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The Advocate Study Guide

Lesson Seven

CASE CORRESPONDENCE AND ARGUMENTS

Effective communication with the Social Security Administration (SSA) is critical to successfully representing disability claims. This section covers standard form letters that you will use and provides tips for writing great Formal Arguments.

Overview of Correspondence

Correspondence is the engine that drives your case through the disability process. As Disability Advocates, we use correspondence to:

·       Inform

·       Make requests

·       Argue for allowances

Written communication is important in this field because it leaves a paper trail that can be used to verify Advocate action and protect the Advocate from unsubstantiated allegations. If there are any questions about case events – what happened and when - the paper trail is the most reliable documentation method.

All correspondence sent to SSA, medical sources or the claimant should be neat and professional in appearance. A well-structured, neatly-presented piece of correspondence can go a long way toward helping you win cases and gain customer satisfaction.

You will present almost every case you represent in writing. Even if you appear in person, you will submit your argument in writing to assure that SSA considers all aspects of your position. Written correspondence creates a paper trail that documents your actions from your entry into the case to its conclusion.

Correspondence commonly used in Disability Advocacy includes:

·       The Introductory/Cover Letter

·       The Request Letter

·       The Rebuttal Letter

·       The Formal Argument

Introductory/Cover Letter: Used primarily to introduce yourself to a claimant or to inform SSA of your status as the claimant’s authorized representative. It can also be used to request documentation, and becomes part of the case evidence.

Request Letter: Used to request case-related materials from the claimant, the claimant’s medical or vocational sources or directly from SSA. Also useful if you need to request a specific action be taken by some agency or person.

Rebuttal Letter: Used occasionally to disagree with an SSA action such as a request for a consultative examination. It can also be used within the Introductory Letter to indicate disagreement with SSA’s prior decision.

Formal Argument: The Formal Argument is also known as the Memorandum. It is used to present your position on the case facts that you accumulated in the Case Evaluation. Creating the Formal Argument is the second phase of Case Development, in which you assemble detailed case facts into a convincing story. This is perhaps the most important form of correspondence to get right, so we will discuss it in more detail below.

With the exception of the Formal Argument, any correspondence type can be used for more than one purpose. For example, you can use the Cover Letter to request information, provide copies of medical evidence, inform SSA of an event or introduce a new or additional impairment for consideration.

Don’t get hung up on correspondence categories! Use your correspondence to get things done. If one letter can do the job, use one letter! If there’s an important case issue that must be addressed, use a single letter to explain it.

Note: The section “Sample Letters” in the Program Syllabus contains a number of examples for your consideration. To help with Formal Arguments, we include two sample cases with effective arguments.

Sample Introductory/Cover Letter

A Cover Letter is versatile. Use it to:

·       Introduce yourself to SSA, a medical evidence source or a claimant

·       Request materials and address case issues

·       Ask questions or provide information to anyone involved in a case

·       Summarize a case’s main issues

·       Describe the purpose of attached correspondence, such as a Formal Argument

This sample cover letter is asking to waive a face-to-face hearing:

COVER LETTER EXAMPLE
Waiver of Hearing

Date
Your full name/Company name
Street address
City, State, Zip

Dear ______________:

This correspondence is on behalf of claimant _____________ SSN (Last four # only), who has applied for disability benefits. He/she is currently on the Administrative Law Judge application level as he/she was denied benefits based on his/her ability to perform less demanding work.

I am requesting that this case be reviewed by a presiding Administrative Law Judge and a favorable decision be rendered based on the evidence of record. I am also formally requesting a waiver of our right to attend a face-to-face hearing, as we feel the evidence of record is sufficient to find this claimant totally disabled, as defined within the Federal Code of Regulations and the Social Security Act. Please review the attached formal evaluation of this claimant's condition and consider it in your review of the issues involved in this case.

Thank you for your cooperation in this matter.

Sincerely Yours,

Authorized Representative

Request Letter

Request Letters have a specific use, as the name indicates. Use them to request action from the client, a medical or vocational source or SSA.

