Sample Fee Contract

Be sure to review the Business Guide, lesson six, The Representative Fee Structure, prior to reviewing this segment.

In disability representation, there is a document often referred to as a fee contract or fee agreement.  The contract content and structure can differ from State to State which is why we cannot provide a fully written example of a fee contract.  We can provide sample language covering common issues that should be included in your contract.  To create a contract that meets your State's standards, see a local attorney to assist you in the development of your contract. 

Using an Attorney:

A competent attorney licensed to practice in your state can be of great value in assisting you in the creation of your fee contract.  Have the attorney review the basic social security regulations associated with non-attorney fees.  Also instruct your attorney to enter a clause addressing any obvious areas of concern that could arise during the representation of a disability claim.  Concerns like:

1.  Early termination of service.
2.  Repayment of out-of-pocket fees for records or other services.
3.  Termination of agreement for client non-compliance or fraud.
4.  Level of representation - Initial - Recon - ALJ or all of the above.

Before writing your contract, try to determine some of the common problems that might occur when representing a disability claim. 

Examples:
Claimant refuses to follow your instructions
Claimant has provided unreliable information
Claimant has proven to be dishonest or is attempting to commit fraud
Claimant has more than one representative.
Claimant is reluctant to pay for services rendered.

Sample Contract Language

I (claimant's full name) do hereby agree to be represented before the Social Security Administration for the purpose of applying for Social Security disability benefits.  It is agreed that (your name) will act as my authorized representative before the Social Security Administration in pursuit of SSDI and/or SSI disability benefits. 

I further understand that I (claimant's name) will be charged a fee as described in this contract upon the successful completion of the case or as otherwise stipulated in this contract.  Upon consultation with (your name) my representative, I have agreed to be charged a fee under the following fee structure:

a)  Contingency fee:  Twenty five percent of back benefits paid, not to exceed $5,300.
b)  Times monthly:  1, 2 or 3 times the amount paid to the claimant in monthly benefit, not to exceed $5,300.
c)  Advance fee:  An advance fee paid to escrow in the amount of $ __________, for the successful representation of my Social Security disability claim.

Optional:  I also agree to pay in advance, a development fee in the amount of $__________.  I understand that the development fee will be used by my representative for the development and processing of my Social Security disability claim.  The development fee will be used for the acquisition of medical records, long distant phone calls and any other processes required in the representation of my disability case. 

I further understand that all funds not used in the development of my claim will be returned to me if the application for disability benefits is unsuccessful.  I also agree to pay any additional costs paid or carried by the representative in the representation of my Social Security disability claim regardless of case outcome.  

I understand and agree to pay for representational services in full as set-forth in this contract upon the successful completion of the case.  I further understand and agree that in the event that I fail to pay agreed upon fee, this will constitute a breech of contract.  In the event of a breech of contract, this will be considered fraud by the representative and said circumstance will be reported to Social Security.  I understand that these actions taken by the representative could result in the loss of my Social Security disability benefits. 

It is also my understanding that this representational contract encompass all delegate support and responsibilities on case level initial, reconsideration, Administrative Law Judge or until my (claimant) case has been approved by the Social Security Administration.

I (claimant's name) have no other representative other than (your name) and will not seek any other representation until this contract has been successfully fulfilled or mutually terminated.

I have been informed by my representative (your name) and I fully recognize that there are no assurances that my case will be won.  However, I have been told and fully expect that my case will be represented in such a manner to assure that I will receive the best possible chance of being awarded Social Security disability benefits in the most timely manner possible given the particulars of my case.

* At this point, you may add any additional language to this agreement that is appropriate for a particular contract between yourself and the person you are representing.  For example, you may want to mention your refund or payment policy if claimant changes his mind after you have performed certain duties on his behalf.  

* You may also want to lay out any action you will take against the client if he refuses payment upon successful completion of the case.  For additional contract statements, see Business Guide.  See Executive web for payment warning language when representing out-of-state cases.

* A third party signature on a contract is only required if the client is suffering from a mental illness or is otherwise unable to act responsibly in respect to his/her case.  A third party can be any adult family member or friend who has agreed to assist the claimant in pursuing their claim.  Adding a third party in non-mental health cases is a great way of protecting your fee as it make another person responsible for the fee if claimant cannot or will not pay.  Be sure to explain the contract to the third-party and instruct him/her to sign this form in the appropriate space.

Client Signature: ______________________________      Date: ___________.

Third party signature: _________________________  Date: ___________.

Authorized Representative Signature: _____________________  Date: ____________.

Your local attorney should be able to add any additional features to your contract that might be required given the laws of your state.

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