The fee authorizer must consider the purpose of the programs:

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  Under Title II, the purpose of the program is to provide a measure of economic security for program beneficiaries; and

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  Under Title XVI, the purpose of the program is to assure a minimum level of income for the recipients who otherwise do not have sufficient income and resources to maintain a standard of living at the established Federal minimum income level.

The fee authorizer must also consider each of the regulatory factors described in subsection B. to determine a “reasonable” fee.

The fee authorizer will consider the extent of the representative’s services, such as the representative’s diligence in obtaining the necessary medical evidence, the type of services provided by the representative, and whether the representative researched or applied relevant law or rulings in a manner that promoted the expeditious processing of the case. Other considerations include whether and how timely the representative:

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  arranged any required medical examinations,

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  submitted relevant medical or other evidence related to the question of disability or other factors of entitlement or eligibility,

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  contacted us, as needed, about the status of the claim,

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  prepared for and participated at the hearing, and

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  furthered the timely determination or decision of the claim.

The fee authorizer will also consider whether the representative, without justification:

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  acted in a manner that delayed the determination or decision, or

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  did not provide or was delayed in providing information we requested or required.

NOTE: Fee authorizers must be mindful that there is no standard value for each type of service, there are many activities performed by a representative during the administrative proceedings, and the same activity may be more challenging in one situation than in another situation. Additionally, decision makers may also need to consider locality or the geographical area when evaluating fee rates for services.

For additional detail and examples on evaluating services, refer to GN 03930.015A.1. and HALLEX I-1-2-57 A.

When considering the services performed by the representative, the fee authorizer will examine the complexity of the case, which might have affected the documentation that was necessary to move the case forward, the research that was required, and the various legal issues presented and argued.

The fee authorizer will consider the issues related to the case, whether and how the representative assisted in properly resolving them, and whether the representative supported each contention with evidence. The fee authorizer also will consider the representative’s familiarity with our rules and policies, and whether the representative complied with or applied them correctly and effectively during representation.

The fee authorizer will consider the amount of time the representative spent on services they performed before us on the case. In evaluating the amount of time spent on a case, the fee authorizer must exclude any time spent preparing any fee documents, such as the fee petition or relevant agency forms, and services the representative did not provide before the agency (e.g., preparing a complaint and briefs for a federal court).

The fee authorizer will consider the results achieved but will not authorize or deny a fee simply because of a favorable or unfavorable outcome. While a favorably decided case will typically warrant a higher fee, the results achieved will not override other factors. For concurrent claims, a favorable result for one title is sufficient for this factor (i.e., an unfavorable result for one title or action will not discount a favorable result for the other).

NOTE: The authorized fee does not depend on the amount of the past-due benefits. However, our ability to directly pay the authorized fee is subject to the limitation of 25 percent of past-due benefits. Any amount we authorize beyond the 25 percent limitation is a matter between the claimant and the representative. For Title XVI, the calculation of past-due benefits for representative fee purposes must consider the Title II benefits as if they had been paid timely.

The fee authorizer will consider the level of the administrative review process when the representative began providing services to the claimant, as well as the level to which the representative pursued the case. For more details, refer to GN 03930.015B.6. and HALLEX I-1-2-57A.

The fee authorizer will evaluate the amount the representative is requesting, including any amount previously authorized or requested (e.g., any fee authorized and paid under a fee agreement that we subsequently disapproved), or previously paid or will be paid by another source (e.g., third-party entity). Even though we are not responsible for directly paying any portion of an authorized fee that may be paid by another source, we must authorize the total fee the representative may charge whenever a claimant or any auxiliary beneficiary is financially liable for paying part of the fee (see GN 03920.005B.). The fee authorizer will also consider any agreement the representative made with the claimant to only collect a fee if there is a favorable outcome. This evaluation will not include the amount of any expenses incurred.

NOTE: For the policy on out-of-pocket expenses, refer to GN 03920.010C., and for services not provided in proceedings before us, refer to GN 03920.010D. and GN 03920.010F.2. For the policy on when representatives’ fees are not subject to our authorization, refer to GN 03920.010.