TN 19 (09-19)

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

CITATIONS:

20 CFR 404.1512 through 404.1519t , and 416.912 through 416.919t

NOTE: These procedures are not required for CE appointments scheduled 10 days or less before the date of the appointment, see DI 22510.016C2.

A. CE appointment communication procedures

For who to contact when the claimant does not requires special handling, see DI 23007.005A.

For who to contact when the claimant requires special handling, see DI 23007.005B.

For how to make a reasonable effort to identify and involve a third party, see DI 23007.010.

B. Claimant confirms the CE appointment

When the claimant confirms he or she will attend the CE appointment scheduled for a specific location, date, and time:

  • Document the CE appointment confirmation on an SSA-5002 Report of Contact, the claims communication section in eCAT, or DDS worksheet, and

  • Make any required CE appointment reminder per DI 22510.019D in this section.

NOTE: When the claimant confirms the CE appointment in writing, add the confirmation to the file. There is no need to document elsewhere.

C. Claimant states he or she will not attend the CE appointment

When the claimant tells you that he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.001B.

When the claimant requires special handling, you must make a reasonable effort to identify and involve a third party prior to discontinuing efforts to secure evidence that requires claimant cooperation.

For instructions on making a reasonable effort to identify and involve a third party, see DI 23007.010 . When the Field Office (FO) documented that the claimant refused to identify a third party contact, do not attempt to identify a third party, see DI 23007.001C.

D. Claimant does not respond to CE appointment notice

When the claimant does not confirm the CE appointment within 10 days from the date of the CE notice, you must follow up to determine whether the claimant will attend the CE appointment.

1. Special handling required

When the claimant requires special handling:

  • Make a reasonable effort to identify and involve a third party to assist the claimant. For additional information on special handling, see DI 23007.001A.

  • Attempt to reach a third party at the same time you follow up with the claimant.

  • Make a phone call attempt to the third party. When the phone call is successful or you can leave a message, explain the reason for your call.

  • Send a call in letter to the third party when you do not reach him or her by telephone or leave a message.

For details on what to include in your conversation, message, or letter to the third party, see DI 23007.010C.

REMINDER When the telephone is not in service, you cannot speak to the claimant, or cannot leave a message, send a call in letter per DI 22510.019D.3.

2. Telephone follow up to confirm the claimant will attend the CE appointment

  1. a. 

    When the claimant provided a telephone number, attempt to reach the claimant by telephone.

  2. b. 

    When you reach the claimant:

    1. 1. 

      Ask the claimant if he or she will attend the CE appointment.

    2. 2. 

      Remind the claimant that if he or she does not attend the CE appointment, we may make a decision based on the evidence in file.

    3. 3. 

      Explain that this means we may find that he or she is not disabled.

    4. 4. 

      When the claimant tells you he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.001B.

      • When the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule the CE.

      • When the claimant does not provide a good reason and the claimant does not require special handling, adjudicate the claim using the procedures in DI 23007.015.

  3. c. 

    When the telephone number is not in service or you do not reach the claimant, send a call in letter per DI 22510.019D.3. in this section.

  4. d. 

    Document the date and content of your conversation on an SSA-5002 Report of Contact, the claims communication section in eCAT, or DDS worksheet.

3. Contact by telephone not possible

When the claimant does not have a telephone or you did not reach the claimant by telephone, send a call in letter.

  1. a. 

    Indicate in the letter that if the claimant does not respond within 10 calendar days from the date of the letter, we may make a decision based on the evidence in file. Explain that this means we may find that he or she is not disabled.

  2. b. 

    Allow 10 days from the date of the call in letter for the claimant to respond.

  3. c. 

    When the claimant calls before the CE appointment, ask if he or she will attend. Remind the claimant that if he or she does not attend the CE appointment, we may make a decision based on the evidence in file. Explain that this means we may find that he or she is not disabled.

  4. d. 

    When the claimant tells you he or she will not attend the CE appointment, consider whether he or she has a good reason. For examples of good reasons, see DI 23007.001B.

    • When the claimant provides a good reason why he or she cannot attend the CE appointment, reschedule the CE.

    • When the claimant does not provide a good reason, adjudicate the claim using the instructions in DI 23007.015.

  5. e. 

    When the claimant does not respond within 10 calendar days from the date of the letter, you may cancel the CE appointment and process the determination per DI 23007.015.

4. If you did not send the call in letter more than 10 days before the CE appointment

  1. a. 

    Do not cancel the CE appointment.

  2. b. 

    When the claimant does not attend the CE appointment and does not respond within 10 calendar days from the letter, and the claimant does not require special handling, process the determination using the instructions in DI 23007.015. You are not required to do additional follow ups under DI 23007.010.

  3. c. 

    When the claimant does not attend the CE, but responds within 10 calendar days from the call in letter, consider whether he or she has a good reason for missing the appointment. For examples of good reasons, see DI 23007.001B.

    1. 1. 

      When the claimant provides a good reason why he or she did not attend the CE appointment, reschedule it.

    2. 2. 

      When the claimant does not provide a good reason, and does not require special handling, adjudicate the claim using the instructions in DI 23007.015. NOTE: If the claimant requires special handling, see DI 25510.019D of this section.

    3. 3. 

      Document your development on an SSA-5002 Report of Contact, the claims communication section of eCAT, or the DDS worksheet.

5. The claimant confirms the appointment

  1. a. 

    When a claimant confirms that he or she will attend a scheduled CE appointment, you must attempt to remind the claimant of the appointment, unless:

    • You reached the claimant during a follow up to the CE appointment notice performed within 10 calendar days of the CE appointment, or

    • The scheduled CE appointment is for a date 10 days or less in the future, see DI 22510.016C2.

  2. b. 

    Make the CE appointment reminder 10 calendar days prior to the date of the CE appointment. When the reminder date falls on a non-business day, make the reminder on the next business day.

  3. c. 

    You may make the CE appointment reminder by telephone or by letter.

  4. d. 

    When you reach the claimant by telephone or choose to send the CE appointment reminder by letter, provide:

    • The CE appointment information,

    • A reminder that if he or she does not attend the CE appointment we may make a decision based on the evidence already in file, and

    • An explanation that this means we may find that he or she is not disabled.

  5. e. 

    Document your development on an SSA-5002 Report of Contact, the claim communication section of eCAT, or the DDS worksheet.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422510019
DI 22510.019 - Consultative Examination (CE) Appointment Notice Follow up and Reminder - 12/06/2019
Batch run: 01/06/2020
Rev:12/06/2019