In the event of a denial at the Hearing level, we reserve the right to Appeal the client’s case to the Appeals Council for an additional separate fee paid by the Claimant if they opt to select this additional Appeal Service. The client will be thoroughly advised in writing of his/her Appeal rights whether or not we intend to pursue an Appeal to the Appeals Council.
Each Unfavorable Decision is received by the clerk or coordinator – The Decision is timely forwarded to an experienced And Benefits For All attorney for review and consideration of appeal to SSA Appeals Council.
The Original attorney assigned to the case and who represented the Claimant at the hearing will review the Unfavorable Decision and will enters notes into our case management system and either recommend an A/C appeal or to proceed to close the case. Appeals Council criteria are limited to the following criteria:
- ALJ abused his/her discretion;
- Error of law;
- Decision not supported by substantial evidence in the record;
- Broad policy of procedural issue that would affect public interest;
- New and material evidence that is contrary to evidence on the record.
The Unfavorable Decision is forwarded to Case Manager’s in–box. The Case Manager will review the attorney’s notes/instructions and proceed according to the attorney’s notes/instructions.
- If A/C appeal is recommended by the original attorney who attended the hearing, the Case Manager will forward the file to the A/C attorney for final review.
- The attorney will review the file within 5 to 7 working days to decide if he/she will move forward with A/C appeal.
- If A/C appeal is recommended, the Case Manager will proceed to request the HA-520 and proceed to fax the request for review to the Appeals Council.
- The Case Manager will contact the Claimants on a regular basis (at least every 30 days or send the status letter with case status) and follow-up with the A/C on a monthly basis to get status on pending appeals.
- All of the original correspondence will be associated it with the original file. There should be no creation of duplicate files.
- The Case Manager will be responsible for ALL medical development needed on each case and the A/C attorney will write clear instructions on the CUBS case notes of what is needed and by when it is needed.
- The A/C attorney MUST document all the conversations with the Claimants, relatives, Doctor’s, etc. on the day the calls were made.
- When the Notice from Appeals Council is received with a Deadline to submit additional medical evidence, the A/C attorney will update the financial fields to reflect the Deadline and immediately forward the file to the attorney for review and preparation of brief or response to the A/C Notice.
- The Case Manager will assist the A/C attorney to keep track of the Deadlines by reviewing the Deadline report on a daily basis.
- There shall only by one (1) A/C deadline report that will be printed weekly (or as needed) so that the entire department (Attorneys, Managers, Supervisors, Case Managers, etc) shall use. Personal or Private “Transaction Reports” and/or other personal modified deadline reports shall not be created or used during this process.
- If an extension is needed, the A/C attorney will send the Case Manager an email asking her to fax a request for extension to the A/C with the specific instructions – extension for brief or additional medical evidence.
- The Case Manager will fax request, update financial fields and follow-up with the Appeals Council.
- Appeal Extensions should not be filed as a matter of course, but only in limited circumstances that are first reviewed and authorized by A/C attorney.
Call And Benefits For All today at 1-888-755-0077 for your free screening and consultation!
