Effective Dates: 06/06/2023 - Present Previous | Next

TN 18 (06-23)

DI 33015.005 Beneficiary (or Recipient) and Representative Review of Claims Folder

Citations: 20 CFR 404.916(b)(3), 416.1416(b)(3)

A. Offering opportunity for claims folder review

The regulations provide that a beneficiary (or recipient) and the appointed representative may review the evidence in the claims folder, either on the date of the disability hearing or at an earlier time, at the beneficiary's (or recipient's) or the appointed representative’s request.

  1. 1. 

    The disability hearing officer (DHO) will advise the beneficiary (or recipient) and appointed representative in the hearing notice that if they want to look at the case file before the hearing date, they will need to contact the disability hearing unit (DHU) or Social Security Administration (SSA) office in their area to arrange another time or place to review the file.

  2. 2. 

    For suggested notice language, see DI 33010.080 Language for Disability Hearing Scheduling Notice for Domestic Claims-Exhibit, or for foreign claims see DI 33010.085 Language for Disability Hearing Scheduling Notice for Foreign Claims – Exhibit.

  3. 3. 

    The DHO will burn an encrypted compact disc (CD) of the documents used in the evidence of record if the beneficiary (or recipient) or appointed representative requests to review the folder prior to the date of the hearing for an electronic claim. Annotate this action on an SSA-5002 Report of Contact and include the date the CD was burned. Do not send a CD to an incarcerated individual.

    NOTE: The DHO may also send an encrypted PDF via secure email. See DI 81001.035F for complete instructions.

  4. 4. 

    The beneficiary (or recipient) or appointed representative may review a paper folder at the field office (FO) or the DHO if they request to review the folder prior to the date of the hearing.

  5. 5. 

    See GN 03340.000 Access to SSA Records for additional information.

B. DHO preparation of claims folder for review

Claims folders (comparison point decision (CPD) and reconsideration) may be completely electronic, partially electronic or completely paper.

1. General preparation for folder review:

  1. a. 

    Only include material relating to the beneficiary (or recipient).

  2. b. 

    Provide a paper copy of the medical evidence contained in the certified electronic folder (CEF) only if there is no means of viewing the evidence electronically or if the beneficiary (or recipient) or appointed representative requests a paper copy.

  3. c. 

    The DHO may scan all relevant information from the CPD folder into the CEF prior to burning a CD.

  4. d. 

    Medical assessment forms (e.g., SSA-416 Medical Evaluation, SSA-4734 Physical Residual Functional Capacity, SSA-2506-BK – Psychiatric Review Technique Form) may be found on the disability determination explanation (DDE) in Section A Payment Documents/Decision (Yellow Front) or in Section F Medical Records (Yellow Back).

  5. e. 

    Handle adverse effect material as set forth in DI 33010.015 Adverse Effect.

2. If a portion of the folder is electronic:

  1. a. 

    Burn a CD containing the evidence used to make the determination. This includes medical assessment forms and any documents in sections E. Disability Related Determination (blue) and F. Medical Records (yellow back) of the electronic folder.

  2. b. 

    The CD should be a “read only” CD. Refer to DI 81001.035 Copying a Certified Electronic Folder (CEF) to Compact Disc (CD) - for detailed instructions on burning a CD.

  3. c. 

    Handle adverse effect material as set forth in DI 33010.015 Adverse Effect.

3. If a portion of the folder is paper:

  1. a. 

    Provide a paper copy of the medical evidence used to make the medical determination. This includes medical assessment forms and any documents in sections E. Disability Related Determination (blue) and F. Medical Records (yellow back) of the paper folder.

  2. b. 

    Handle adverse effect material as set forth in DI 33010.015 Adverse Effect.

C. Access at the DHU

  1. 1. 

    A DHU or SSA employee must be present during the review and available to answer questions.

  2. 2. 

    Provide an area that affords privacy where the paper folder can be reviewed or a workstation or laptop that only has access to the CD.

  3. 3. 

    For information concerning disclosure of medical records to a representative, see GN 03910.025 Authority of Representative, and GN 03305.025 Disclosure to Legal Aid Groups, Private Law Firms, and Appointed Representatives.

  4. 4. 

    The DHO must ensure that any Personally Identifiable Information on a laptop computer, CD, or paper folder is kept secure.

  5. 5. 

    If the beneficiary (or recipient) or representative requests the CD, provide it to them at no charge. See DI 81001.030 Claimant or Representative Requests a Copy of the Claims Folder.

  6. 6. 

    If the beneficiary (or recipient) or appointed representative does not request the CD, destroy the CD. See DI 81020.055E Document Retention and Destruction for instructions on how to destroy the CD and other sensitive materials.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0433015005
DI 33015.005 - Beneficiary (or Recipient) and Representative Review of Claims Folder - 06/06/2023
Batch run: 10/08/2024
Rev:06/06/2023