Those seeking Social Security disability benefits often contact a lawyer after they receive a notice of disapproved claim in the mail. That denial letter offers some explanation of why the claim was disapproved, but it is often too vague to be much help to the lawyer developing the claim.
After an appeal of that initial denial, you are at Reconsideration. At that stage of the administrative process, the Representative does not have access to the entire electronic claim file. Rather, just section E – Disability Related Development – and section F – Medical Records – are viewable by the claimant’s representative (to see how an electronic claim folder is organized, click here).
Once a claim is at the Hearing level of review, the lawyer has access to the entire electronic file. Until then, there is no access through the electronic file to the A section of the file, which contains the Decisions for the claim, specifically the Disability Determination Explanation made at the initial level of review.
The Explanation is a keystone document in the file. It is the first thing I read when I review a file. It details the evidence, assesses an RFC, and specifies how the claim was decided by DDS. Was the claim denied at Step 4? Step 5? What was the RFC? The Explanation will tell you. It is the roadmap of how the claim was evaluated by DDS. It is invaluable information to have while developing a claim.
For claims at the Reconsideration level, I fax a request to the local field office (or the Workplace Support Unit with jurisdiction over the claim) for a copy of the Disability Determination Explanation. I usually get it in the mail in a week or two. It is too important a document not to have available at the Reconsideration level.