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 Supplemental Security Income and Medi-Cal Advocacy Program (SSIMAP) Advocate. The reconsideration (or review of the participant's SSI application), is done by Social Security Administration (SSA) or Disability Determination Service (DDS) 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.
- In Los Angeles County, SSA has gradually phased out the request for reconsideration, which SSA calls the appeal redesign. SSA offices part of the redesign will grant participants a hearing with an Administrative Law Judge (ALJ) when an appeal request is filed. SSA offices not part of the redesign will grant participants a reconsideration.
The following Department of Public Social Services (DPSS) offices were affected by the SSA appeal redesign and do not grant reconsiderations as the first level of appeal:
- When filing for an appeal, the following is assessed by the SSIMAP Advocate:
|If an SSI application was denied…||Then…|
|in the last 60 days||a request for reconsideration is filed.|
|more than 60 days ago||If the participant has a good cause (per SSA regulations), a request for reconsideration is filed.|
Note: 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.
- Assessments for supportive services needs, referrals to appropriate medical facilities, and authorizations of 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 SSI application. The participant needs to contact the SSIMAP 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 (contracted SSI Hearing Representative) at no charge to the participant, who can assist with filing the SSI hearing, or the participant may choose other/self-representation.
If the participant informs the SSIMAP Advocate that he/she has or will have other/self-representation during the reconsideration stage, he/she is required to provide verification of that a request for reconsideration was filed and provide periodic updates on the status of his/her reconsideration request.
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.
Note: If good cause is determined, the request for reconsideration will be filed after 60 days have passed from the denial of the SSI application. If no good cause is determined, a new SSI application is taken.
- Records all participant contact and SSIMAP case activity on the electronic case record.
- Updates the electronic case record with new or changed information and documents all actions taken.
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 SSIMAP Advocate's name, file number, and telephone number.
- The request for reconsideration was forwarded to SSA within 60 days of the denial of the SSI application or after 60 days if good cause is determined.
- The electronic case record has all participant contact and SSIMAP case activity recorded.
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