This manual has been written to provide guidance to case managers about how to help people who are disabled apply for and retain SSI and/or SSDI. While there are many specific tasks and responsibilities related to providing this assistance, there are generally three "roles" that a case manager can play: contact person, representative, and representative payee. This chapter explains the different roles associated with the application process and provides advice to case managers about the decision to take on one or more of these roles.
Case managers play an important role in helping to secure SSI and/or SSDI for the people with whom they work. First and foremost, a case manager can encourage a potential applicant to apply for benefits. This is especially important for people who may presume they are not eligible because they do not have a single, defining disability, or for those who have current or past histories of substance abuse and may believe wrongly that these histories disqualify them from benefits.[1] Offering accurate information and encouragement may be the first important function a case manager can fulfill. However, case managers also can play a critical role in the application process by facilitating accurate and timely case determinations. If case managers successfully work with their clients and with their contacts in the SSA and DDS agencies, they can have a beneficial impact on the disability determinations. Case managers can be helpful to applicants by serving in one or more of three specific roles:
This chapter provides additional details about a case manager's roles and functions as contact person and representative. The role of representative payee will be discussed in-depth in Chapter 9.
Generally speaking, a contact person is the "go to" person for a claim when a claims representative cannot reach an applicant. The contact person can receive messages and facilitate the exchange of information. However, the person has no legal role in the disability proceedings and no legal basis for receiving or imparting information on behalf of the applicant. That means, for example, that a contact person cannot file an appeal for an applicant if the person is found not to be disabled, even if the applicant, for any reason, cannot file the appeal him- or herself.
Even if a case manager and an applicant decide together that the case manager will limit his or her role to that of a contact person, many functions still can be performed. Basically, responsibilities fall into two broad categories:
Chapters 3 and 4 provide details about assisting individuals with the application process itself. Functions include:
By ensuring an applicant knows what to expect and has important documentation available at the time of filing, the case manager can facilitate the determination process. However, an applicant should not delay filing if the necessary documentation is not readily available.
A case manager can help SSA and DDS with documentation in two specific ways. The first is to serve as a liaison between the agencies and the applicant—taking calls when information is missing, working with the applicant to find records and documentation, keeping in contact with the claims representative and disability examiner to monitor the process, and ensuring that materials are sent to the SSA field office and DDS on a timely basis. This type of assistance is crucial to move the process forward and support accurate and timely determinations.
Case managers also can help generate information for the SSA and DDS about the applicant’s disability and functioning. While medical records may do a good job of describing a medical condition and listing treatment, they sometimes do a poor job conveying the types of day–to–day limitations a person experiences due to his or her medical condition. Case managers have the ability to collect observations from individuals (such as previous employers who can provide letters and other documents describing the applicant’s functioning on a day–to–day basis. In addition, the case manager can report his or her own observations of the applicant, describing aspects of the applicant’s functioning that indicate the applicant is incapable of working. This type of documentation can help the disability examiner get a clear picture of exactly how and to what extent the applicant is disabled.
Finally, the case manager can file a letter summarizing all of the evidence presented in the applicant’s case. This letter can direct the disability examiner’s attention to specific evidence that documents the applicant’s case. The case manager also can help tie those pieces of evidence together to present a picture of the applicant. A detailed portrayal of the applicant can serve as a careful statement about why and how the applicant is impaired. More information about these activities can be found in Chapters 5 and 6.
Many times, individuals with serious mental illnesses are so disabled, or find the application process so overwhelming, that they need additional help in applying for benefits. In addition, people who are homeless may not be able to respond easily to requests for information in a timely way. In these situations, it is extremely helpful for a case manager or other responsible person to become an individual’s representative. Arepresentative is authorized by an applicant to deal directly with SSA on the applicant’s behalf. A representative can be helpful in the following ways:
At the most basic level, an applicant with mental health problems should have someone who can call a claims representative in the field office or a disability examiner in the DDS to discuss his or her case. Once a case manager is an authorized representative, he or she can call to ask if records have been received, what information is included in a record, and whether it meets the examiner’s needs. Representatives can question SSA and DDS employees about the meaning of particular notices or requests. In fact, representatives are authorized to discuss all aspects of the case and to act on the applicant’s behalf. Without an applicant’s authorization, a claims representative or disability examiner cannot discuss the specifics of a case with anyone else, including contact persons.
Applicants who are homeless may not receive mail and, thus, may be especially difficult to reach. Individuals who are homeless and/or who have mental illnesses may lose claims and/or required documents and may fail to respond to notices. In these cases, applicants are likely to be unable to follow through with important requirements of the disability determination process. A case manager who receives copies of all documents, who is authorized to call the claims representative or disability examiner to get more information, and who can schedule and/or reschedule meetings is particularly helpful.
Since representatives receive copies of all notices sent to applicants whose claims are pending, the representative can respond for the applicant. As a result, case managers can help clients avoid administrative denials based on what SSA calls their “failure to cooperate” or “whereabouts unknown.” Representatives also can appeal on behalf of applicants, helping to preserve the right to retroactive pay back as early as the month after the initial date of application.
To become a representative, a person must be authorized by the applicant using an Appointment of Representative form (SSA–1696). It is available at any SSA field office; it can be printed from the SSA Web site: www.socialsecurity.gov/online/ssa- 1696.pdf. Once this form is submitted, the representative immediately will be able to assist the applicant. The approval process for a representative appointment generally is a formality unless SSA has experienced difficulty with the proposed appointee in the past. Applicants do not have to appoint a representative when they file their initial application. A representative can be named at any time during the process.
A case manager can assume one of three roles when assisting a person who is applying for SSA disability benefits. As a contact person, the case manager monitors a claim and serves as a liaison between SSA or DDS and the applicant. As a representative, the case manager agrees to a more formal liaison role and is authorized to receive information and take action on an applicant’s behalf. Finally, as a representative payee, the case manager agrees to accept and manage a recipient’s benefits over time. This is discussed in greater detail in Chapter 9. The roles of contact person and representative provide essential support to a person who is applying for disability benefits. A case manager should carefully consider the role that he or she will assume in his or her efforts to help potential applicants. To help people more effectively apply for disability benefits, case managers are encouraged to take an active role as a contact person or as a representative whenever possible and as desired by the applicant.
1 The test for determining eligibility is whether “drug addiction or alcoholism is a contributing factor material to the determination of disability” (20 C.F.R. 416.935(a)). This means if an applicant would still be disabled if he or she stopped using drugs or alcohol, then the applicant will be found disabled, providing that all other eligibility criteria are met. For more information on this issue, see Chapter 5.