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DESCRIPTION
A request for reconsideration is completed following the denial of a Supplemental Security Income SSI
application. The request for reconsideration, a formal disagreement with the disability decision, is completed by the SSI Advocate. The reconsideration (or review of the participant's SSI application), is done by Social Security Administration (SSA) or State Disability and Adult Programs Division (DAPD) staff who were not involved in denying the SSI application. The review, which considers all existing medical records plus any new evidence, is done without the participant being present.
KEY POINTS
- When an SSI application has been denied:
- In the last 60 days, a request for
consideration is completed.
- More than 60 days ago, a good cause
determination is done. The good cause criteria are outlined in the
Resource Handbook.
- If there is good cause (for filing more
than 60 days after the denial), a request for reconsideration with
good cause is completed. If there was not good cause, an SSI
application is completed.
- The request for reconsideration must include
an update on the participant's disabling condition, medical treatment,
and medical release forms.
- The update should make a compelling case
for reversing the first decision and could include:
- Photographs of a deteriorating condition,
- Tape recordings/writing samples illustrating
the participant's thought process, or
- Additional medical documentation the
participant has in his/her possession based on treatment records
established subsequent to the SSI
application.
- Supportive
services needs are assessed and appropriate referrals are made to the Department of Mental Health (DMH), the General Relief Health Care Program (GRHCP), and/or needed transportation funds are authorized.
- Following completion of the request for
reconsideration, the next steps are explained to the participant.
- First, he/she will hear from SSA
directly. SSA may send additional forms for completion, an appointment
to see a doctor, or a decision on the reconsideration. A decision
on the request for reconsideration may take about six months.
The participant must contact the SSI Advocate when he/she is
contacted by SSA.
- Second, if
the request for reconsideration is denied, he/she is required
to request an SSI
hearing with
SSA's Office of Appeals and Hearings. DPSS will provide a
hearing representative (County SSI Hearing Contractor) at no
charge to the participant, or the participant may choose other/self-representation.
SSI ADVOCATE DUTIES
- Upon notification of denial of the SSI
application, schedules the participant to come
into the office for an appointment to request a reconsideration.
- Completes all required requests for
reconsideration forms, ensuring all required signatures have been
obtained from the
participant.
- Explains the next steps to the participant,
including his/her reporting responsibilities.
- Assesses any supportive
services needs, making any appropriate referrals and/or
authorizing any needed transportation funds for medical and/or
SSI-related appointments.
- Forwards the request for reconsideration
to the SSA office that processed the SSI
application within 60 days after
denial of the SSI application.
- Records all
participant contacts/SSIAP case activity on the ABPSSI 16, SSIAP
Activity Record.
- Updates LEADER (including Case Comments)
with new or changed information.
RESULTS
Upon conclusion of the request for reconsideration,
the outcomes should include:
- The participant completed/signed the
request for reconsideration, understanding the next steps in the
process and
his/her reporting responsibilities.
- Any needed supportive
services referrals were made or transportation funds were
issued.
- The participant has the SSI Advocate's
name and telephone number.
- The request for reconsideration was
forwarded to SSA within 60 days of the denial of the SSI
application.
- The ABPSSI 16 and LEADER were updated with new or
changed information.
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