approach (do not state amounts!) and when fees are due if you become the authorized representative in the future. 

Explanation:  Provide a brief letter on your letterhead that explains the disability process in lay terms.  Tell the applicant what to expect and exactly what to do if SSA denies the case at the Initial Level.  For the Guidance Package approach to be effective, you must provide the applicant with a convenient method of signing on with you if the case is denied. 

Schedule:   Creating a follow-up and communication schedule reminds the applicant of your availability should the case be denied.  We recommend contact once every four to six weeks during the Initial processing period.  He/she will appreciate the support!

Category 2:  Claimant Applied but Has No Decision or Was Denied

If the case appears strong, take it and send the client an Information Package to become the authorized representative.  If the case appears weak, wait for the decision or find out why it was denied.  Create a relationship with the applicant by sending a Guidance Package with instructions to collect copies of all evidence for his/her personal records.  If you accept the case on appeal you’ll need this documentation, and the fastest way to get it is directly from the applicant. 

Category 3:  Claimant’s Case is now on Appeal

If the case has merit, sign him/her up!  Send the client an Information Package to become the authorized representative.  If the case is weak, send him/her a Guidance Package.  The small amount of time you take with this person can result in unknown future leads through positive word-of-mouth.

In general, our motto is:  When in Doubt, Send a Guidance Package!

Getting Authorized:  The Information Package

Most potential clients will contact you by phone.  If you are using Case Assessment marketing, he/she will be seeking a free case review to find out his/her chances of receiving Social Security disability benefits.  This is your opportunity to:

1.      Put the person at ease, assuring him/her that you're not selling anything

2.      Explain your service

3.      Ask screening questions

4.      Perform a Case Assessment if the case looks at all viable   

5.      Begin a relationship

If the case is weak, send a Guidance Package.  If the case seems viable, accept it.  Formalize the business relationship using signed forms and agreements.  Send your new client an Information Package including appropriate forms with yellow “sign-here” sticky notes at every signature line.  Call to make sure that he/she receives the package.  Follow up again in a week if you haven’t gotten the signed forms back.

The Information Package should contain the following:

·    Cover letter on your company letterhead

·    Brochure explaining your service

·    Explanation of the disability application process

·    Instructions for completing the forms

·    Your business contact information

·    SSA Form 1696: Appointment of Representative

·    SSA Fee Petition form

·    Medical Release forms

·    Optional:  SSA case level application forms

Use company letterhead for all case correspondence except SSA forms and other official government documents.   You may add any items that you want, keeping in mind that the purpose of the package is to:

·    Formalize your representation

·    Increase your credibility with your new client

·    Inform your new client about the disability process and what to expect

Encourage your new client to return the signed forms and signed contract as quickly as possible so you can begin to develop the case.  You do not send a copy of the signed contract to SSA unless SSA specifically request a copy.  You officially become the authorized representative by filing the following with SSA:

·         Signed  Form SSA 1696 Authorization to Represent

·         Signed SSA 827 Medical Release Form

•   Optional:  Signed SSA forms appropriate to the case type and level

In your submittal to SSA, include a cover letter on your company stationery stating who you are and your relationship to the client.  Include the client's Social Security number (last 4 digits only), and send the package via certified mail to the DO handling the case.  Upon receipt SSA will check to make sure you’re not on the “no access” list.  As long as you’re not, you’ll receive notice of authorization by mail. 

If you do not hear from SSA within two weeks of sending in the forms, call to make sure they got them.  Ask who is handling the case or if it has been transferred to another location.  Meanwhile, assume that you will be authorized and act accordingly.  If you’re in doubt, check your representative status while processing the case.  Generally SSA will inform you in writing if there’s a problem. 

Even if you don’t receive an authorization letter, SSA may contact you to request information about the case.  If this occurs, you can assume you’re the listed Advocate. 

Keep copies of all signed paperwork associated with the case.  Always follow SSA instructions and make sure you always keep the client informed.
 

Compromised Clients

If the claimant has a mental disorder or is otherwise compromised, handle the case through a third party.  Do not accept the case if there is no responsible third party and the claimant is clearly compromised or incompetent.

Manual vs. Automated Case Assessment

Does the Case Assessment process sound a little tricky?  It is!  It takes many years to develop the ability to accurately assess a case’s worthiness.  It takes many more years to translate that experience into an effective user-friendly software tool.  Our Case Assessment system known as the Navigator©, is the result of our experience and our expertise.  Contained in our new Olivia© system, Navigator’s© most recent and versatile update is useful as a marketing tool and as a means to generate additional income through paid assessments.

If you perform a manual assessment, review at least one piece of medical evidence to help you make your accept/reject decision.  Until you’re very experienced in this field, your manual assessments will be considerably less accurate than those performed by our software, but the more of them you do the more adept you’ll become. 

As you start up you will want to maximize your chances for early wins, so we recommend relying on our Assessor©.  Our Olivia case assessor tool will provide you with a tremendous operational advantage over those not using this technology.

Choosing to Accept a Case – Stick With It!

