DPSS Online

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 Disability Determination Service Division (DDSD) 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.

• 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 applicationwithin 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.

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.