TN 9 (07-11)

DI 22510.016 Consultative Examination (CE) Appointment Special Scheduling Procedures

Citations:

20 CFR 404.1516 through 404.1519t , and 416.916 through 416.919t

The CE appointment special scheduling procedures apply only for the situations described in this section. Follow the special scheduling procedures in addition to the general CE procedures. When a special scheduling procedure conflicts with the general CE procedures, you should follow the special scheduling procedure.

See also:

  • DI 22510.017, Consultative Examination (CE) Appointment Notice,

  • DI 22510.019, Consultative Examination (CE) Appointment Notice Follow up and Reminder,

  • DI 23007.009, Refusal to Attend a Consultative Examination (CE) Appointment

  • DI 23007.010, Failure to Attend a Consultative Examination (CE) Appointment, and

  • NL 00705.745, Model Consultative Examination (CE) Appointment Notice and forms.

A. CE appointment scheduling in special handling situations

Special handling situations include, but are not limited to, homelessness, mental impairment, illiteracy, limited English proficiency (LEP), and communication-related disabilities (i.e., vision, speech, or hearing impairment). Consider special handling procedures whenever the file indicates that the claimant may need accommodation or assistance to attend or participate in a CE.

1. In any special handling situation:

  • Carefully consider any request for accommodation. If POMS does not provide relevant instructions, consult local procedures. Document your actions in response to any request for accommodation.

  • Attempt to involve a designated third-party contact, whenever appropriate. For information on involving a designated third-party contact with a CE appointment, see DI 22510.016B in this section.

2. If the claimant needs language assistance:

  • Provide an interpreter free of charge. Do not require a claimant who needs language assistance to provide his or her own interpreter.

  • Follow the guidelines regarding interpreters for claimants with LEP in DI 23040.001.

3. If the claimant is homeless:

  • Attempt to involve the third party immediately. Do not wait until a homeless claimant fails to attend a CE appointment to involve the third party.

  • Schedule the CE appointment as quickly as possible.

  • Assist in making travel arrangements according to State agency guidelines, even if only a short distance is involved (e.g., provide a printed map, verbal directions, taxi voucher, or a subway token).

4. If the claim involves mental impairment:

  • Consider involving a third party when arranging a CE appointment.

  • Always attempt to involve a third party as directed by CE appointment notice follow-up procedures in DI 22510.019D and CE failure follow-up procedures in DI 23007.010D.3.

5. If the claimant is unable to travel due to a health reason or risk:

The claimant may report or the evidence may suggest that the claimant is unable to travel due to a health reason or health risk. If so:

  1. Confer with the claimant’s treating source (TS), if possible, about the need for the CE appointment. Determine whether the TS agrees it is reasonable for the claimant to travel to the CE appointment.

  2. If the claimant refuses to travel or the TS advises against travel to a CE appointment due to a health reason or health risk:

    • Schedule the CE appointment at the claimant’s residence, if appropriate. Consider the need for, and availability of, special equipment or facilities.

    • Do not schedule a CE at the claimant’s residence if the claimant refuses the CE, or if we cannot obtain the needed CE evidence in the residential setting.

B. Guidelines for involving a designated third-party contact with a CE appointment

The claimant usually provides the name of someone we can contact to help him or her with the claim. We refer to this person as the designated third-party contact or third party. The designated third party is not the claimant’s doctor, but knows about the claimant’s medical conditions.

The claimant may designate a third-party contact verbally or in writing (e.g., on the SSA-3368-BK, Disability Report - Adult, Section 2 - Contacts, or SSA-3441-BK, Disability Report - Appeal, Section 1.D).

Examples of potential third parties include, but are not limited to, the following:

  • relative,

  • friend,

  • member of a religious group,

  • labor union representative,

  • veterans’ group member, or

  • member of a senior citizens’ association.

1. When to involve a third party

Involve a third party when:

  • required by any POMS instruction, or

  • indicated by the facts of the claim and your business process.

EXCEPTION: You are not required to involve a third party if the claimant has an appointed representative or an applicant has filed for the claimant.

2. When you are not required to involve a third party

You do not have to involve a third party if:

  • the claimant did not designate a third party,

  • your efforts to reach the third party are not successful, or

  • the third party is unable or unwilling to assist the claimant.

