When you need a social Security advocate

Elderly, disabled, and other individuals seeking or with questions about Social Security or Medicare eligibility, benefits, or other rules often need or want help or representation from an attorney, family member, or other third party.

Social Security Administration (“SSA”) rules allow generally permits any individual that the claimant requests to provide general assistance to a claimant on a claim, matter, or issue without being appointed as a representative when requested by the claimant. Examples of general assistance include:

Accompanying a claimant to an appointment or SSA offices; or
Providing general help or casual advice.

However, when an individual intends to act in an ongoing role as the claimant’s representative, the claimant must appoint him or her as a representative in accordance with SSA procedures.

During the course of an interview or other administrative process, if an individual is assisting the claimant but the SSA representative feels it is unclear whether this individual is informally helping or acting as the claimant’s representative, SSA procedures provide that the SSA representative will explain the SSA rules for appointment of a representative and requirements for the payment of fees to a representative and invite the claimant to follow the procedures if the claimant wants to be represented.

When a claimant requires more than general, short-term assistance from another party to deal with the SSA, SSA rules require the claimant following SSA rules to appoint the person providing assistance as the claimant’s representative.

When contemplating or using a representative, or serving in that capacity, it is important to remember a representative can help the claimant but not guarantee that a claimant will receive benefits. Nevertheless, many elderly, disabled, or other individuals concerned about dealing with the SSA often need or benefit from assistance or representation from a properly qualified representative. For instance, representatives can help an individual to investigate or apply for enrollment or benefits, collect information, gather or prepare medical or other evidence, clarify rules or requirements, appeal determinations or denials, prepare or participate in hearings, translate or assist with other communication or comprehension barriers, or for other reasons.

The persons eligible to serve as a representative under SSA rules include an attorney or a non-attorney, who meets the SSA’s qualification and rules of conduct requirements, who are appointed in writing by the claimant in a properly completed and submitted SSA Form SSA-1696, “Claimant’s Appointment of a Representative.”

Attorney representatives must:

Be in good standing and admitted to practice before the highest court in at least one state, territory, district, or island possession of residence, or before the Supreme Court or a lower Federal Court;
Not be disqualified or suspended from acting as a representative, either by us or another Federal agency; and
Not be prohibited by any law from acting as a representative.

Non-attorney representatives must:

Be generally known to have good character and reputation;
Be capable of giving valuable help to the claimant in connection with the pending claim, matter, or issue;
Not be disqualified or suspended from acting as a representative, either by us or another Federal agency; and
Not prohibited by any law from acting as a representative.

Individuals lacking good character and reputation include but are not limited to:

Individuals who have a final conviction of a felony (as defined by 20 CFR 404.1506(c)) or any crime involving moral turpitude, dishonesty, false statements, misrepresentation, deceit, or theft; a civil monetary liability in any matter involving the Social Security Act;
A disbarment or suspension from any court or bar based on misconduct (in those situations where the non-attorney representative is a former attorney);
A disqualification or suspension, based on misconduct, from participating in any Federal program or appearing before any Federal agency;
A finding by the agency or a court that as a representative payee, the individual misused benefit payments;
A debarment from acting as a contractor with any Federal or State agency; a revocation of any professional license issued by a state or local government; or
Acceptance of direct fee payment from us for representational services when the non-attorney representative knows he or she is ineligible for direct payment.

Non-attorneys seeking to qualify to serve as representatives generally must demonstrate their qualifications, complete training and fulfill other requirements SSA generally assumes that the non-attorney representative seeking appointment by the claimant meets the statutory and regulatory requirements unless there is evidence showing otherwise. For more information, see here.

The SSA generally will not deal with a prospective representative until it receives and processes the required Form SSA-1696 appointing that person to represent the individual. To work, an appointment of a qualified representative must be made through the completed SSA-1696 and filed with SSA. To expedite submission, the SSA-1696 can be completed electronically using the e1696 portal. Consequently, individuals desiring representation and a person intending to provide representation should take steps to complete and file Form SSA-1696 as soon as the representative is selected to reduce the risk of prejudice of rights or other disruptions as a result of the failure to file the Form.

While some representatives serve without charge, many do not. If the claimant appoints a representative, the representative generally cannot charge or collect a fee for those services without first getting written approval from the SSA, even if the claim is denied. To get this approval, the representative must use one of Social Security’s fee authorization processes. Individuals planning to use a representative and attorneys or others intending to provide assistance as a representation must keep in mind that SSA rules only allow a representative to charge fees for this assistance with the prior approval of the SSA. Representatives who don’t obtain prior approval for fees are prohibited from charging or collecting fees for their representation. When the required prior approval of fees is obtained, SSA procedures include a process for the representative to seek payment of the approved fees.

We hope this update is helpful. Solutions Law Press, Inc. invites you to receive future updates by registering on our Solutions Law Press, Inc. Website and participating and contributing to the discussions in our Solutions Law Press, Inc. LinkedIn Health Care Risk Management & Operations Group, HR & Benefits Update Compliance Group, and/or Coalition for Responsible Health Care Policy Group.

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.

About Solutions Law Press, Inc.™

Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also may be interested in reviewing some of our other Solutions Law Press, Inc.™ resources available here such as:

About Solutions Law Press, Inc.™

Share this:

Like this:

Related