TN 3 (07-10)

DI 12010.005 Development of Administrative Law Judge (ALJ) Hearing Cases

A. Policy for developing a case for an ALJ hearing

The field office (FO) does not undertake any disability or work development after receiving a request for hearing unless one of the following applies:

  • The ALJ requests additional development;

  • The claimant submits additional information or evidence; or

  • When the case has been informally remanded and the DDS requests additional development.

See GN 03103.130 for more information on developing hearing cases.

NOTE: In Title XVI childhood cases, an SSA-3881 (Questionnaire for Children Claiming SSI Benefits) is mandatory and should be obtained along with the SSA-3441-BK (Disability Report-Appeal), see DI 11005.016B.11.

B. Procedure when developing a case for an ALJ hearing

1. Form SSA-3441 (Disability Report – Appeal)

If the case is electronic:

  • Follow instructions in DI 11055.020, DI 81010.135, DI 81010.150 to create the document in the Electronic Disability Collect System (EDCS).

  • If the document was completed on the Internet application, follow instructions in DI 81007.030, DI 81007.040, DI 81007.045 and DI 81007.050 to create the report and to follow-up with the claimant. DI 81007.045 contains instructions for completing the Child Disability Report, the i3820.

  • Annotate anything unusual in the “Remarks” section of the EDCS 3367.

  • If the claimant fails to file the necessary forms and the appeal can be processed in EDCS, follow the instructions in DI 81010.150E - Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

  • If the paper SSA-3441 is received after the claim has been transferred to the DDS or HO, compare it to the EDCS 3441 and record any new or changed information using the Update After Transfer (UAT) function and destroy the paper form. See DI 81010.135. If the file contains a limited SSA-3441, scan the newly received SSA-3441 into the certified electronic folder (CEF) as instructed in DI 81010.150E.

If the case is an EDCS exclusion and is paper:

  • Record any changes of the claimant’s condition and symptoms (better or worse) since they filed the reconsideration disability report.

  • Review with the claimant the information on the SSA-3441 and complete the report. Obtain any incomplete or missing information.

  • Ask the claimant if he or she has filed for workers' compensation or other public disability benefit. If the claimant has filed, take appropriate action per DI 52140.001.

  • Prong file the SSA-3441 in the modular disability folder (MDF) in the section titled “Disability Related Development and Documentation” (blue) if the case is paper. If the case is electronic, key the SSA-3441 into EDCS.

  • See DI 11005.030, DI 11005.037, and DI 11005.040 for instructions on how to complete the Child Disability Report (SSA-3820).

NOTE: If the FO cannot obtain the necessary information to complete the SSA-3441 when the claimant files the hearing request, do not delay sending the hearing request to the hearing office (HO). Instead, complete the SSA-3441 as soon as possible and forward it directly to the HO for association or if the case is electronic, follow the instructions in DI 81010.150E - Processing Claims Appeals of Medical Decisions in Electronic Disability Collect System (EDCS).

2. Development

Suspend all actions not directly related to the hearing request unless the hearing office requests assistance. Do not initiate development. Assist the ALJ or the claimant as follows: If the claimant reports work activity since the last disability update (e.g., answers “yes” on item 6 of the SSA-3441), obtain the name and telephone number of the employer, beginning and ending dates of employment and notify the HO per DI 12010.005B.4. in this section.

a. Claimant submits evidence

  • If the case is electronic, document the CEF to show that the evidence was submitted to the FO. Accept the evidence and scan it into the CEF using the instructions in DI 81010.125, DI 81010.135 and DI 81010.090.

  • If the case is paper, accept the evidence and attach it to the claims folder copy of the HA-501-U5 and write “evidence attached” in item 6.

NOTE: If the claimant has evidence but refuses to submit it, document this on an SSA-5002 (and scan it into the CEF or for paper cases, annotate this information on the claims file copy of the HA-501-U5).

b. Claimant does not have evidence

If the claimant does not have evidence with him or her, provide the claimant with a self-addressed envelope to the hearing office and request that it be submitted to the hearing office within 10 days. See GN 03103.020D.1.c. for more information on when the claimant has evidence. If the claimant submits evidence through the FO at a later date, accept the evidence and forward it to the HO.

c. Claimant requests assistance

If the claimant requests assistance, make all reasonable efforts to obtain the evidence, but do not delay sending the HA-501 to the hearing office while awaiting receipt of evidence.

3. ALJ requests assistance

Refer to GN 03103.130 for instructions regarding development requests from the ALJ. For electronic assistance requests from hearing offices, see DI 81010.100 (Electronic Disability Collect System (EDCS) Actions Page).

4. Non-medical issues

Continue to defer development of non-medical issues until the ALJ issues a favorable medical decision. If non-medical ineligibility is discovered, or work activity is reported, notify the HO.

EXCEPTION: Ordinarily, the ALJ rules on issues formally considered by a lower adjudicatory level. Therefore, if a new non-medical ineligibility issue is discovered or completely developed after the HA-501-U5 and the claim has been forwarded to the HO, retain the development in the FO pending the outcome of the hearing. Take no action unless a favorable decision on the medical issue is received.

However, in a few cases, non-medical ineligibility, (e.g., excess resources) may be discovered when the HA-501-U5 and the claim folder(s) are being forwarded to the HO. In this instance, fax any development and an SSA-5002 (Report of Contact) summarizing the new issue in the CEF for electronic cases or mail it to the HO for paper cases. The ALJ may choose to decide the new issue along with the medical issue, if the decision can be resolved quickly (usually within 90 days for non-medical issues), or address only the medical issue and refer resolution of the non-medical issue to the FO.

C. References

GN 03103.130 - Development in Hearing Cases.

SI 00603.015 - Processing Non-Disability Aspects of a Disability Appeal.

DI 11005.055 - Completing the Authorization to Disclose Information to the Social Security Administration (SSA) Form SSA-827.

DI 11010.150 – Processing Return-to-Work Reports.

DI 81010.090 – Faxing Documents into the Certified Electronic Folder (CEF) Using Barcodes

DI 81010.125 – Receiving Medical Evidence in the Field Office (FO).

DI 81010.135 – Storing Non-Medical Evidence in the Electronic Folder (EF).

To Link to this section - Use this URL:
DI 12010.005 - Development of Administrative Law Judge (ALJ) Hearing Cases - 01/15/2013
Batch run: 01/14/2019