426-6 CASE CONTROLS DURING THE SSI APPEAL PROCESS

426-6 CASE CONTROLS DURING THE SSI APPEAL PROCESS

426-6 A. VERIFICATION TIMEFRAMES

Under Interim Assistance Reimbursement provisions, SSA will notify the Claims Unit of initial SSI approval or denial decisions for all SSI applicants for whom they have an IAR authorization on file. However, SSA will not notify the Claims Unit about an SSI applicant's appeal status, unless the appeal is successful, in which case SSA will notify the Claims Unit of the SSI approval. The Claims Unit will in turn notify the case worker responsible for the applicant's Interim Assistance case.

Since the time required at each step of the SSI appeals process varies widely by appeal stage, by individual circumstances, and even by the time of year, periodic checks with the Social Security Administration to verify the status of SSI appeals are necessary to ensure that the SSI applicant or recipient has continued the appeals process as required for continued Interim Assistance benefits.

Although the applicant or recipient is responsible for reporting any changes in appeal status, follow-up may be necessary if the client does not report the change. When the client is represented by an attorney or paralegal, the case worker should use that person as a source of verification during the appeal process. The SDX paper printout is another source of verification of SSI appeal status. Field staff may also contact their local servicing SSA district office to verify SSI appeal status if the information is not readily available through other sources.

Reconsideration. After a reconsideration with SSI has been filed, verify the status within 90 days after the date the client filed the request.

Administrative Law Judge hearing. If the client files a hearing request, seek the scheduled date of the hearing within 60 days of the time the client filed and schedule periodic inquiries for verification of the hearing status approximately every 90 days after the scheduled hearing date.

Appeals Council review. After a request for Appeals Council review is filed, verify the decision status approximately every 120 days.

426-6 B. NOTICE REQUIREMENTS

An initial finding of no blindness or disability by SSA forms the basis for the denial of an APA application. Written notice of APA denial must be sent to the APA applicant whenever a case worker becomes aware of an initial SSA finding of no blindness or disability. The denial notice must inform the client that the APA application is denied, and that continued eligibility for Interim Assistance may still exist if the individual appeals the SSI decision. If the appeal process results in a final finding of blindness or disability, the APA application shall be reevaluated.

IA benefits must be continued for a reasonable period of time after a case worker becomes aware of an adverse SSI decision from any level except the final Appeals Council review, to allow the client time to appear, offer good cause, file an appeal to the next level, etc. Written notice of Interim Assistance closure must be sent to each client immediately upon discovery of each adverse SSI decision or notice of failure to appear at an SSI hearing. SSI allows up to 60 days from the point of notice of adverse action for the client to file for the next level of appeal. APA denial notices must give the client at least 30 days to offer proof of re-entry into the SSI appeals process.

The 30-day period for a client to offer proof of re-entry into the SSI appeals process may be extended by the case worker's prudent judgment if there is good reason to believe that 30 days is inadequate for the client to appeal or to offer good cause for not appearing. Examples of good cause are remoteness from an SSA or Alaska Legal Services office and personal or family illness.

When the appeals process ends because of the client's written withdrawal, a 10-day advance notice of closure is sufficient.

Previous Section Next Section