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Sample Reconsider Request Letter

Disability Associates Logo

Date:

Your Name
Business Address
City, State. Zip

Dear Sir:

This correspondence is on behalf of claimant Social Security number __________________ .who has asked to be represented by me, ________________ on reconsideration or ALJ appeal of his or her prior denial decision.

On behalf of this claimant, I am formally requesting a reconsideration of the previous denial decision in this case. Along with this letter, you will find a completed SSA form 1696-U4 naming me as the claimant's authorized representative.

Together with this request for reconsideration. I am also requesting that I be sent copies of all pertinent doctor's reports. hospital admissions and discharge summaries. consultative examinations. X-rays and any special testing of any type if available. This request is to include any medical reports or hospitalizations occurring shortly after claimant's initial determination which may not have been incorporated into the claimant's file.

I would also like a copy of the initial SSA-3368, 3369 and the SSA form 4268 technical rationale completed in the initial case or reconsideration application levels. Please forward this information to me at the above address at your earliest possible convenience. Thank you very much for your cooperation in this matter.

Sincerely Yours.

Authorized Representative

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