The Request Letter is most often used to ask a source for medical and/or vocational information, in which case the letter must be accompanied by a Release of Information form signed by the claimant:

Request For Information from SSA

Date
Your full name/Company name
Business Address
City, State, Zip

Dear Social Security Administration Representative [BY NAME IF APPROPRIATE]:

This correspondence is on behalf of claimant ____________, SSN (Last four #only), who has requested to be represented by me, [YOUR NAME HERE], on the Reconsideration or ALJ Appeal of his/her denial of Social Security benefits. Attached please find a signed copy of the “Authorization to Represent” form.

I am formally requesting a Reconsideration of the previous denial decision. Together with this request for Reconsideration, I am asking to be sent copies of all pertinent doctor's reports, hospital admissions, discharge summaries, consultative examinations, X-rays and any special materials relevant in this case dated from (dates of evidence requested – Example: (10/1/10 – 6/30/11). I would also like a copy of the claimant’s Vocational Form SSA-3369 and the SSA-4268 Technical Rationale or Personalized Denial Notice completed by SSA in the prior decision.

Please forward this information to me at the above address at your earliest possible convenience. If fulfillment of this request is not possible, please contact me immediately at (YOUR PHONE NUMBER), so that I may make other arrangements to acquire this important case-related information.

Thank you very much for your cooperation in this matter.

Sincerely Yours,

Authorized Representative

Rebuttal Letter

A Rebuttal Letter usually consists of a brief summary of the previous denial decision along with a concise explanation of why you disagree with it. When appropriate, you can use the Rebuttal Letter format as an Introductory/Cover Letter or a Request Letter. Rebuttal Letters only come into play on the Reconsideration or ALJ Appeal Level, since they refer to a previous decision. This letter is not a substitute for a Formal Argument.

In this example we use the Rebuttal Letter format as a Cover Letter that also introduces us to SSA as the claimant’s authorized representative. In this case, we must attach an “Authorization to Represent” form to the letter.

Rebuttal Letter used as a Cover Letter to the SSA

Date
Your full name/Company name
Street address
City, State Zip

Dear Social Security Administration Representative [BY NAME IF APPROPRIATE]:

This correspondence is on behalf of claimant ____________, SSN (Last four # only), who has requested to be represented by me, [YOUR NAME HERE], on the [RECONSIDERATION or ALJ APPEAL] of his/her prior denial of Social Security benefits. I have attached a copy of the “Authorization to Represent” form signed by both the claimant and myself.

On behalf of this claimant, I have reviewed the issues involved in the Initial decision which states that Social Security believes my client capable of performing light work and therefore capable of returning to his/her past work as an accountant.

My preliminary interview with the client leads me to believe that he/she is incapable of any type of substantial work. It is my belief that (CLAIMANT’S NAME) is unable to sustain any work, including work that requires less physical or mental demand. I am further asking that you reconsider your prior decision based on (BRIEF DESCRIPTION OF ADDITIONAL EVIDENCE) and/or (NEW OR ADDITIONAL IMPAIRMENTS).

Please reconsider your prior decision and award disability benefits to (CLAIMANT’S NAME) as quickly as possible. Thank you for your cooperation in this matter.

Sincerely Yours,

Authorized Representative

Important Elements of Any Letter Type

No matter what the letter type, SSA requires that it contain certain elements. The following information should be included in all SSA correspondence:

Date

Advocate’s name and address (can be a letterhead)

Claimant’s name and the last four digits of his/her SSN

Statement that you are the claimant's authorized representative

BRIEF statement of the reason for the letter - get to the point and ask for exactly what you want

Summary of claimant's allegations and/or a list of alleged impairments

Sources and dates of any medical or vocational evidence requested

Clarity and brevity if informing SSA of an issue

List of all materials that accompany the letter

If requesting a claimant's folder, say so directly. If asking for a specific piece of evidence, provide the name of the sources, dates, report types, etc.

Think Before You Write!

The type of information that you provide will depend on the letter’s purpose.   Do not include anything that isn’t necessary. For example, don’t waste time arguing the case in a request for medical documentation!

Be careful what you disclose in correspondence, as you could unknowingly harm your client's case. Never criticize your client or SSA directly. Your position as the claimant's authorized representative makes your letters part of his/her official SSA file. Your correspondence is part of the evidence of record.

The Formal Argument

This is the most important correspondence that you will produce in any case. It is the formal case presentation, identifying and documenting all impairments suffered by the claimant. It is your opportunity to bring forth issues that may not have been properly addressed at the Initial and/or Reconsideration Levels. The Formal Argument summarizes the case in a way that supports your position.

