TN 2 (08-16)

DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

An individual who is dissatisfied with the medical cessation or adverse medical reopening determination may ask for an explanation of the determination by calling, writing, or visiting the FO.

NOTE: A telephone conversation is not considered a request for appeal and does not protect the appeal filing date.

A. Review the individual’s records

Before interviewing the individual, review his or her Social Security Administration (SSA) records. Determine the type of determination the individual would be appealing (i.e., medical, non-medical, or a combination of determinations).

NOTE: Do not explain any medical aspects of a determination.

B. When the individual writes to the FO

Any writing submitted by the individual, his or her representative payee, or authorized representative after receipt of a notice of initial determination, which clearly implies disagreement with the medical cessation or adverse medical reopening determination, establishes a request for reconsideration. For more information on what constitutes a request for reconsideration, refer to GN 03102.100.

For all requests for an explanation of determination, call the individual or send an SSA-2708 (Field Office Call/Come In Request) to try to arrange a personal interview. For telephone conversations with the individual, follow instructions in DI 12026.015C in this section.

When sending an SSA-2708:

  • Ask the individual to call or come into the office for an interview;

  • Explain that the letter, replying to the individual, does not establish a new or reconsidered determination;

  • Explain the right to appeal, the time limit for filing an appeal, and if appropriate, good cause for late filing of an appeal; and

  • Do not attempt to explain the basis for the determination.

C. When the individual telephones the FO

After reviewing the individual’s SSA records to determine the type of information you need:

  • Attempt to conduct the interview by telephone or ask the individual to come into the office for an interview;

  • Explain the right to appeal, the time limit for filing an appeal, and if appropriate, good cause for late filing of an appeal;

  • Do not attempt to explain the basis for the determination;

  • Document or update any new contact information for the individual (e.g., address, telephone, third party information);

  • Explain that we do not consider the telephone conversation a request for appeal and it does not protect the appeal filing date. Explain that all appeal requests must be submitted and received in writing;

  • Mail the appropriate forms to the individual if he or she wants to file an appeal;

  • Document the telephone conversation on an SSA-5002 (Report of Contact), and add this form to the blue tab of the electronic or paper folder.

D. Conduct the interview with the individual

When you conduct the interview:

  • Discuss the reasons for the determination (e.g., “you missed a scheduled exam,” “the DDS determined you are no longer disabled,” “the DDS was not able to contact you,” etc.), the individual’s dissatisfaction with the determination, and his or her appeal rights.

    REMEMBER: Do not explain any medical aspects of the determination.

  • Provide the necessary forms to the individual if he or she wants to file an appeal. For more information on appeal forms, refer to DI 12026.020A.4.

  • Make it clear to the individual that he or she has not filed the appeal until he or she completes and submits the appeal forms.

  • Document the interview conversation on an SSA-5002 and add this form to the blue tab of the electronic or paper folder.

If the individual wants to file an appeal, follow the procedures in DI 12026.020.

E. References

  • DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

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

  • GN 03102.100 The Reconsideration Process