TN 18 (01-15)
DI 22505.035 Follow-up on Requests for Medical Evidence of Record (MER)
A. Policy for following-up on MER requests
1. Every reasonable effort required for MER
We must make every reasonable effort to help claimants obtain medical evidence from all of their medical sources. See DI 22505.001A.2.
NOTE: In child claims under Title XVI, we also must make every reasonable effort to obtain evidence from all relevant non-medical sources. See DI 25205.001.
2. When follow-up may not be required for MER
You are not required to follow-up with a medical source solely to obtain a medical opinion. However, you should recontact a medical source for specific information about a claimant's functional abilities and limitations if necessary to adjudicate a claim. See DI 22505.008C.
B. Procedure for following-up on MER requests
1. How to follow-up
Follow-up with the source by:
mailing a letter to the source,
faxing a letter to the source,
calling and speaking to the source by telephone, or
calling the source by telephone and leaving a clear and detailed message on the source's voicemail.
Any of these contacts constitute a successful follow-up attempt with the source. For more instructions on how to request and document receipt of evidence by telephone or fax, see DI 22505.030.
2. When to follow-up
a. Regular claims
Initiate one follow-up request for each medical source that has not provided requested MER at any time between 10 and 20 calendar days after the initial request.
Allow at least 10 calendar days from the date of the follow-up request for the source to reply. Allow more time for a particular source to reply when experience with that source indicates a longer period is advisable.
b. Compassionate Allowances (CAL) and Quick Disability Determinations (QDD)
For procedures about when to follow-up in CAL and QDD claims, see DI 23022.040D.
3. When to stop follow-up activities
a. Sufficient evidence for an allowance
If the case contains sufficient evidence to make a fully favorable determination, do not await receipt of or follow-up on outstanding MER requested from other medical sources. See DI 24515.020.
b. Source clearly will not provide evidence
Discontinue follow-up activities when circumstances of contact with a medical source clearly indicate that the medical source cannot or will not at any time provide the requested MER.
4. Documentation requirements
In all cases, document the details of all follow-up activities on the electronic claims analysis tool disability determination explanation (eCAT DDE) or on the Case Disability Summary Worksheet. See DI 20503.001E.
DI 20503.001 Documenting the Disability Folder - Disability Determination Services (DDS)
DI 22505.003 Medical and Other Evidence of an Individual’s Impairment(s)
DI 22505.007 Developing Initial Evidence from Medical Sources
DI 22505.008 Developing Supplemental Evidence
DI 22505.030 Obtaining Medical Evidence by Telephone
DI 23022.040 Compassionate Allowances and Quick Disability Determinations Fast-Track Case Development