NOTE: Third-party contacts are subject to Privacy Act requirements, including the agency minimization policy. For more information on the minimization policy and disclosure without consent, see GN 03316.005.

C. Guidelines for involving an appointed representative with a CE appointment

Any claimant may appoint a representative to act on his or her behalf in the matter of a disability claim. Identify represented claimant cases by the completed Form SSA-1696 (Appointment of Representative), or equivalent writing, in file. If the claimant appoints a representative, we flag the file “representative involved.”

  1. The appointed representative may confirm or refuse the CE appointment for the claimant.

  2. When contacting the appointed representative about the CE:

    • Send all written correspondence to the appointed representative and to the claimant.

    • Direct all telephone contact to the appointed representative unless asked to communicate directly with the claimant.

      NOTE: You may speak with an unappointed assistant, instead of the appointed representative, if the representative delegated responsibility for handling the CE scheduling matter to the assistant; see GN 03910.025.3.

    • Advise an appointed representative who asks to accompany the claimant to the CE appointment to make the request directly to the CE source. Also, advise the representative that the CE source’s decision is controlling. If the appointed representative objects to the CE source, see DI 22510.010E.

See also:

  • GN 03910.040, Appointment and Revocation of Appointment of Representative

  • GN 03910.050, Contacting a Represented Claimant

  • DI 31001.010, Disability Determination Services (DDS) Responsibilities When an Appointed Representative is Involved

D. Involving an applicant, other than the claimant, with the CE appointment

If an applicant filed for the claimant, send all written correspondence to the applicant who filed for the claimant and to the claimant. Direct all telephone contact to the applicant who has filed for the claimant unless asked to communicate directly with the claimant.

EXCEPTION: If the claimant has an appointed representative, see DI 22510.016C in this section.

E. Scheduling an appointment if a CE source is not available in the claimant’s immediate area

If a CE source is not available in the claimant’s immediate area:

  • Schedule the CE appointment at the most convenient location to the claimant (e.g., consult a map or contact the claimant).

  • For guidelines on purchasing a CE in a neighboring State, see DI 39545.225.

  • For guidelines on travel reimbursement, see DI 39525.005.

F. Scheduling a CE appointment for an incarcerated claimant

REMINDERS: If the correctional facility has relevant medical records, you must make every reasonable effort to obtain them, see DI 22505.001A.2. For guidelines on pre-release case processing, see DI 23530.001.

  1. If you need to schedule a CE appointment for an incarcerated claimant, determine if the following options are available:

    • The staff medical source at the facility has permission to do the CE at the facility, or

    • The facility may permit an outside CE source selected by the adjudicator to do the CE at the facility, or

    • The facility may permit the claimant to attend a CE at an outside facility selected by the adjudicator.

  2. If the claimant can attend the CE under any of the options in this section, make necessary arrangements for the appointment.

  3. If the claimant cannot attend a required CE because none of the options in this section are available:

    • Document the case development summary worksheet with the details of the development undertaken, and

    • Process the failure to cooperate determination under DI 23007.005H.

      EXCEPTION: If the case is a Title II continuing disability review, see DI 28065.030.

G. Scheduling a CE appointment for a date 10 days or less in the future

1. Preferred scheduling procedure

  1. As early as possible:

    • Contact the claimant by telephone to determine whether he or she agrees to attend the CE appointment, and

    • Send the CE appointment notice to the claimant.

  2. If you reach the claimant, and the claimant agrees to attend the CE appointment:

    • Explain the necessary details of the appointment, including location, date, and time.

    • Explain that if the claimant does not attend the CE appointment, we may make a determination based on the evidence in file. Explain that this means we may find that he or she is not disabled.

  3. If you do not confirm that the claimant will attend the appointment before the date of the appointment:

    • Reschedule the appointment.

    • Follow your local business process with regard to cancelling the appointment with the CE vendor.

      NOTE: Short notice is a good reason to decline the appointment. If the claimant does not agree to attend the short-notice appointment and asks for a later appointment, you cannot establish refusal to attend a CE appointment.

  4. Document the case development summary worksheet with the details of the development undertaken; see DI 20503.001.

  5. If the claimant agrees to attend the CE appointment, but does not attend, see failure to attend a CE procedure in DI 23007.010.

    NOTE: If you schedule a CE appointment for a date 10 days or less in the future, disregard the CE appointment notice follow-up and reminder requirements in