TN 55 (07-15)

DI 11010.525 Assisting Claimants who are Unable to Provide Medical Evidence

A. Claimant‘s responsibilities for obtaining medical evidence

Claimant’s responsibilities are to:

  • provide complete information about all of his or her medical sources;

  • request, submit to us, or authorize us to obtain medical reports from physicians or medical facilities when asked by the field office (FO) or the disability determination services (DDS); and

  • attend a consultative examination when requested.

NOTE: For information about obtaining, a signed Form SSA-827 (Authorization to Disclose Information to the Social Security Administration (SSA)), see sections DI 11005.055 through DI 11005.057.

B. Claimant can obtain medical evidence

If the claimant informs the FO that he or she will obtain additional evidence, the FO will forward the following to the DDS:

  • the disability folder, and

  • any medical evidence, upon receipt.

NOTE: For information on receiving medical evidence in the FO, refer to DI 81010.125.

C. Claimant cannot obtain or provide us with access to medical evidence

1. FO actions

If the claimant is unable to obtain medical evidence, document this fact on Form SSA-5002 (Report of Contact) in the Electronic Disability Collect System (EDCS), or on a paper Form SSA-5002 for EDCS exclusion claims, with the remark, “No medical evidence available for reasons beyond the claimant’s control” and provide the reason(s) the claimant cannot obtain the medical evidence.

NOTE: When a claimant is unable to obtain or provide access to medical evidence due to circumstances beyond his or her control, a third-party contact may be helpful in securing the necessary evidence. Document claimant-supplied third-party contact information on the disability report form (SSA-3368 (Disability Report - Adult) or i3368).

2. DDS actions

The DDS will decide how, or from whom, to request the medical evidence. In some situations, the DDS may ask the FO for assistance, see DI 11010.645.

D. Special situations when the claimant cannot obtain medical evidence

1. Limited English proficiency (LEP)

An inability to obtain medical evidence can be the result of a claimant’s LEP. For instructions on processing claims for non-English speaking and LEP claimants, see GN 00203.011.

2. Religious or personal reasons

If the claimant identifies a religious or personal basis as the reason he or she cannot provide medical evidence, see DI 11010.530.

3. Obvious impairment

If the claimant has an obvious impairment, and is unable to obtain medical evidence, document this information with the explanation on form SSA-5002.

E. Claimant cannot obtain medical evidence in foreign claims

If the file contains the name of a third-party contact who may help in securing the necessary evidence, the Office of Earnings and International Operations may contact the third party:

  • directly,

  • through the resident FO, or

  • through the Foreign Service Post.

If the claimant is unable to pay for medical evidence, the FO should inform the claimant that the Social Security Administration will pay necessary expenses due to the unusual circumstances of the case.

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DI 11010.525 - Assisting Claimants who are Unable to Provide Medical Evidence - 12/22/2014
Batch run: 07/14/2015