When Should I Submit the Formal Case Argument?

There is no specific rule governing when to submit an argument to SSA. Of course, it is common sense that submitting an argument before you have the facts or after the case is decided would not do the claimant much good!

On the Initial Level, submit the Formal Argument when you have enough evidence to formulate a reasonable case. If you are involved at this level, you get to develop the case from the outset. You know all the case issues and you’ve got a strategy at your fingertips - even if you lose at the first level!

Prepare and submit your Formal Argument in a Reconsideration or ALJ Level case after acquiring any additional evidence. If you have written an argument on a previous adjudicative level, you can and should use it again, adding new evidence and/or overlooked allegations. Submit your argument to SSA as soon as possible during these appeals, because they move faster than Initial Level cases. Also, the ALJ Level has document submission deadlines.

We have found that Formal Arguments are generally most effective at the Initial and ALJ Levels, and usually only work at the Reconsideration Level if there are added impairments. At the Reconsideration Level, a letter claiming additional limitations forces the DDS Examiner to revisit the case taking into consideration all new allegations presented. We have found that symptomatic limitations like pain can be effectively added on all adjudicative levels. Supporting evidence for any new alleged impairment is critical to success.

The Formal Argument is the backbone of case representation on all adjudicative levels and must be carefully constructed. All things being equal, if you develop a strong Formal Argument you’ll have a good shot at winning the case for your client regardless of your writing style.

Things to Mention in a Formal Argument

Present the Formal Argument or Memorandum in chronological order based on the claimant’s impairment history. Important elements to include are:

Claimant’s identifying information

Brief introduction to the case

Brief discussion of the reason for the previous denial if applicable

List of all favorable medical sources with a discussion of their contribution and their opinions of the claimant’s condition

Concise discussion of case issues

Discussion of the limiting effects of the claimant's impairment, including description of restrictions and references to all supporting evidence

Brief vocational evaluation, formal or informal

Reference sources relevant to the description of the claimant's past or other work, if any

Your opinion of the claimant's condition as supported by the medical findings, pointing out reasonable restrictions on his/her ability to work and any physical, mental, educational or age-related limitations that are directly supported by the evidence

Note: Because of the ALJ’s power, he/she is able to consider all factors that are important to a case. He/she can take into account things that would not come into play at the previous adjudicative levels, such as the physical appearance of the claimant. So, by all means point out all relevant findings in your Formal Argument, especially at the ALJ Level. In most states, the claimant’s best chance of winning is at the ALJ Appeal Level.

At the end of your Formal Argument, summarize the case and end with a statement of your conclusion. Make sure your position is clearly stated and in the claimant's favor. Never appear apologetic or uncertain about your position. Always conduct yourself in a polite and professional manner.

If you feel that your case is weak, ask for a diary date. This approach is usually effective only at the ALJ level and is discussed in Lesson Eight under “Fine-tuning”.

Remember, include the basic components of a Formal Argument in all cases that you represent, but do not become too rigid in your approach. Allow room for creativity while always remembering that the facts MUST support your position. When in doubt, refer to the sample Formal Arguments in the Program Syllabus. Within our Olivia Prime software, we provide a unique argument creation tool called the MW Composer. This tool will enable you to easily meet the above criteria for creating an effective Social Security argument.

The Olivia MW Composer Tool

Objective of the Formal Argument

Your primary objective in the Formal Argument is to make the claimant appear as disabled as possible without altering the facts of the case.   In this course, we concentrate on teaching you to use real evidence as the primary ammunition in a claim. However, a little professionally expressed empathy in your argument can go a long way toward helping you win a weaker case.

Care about Your Work!

Care about the outcome of every case you represent! Positive energy attracts people because where there is energy and enthusiasm there is opportunity. If you take your Advocate responsibilities seriously, you’ll win far more cases and build a great reputation. If a claimant sees that you’re passionate about your work, he/she will not only sign on to become your client, he/she will also become one of your best marketing allies - regardless of his/her case’s outcome. Remember – positive word of mouth is critical to any professional’s success!

Preview of Lesson Eight

In Lesson Eight, the final lesson of the Study Guide, we’ll discuss the art of fine-tuning your argument and how to properly submit it to SSA.