In the beginning, accept cases with assessment scores above 70%.  As you gain experience you can lower this score to 60% and still win the majority of the cases you represent. 

If you experience early losses you are in good company.  When we first started we lost our first nine cases.  We almost gave up - but Thank God we didn’t!   We kept struggling along until finally there was a win.  It was one of our best days ever, and we bet your first win will feel just as good!

Positive Rejections

If the applicant's case is weak, explain why in laymen's terms.  Send him/her a kind rejection letter encouraging him/her to contact you if his/her condition worsens.   Rejection is difficult, so create a form letter ahead of time that you can use any time you say “No”.  The Olivia© program can help you with this task.  Send a Guidance Package with the letter so the person doesn’t feel abandoned.

Rejected applicants are often cases that are not yet ready for representation.  Use Olivia© to build a database that tracks your “No”s and do follow up calls on slow days.   This gives the impression that your service continues to show concern even for those you have rejected, which is excellent public relations.

The practice of maintaining contact with rejected applicants can significantly energize your company down the road.  If a claimant's condition worsens, he/she will remember your kind concern and ask for your assistance again.  At this point, reassess his/her condition to see if you want to change your decision. 

Case Assessment Review

This is a good time to revisit the steps for screening potential clients: 

1. Perform a phone interview
2. If the interview is promising, proceed with a case assessment
3. If the assessment score is <70% or if you do not want to take the case at this time for any reason, send the applicant a Guidance Package to maintain the relationship and set up a schedule for maintaining contact
4. If the assessment score is ≥70% and you elect to take the case, send the client an Information Package to sign him/her up
5. In the case of a compromised applicant, be sure to interview his/her third party assistant before accepting the case
6. Follow up with your new client until you receive the signed forms
7. Send the signed forms to SSA, retaining copies for your records
8. Follow up with SSA until you receive official authorization

After you have completed these steps, you are on to Case Development.  As you recall from the Study Guide, the steps in Case Processing are:    

1.      Client Interview

2.      Case Assessment

3.      Case Acceptance

a.      Intake Phase One:  Information Package to Client

b.      Intake Phase Two:  SSA Authorization

4.      Case Development

a.      Phase One:  Case Evaluation

b.      Phase Two:  Argument Creation

5.      Argument Submittal

6.      Receipt of the SSA Decision

There are basically nine steps to processing of a Social Security disability claim.  We have just gone over Steps 1 through 3.   The basic steps or phases of case processing are:

Once you’re sure SSA has authorized you, formal acceptance is complete.  Now it is time to move on to Case Development.

Beginning Case Development – The Second Client Interview

Once you receive the signed, dated and completed forms along with a check for the Development Fee if you charged one, it's time to begin evaluating the client's case.   First, you need the client's medical evidence so that you can perform Sequential and Vocational Analysis.  If you’re using our intake approach, you have already laid the groundwork for this step, getting a broad-brush overview of the client’s medical situation in the initial interview. 

Now that you’ve accepted the case you need to find out the names of all relevant medical sources along with the dates of treatment.  You can request this information from SSA for any case that has gone beyond the Initial Level, or you can get it directly from the client – which is the fastest way if he/she has it.   

Schedule a second interview after the client has returned the signed Information Package materials to determine all medical and vocational sources that have information relevant to the case.  Also use this phone call to make sure the client understands the application process thoroughly to avoid future confusion. 

The Olivia Client Control Panel© contains a standard presentation for providing disability process basic information so you won’t have to re-invent this wheel.   It even makes it easier for you to represent cases in other states and from any location.

Medical Documentation:  How Much is Enough?

Use the second interview information to gather all medical evidence relevant to your client’s limiting impairments:

1.     Send a request for information on your company stationery to every medical source, including dates and brief explanations of specific requests

2.      Include a medical release form signed by your client

3.      Use Olivia© to organize the data you receive within the client’s account

Over the life of a case, you’ll need to go back and request new or additional evidence from medical sources.  Use the same process for any such request.

The trick to efficient Case Development is to know when you have enough.  It can take years of experience to really be sure when you have sufficient documentation to create a convincing argument.  Here are a few tips:

Request evidence for the disability time period only:  The period of disability is usually from the onset of impairment to the present.  In some cases the onset date is the date when your client’s condition forced him/her to alter work or stop it altogether.  The term “altering work” indicates that he/she either significantly reduced work time or the way in which he/she did the job to accommodate disability.  SSA refers to unique conditions created to allow a person to continue working as “special circumstances”.  SSA cannot deny a person back to a job with special circumstances. 

Only request evidence relevant to the impairment:  If your client suffers from heart disease, request evidence specific to that condition:  cardiologist examination reports, hospital summary reports, surgical summary reports, pulmonary laboratory tests, heart tests and chest x-ray reports.  Bone density tests, even if ordered by a treating physician, probably aren’t relevant.

Only request evidence on the limiting diagnoses:  If your client alleges total disability due to heart disease, it wouldn’t make sense for you to request medical evidence about his/her acne.  Usually a person who applies for disability benefits alleges a primary impairment, sometimes accompanied by a secondary one; sometime there are more.

