SAMHSA SOAR

ALJ Hearings: Prehearing and On the Record (OTR) Reviews

Once the Request for Hearing has been processed at OHO, both the representative and applicant will receive a notice indicating the case has been successfully transferred to the court’s Master Docket, where cases are screened. At this stage, representatives can request a Prehearing Case Review or an On-the-Record (OTR) review to avoid the need for a hearing. If the OHO office is not able to grant these requests, the applicant retains the right to a hearing. A request for an expedited hearing due to dire need can also be submitted.

Prehearing Case Review

SOAR representatives can ask the Office of Hearings Operations (OHO) to refer the case back to DDS for a Prehearing Case Review. Under this procedure, the Social Security Administration may only issue a revised determination if it is fully or partially favorable to the applicant.

When requesting a prehearing case review, keep in mind the four circumstances under which the ALJ may refer a case back to DDS:

Reasons for a Prehearing Case Review
ALJ Reason for Prehearing Case Review Benefits of Prehearing Review
Additional evidence is submitted. SOAR providers almost always have additional evidence to submit! Along with an iAppeals submission, additional evidence is submitted.
There is an indication that additional evidence is available. SOAR providers often learn of additional evidence after a claim is filed, and indicate this in the iDisability Report-Appeals.
There is a change in the law or regulation. There may be a new law or regulation which may now result in an allowance. For example, now that Advanced Nurse Practitioners are ‘acceptable medical sources’, medical evidence is considered more favorably. Also, changes in the Listings of Impairments may be more favorable to the applicant.
There is an error in the file or some other indication that the prior determination may be revised. At times, medical evidence may not have been associated into the applicant’s electronic folder. Or, a SOAR provider may discover an error in how Substantial Gainful Activity (SGA) or an Unsuccessful Work Attempt (UWA) was calculated.

Requesting a Prehearing Review

You can request a prehearing case review when filing a hearing request via iAppeals. Make a notation in the Remarks Section of the iDisability Report-Appeal about the reason(s) for which you are requesting a prehearing case review. Be sure to upload all supporting documents! You can also request a prehearing review after a Request for Hearing has been filed and any time before the hearing is scheduled.

Potential Outcomes

  • If the revised determination is fully favorable to the applicant, the hearing request will be dismissed, and the decision forwarded to the SSA field office for processing.
  • Generally, if the revised determination is partially favorable, the request for hearing will proceed unless all parties agree to a dismissal of the request. 
  • If the revised determination would be unfavorable, SSA will continue to process the hearing request.

On-the-Record (OTR) Decision

An OTR review request asks OHO to consider approving a claim based on the documentation in the record without appearing before the judge. Only the ALJ or Attorney Advisors at OHO can make an OTR decision. You can also request an OTR Review after a Request for Hearing has been filed and any time before the hearing is scheduled. 

Requesting an OTR Review

  • The OTR request is simply a letter stating the Listing section that the applicant meets followed by a discussion of how the specific requirements of the Listing are met.
  • No official form is required. See a sample OTR request.
  • The letter is similar to a Medical Summary Report (MSR) that the SOAR practitioner develops for an initial application - it should link the claimant’s functioning to medical records and third-party reports.
  • A SOAR practitioner requesting an OTR review should notify or remind the hearing office that the applicant is in “dire need” (e.g., homeless, residing in shelter, eviction is pending) and provide some proof of the applicant’s situation.

Benefits of Successful Prehearing and OTR Reviews

  • OTR decisions reduce long wait times for hearings and decisions, accelerating access to income and medical benefits.
  • SOAR practitioners save hours of work when they do not have to prepare for and attend a hearing.
  • SOAR practitioners gain credibility with and gratitude from ALJs whose time is also saved when cases can be decided on the record.

Unsuccessful Requests

If the determination of the prehearing case review or OTR review is unfavorable the applicant retains the right to a hearing. You can still submit a request for an expedited hearing due to dire need. SSA considers a case to be “dire need” if the applicant has no shelter or is in imminent danger of losing shelter, or is without/unable to obtain food, medicine, or medical care. This can be a letter written to OHO. No official form is required. 

Details

Type:
Article
Date:
December, 2016

Other Details

Topic
Appeals

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