The primary diagnosis is the disease or injury that prevents performance of work and has caused the individual to apply for disability benefits.  The secondary diagnosis is a slightly lesser condition that also limits ability to work.  Other limiting conditions are also possible.  If there are limitations resulting from more than one disorder, SSA must combine the effects of all when determining the final Proposed RFC.  

SSA creates the Proposed RFC.  You create the Perceived RFC.  Combining the effects of two or more disorders helps to further reduce an RFC and makes it easier to argue that a person is unable to work.  If your perceived RFC is backed by the medical evidence, SSA may accept it and allow benefits.  This is the Whole Body approach that we introduced you to in the Study Guide.

Case Evaluation:  Vocational Analysis

You can begin Case Evaluation once you have all documentation that is:

ü  Within the disability time period

ü  From appropriate medical sources involved with treating the client’s limiting impairments

ü  Related only to diagnoses that are causing impairments

Perform a Sequential Analysis, which in most cases necessitates a Vocational Analysis to answer SA Questions 5 and 6 (Study Guide Lesson Six).  Based on your interviews, you already know something about your client’s ability to perform work.  If the case is at an Appeal Level, you have copies of the medical and vocational forms that were part of the first application – either directly from the client or from SSA.  Begin to systematically organize the relevant evidence to develop your case:

1.      Pull together all information about your client’s primary past job

2.      Compare the physical demands of that job with how it’s performed in the national economy (Study Guide Lesson Six)

3.      Compare your client’s physical limitations with past job demands

4.       If you find he/she cannot do past work, compare his/her limitations to other less demanding work

5.      If you determine that his/her impairments prevent sedentary work, you are ready to argue for a less than sedentary RFC 

Basically, your job in Case Evaluation is to:

1.      Review the medical and vocational evidence to identify the impairments that limit your client.   Highlight items that prove the impairments and the physical and/or mental limitations they cause.

2.      Use the highlighted evidence to create your case strategy.  Define how the limitations caused by the impairments interfere with your client’s ability to perform past work. 

3.      Determine how the limitations prevent your client from doing other less demanding work.

4.      Summarize your findings and prepare to create the Formal Argument.

 A Word on Consultative Examinations

SSA has the option at any time to request that an applicant attend a consultative medical examination.   As the authorized representative, you can and should dispute the findings of such an examination if:

• It was poorly performed
• The report is incomplete or ignores relevant issues
• It was performed by the wrong type of doctor
• Your client complains about the examination quality
• The report is grossly inconsistent with favorable findings in the case

Even if the examination was performed brilliantly you don’t have to accept the report. You may dispute any finding that contradicts your position on an issue, as long as you can justify your opinion.  You can challenge the doctor, the findings and/or the test or examination quality. 

The most effective challenge is a direct attack on the examination itself.  It’s not uncommon for a doctor who is unfamiliar with your client’s case to perform a hurried examination and then write a report that makes your client appear less limited than alleged.  This is a common situation which you can address by pointing out that the examination was merely a snapshot of your client’s complex condition that could have caught him/her on a day of lesser symptoms.  Point out that the preponderance of evidence supports limitations as previously alleged.

The Critical Step:  The Formal Argument

The Formal Argument is your case strategy in written form.  It presents the case from your client’s perspective, highlighting those findings that best support the alleged total disability.

To create the argument, outline your client’s vocational issues and support them with key items from the medical and vocational evidence.  Define how limitations caused by your client’s impairments interfere with his/her ability to perform past work.  Done correctly, this takes about two sentences.  Then go on to highlight the evidence for inability to perform other less demanding work.  In most cases you will need to argue for a less than sedentary RFC if you want to win benefits for your client.

The actual process of writing an argument is covered in our MemoWrite© training segment.  Those of you using Olivia Prime© have access to MemoWrite Composer©, which will make your argument construction faster, easier and more effective.

Make sure you submit your completed argument before SSA makes a decision.  At the Initial Level, you can submit at any time while the case is in adjudication.  Do so as quickly as possible after you’ve received all pertinent evidence. 

Normally on the Reconsideration Level you can get the case evidence faster because SSA already has it in their files.  If there is new evidence at this level, make sure it is requested by both you and SSA.  Submit your argument as soon as you receive and review this new evidence.  It is wise to inform the adjudicator that additional evidence is on its way.  Request that a decision not be made until it is received.

Always keep a copy of your Formal Argument. 

You can send your client a copy of the argument or make it available to him/her via your Olivia Client Control Panel©.  However, this is optional.  It may not be a good idea if you feel you have a less than loyal client who might decide to hire someone else for the appeal.  Ready access to your professionally developed argument would save the new Advocate a lot of work - a gift you probably won’t be in the mood to give!

Where Do I Send The Argument?

The address on SSA’s correspondence with the applicant indicates where the case is located.  Generally location depends on case level.  Send Initial Level materials to the client’s DO or DDS.  Reconsideration Level evidence usually goes to the DDS, but will go to the DO if there is a Hearings Officer involved.  At the ALJ Level, send evidence to wherever the hearing will be held - a satellite office, DO or even a Regional Office.