TN 1 (07-11)

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

Citations:

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

A. Exceptions to instructions in this section

B. Failure to attend a CE appointment defined

Failure to attend a CE appointment means the claimant did not state orally or in writing that he or she would not attend the CE appointment, but the claimant fails to attend the CE appointment. However, a claimant cannot fail to attend a CE appointment if:

• the claimant did not confirm the appointment, see DI 22510.019D; or

• the DDS used an alternative scheduling procedure, see DI 22510.016G.2.

C. Special efforts required for title XVI childhood disability claims

For instructions on Failure Issues for title XVI childhood disability cases, see DI 25205.020.

D. Claimant fails to attend the initial confirmed CE appointment

1. Follow up required

Follow up on a missed CE appointment if you still need the CE report evidence, the claimant had agreed to attend the missed appointment, and the:

• claimant is homeless,

• claimant alleges a mental impairment, or

• evidence suggests a mental impairment.

NOTE: If the required development and evaluation of all mental impairment(s) as explained in DI 24505.025 and DI 24505.030 is complete, consider the claimant’s substantiated severe mental impairment(s), rather than alleged mental impairment(s), to determine whether we require follow up.

2. Follow up not required

If the claimant fails to attend a CE appointment that he or she agreed to attend, and DI 23007.010D.1 does not mandate follow up, process the determination; see determination instructions in DI 23007.010G. in this section.

3. Follow up procedure

If the missed CE appointment requires follow up, the following procedures apply:

NOTE: If the claimant has an authorized representative or an applicant filed for the claimant, the communication guidelines in DI 22510.016C (appointed representative) and in DI 22510.016D (applicant) apply to required claimant contacts.

a. Attempt to arrange third party assistance

Attempt to reach a designated third party contact to assist the claimant at the same time you follow up with the claimant. If you do not reach the third party with two telephone attempts, send a call in letter to the third party. If the claimant declines third party assistance, document the file.

EXCEPTION: If the case involves an authorized representative or an applicant other than the claimant, we do not require designated third party contact; see DI 22510.016B.

b. Telephone the claimant

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

If you reach the claimant:

• ask for the reason for missing the CE appointment; see DI 23007.010E in this section;

• reschedule appointment if the claimant provides a good reason for failing to attend the CE appointment; and

• process the failure to attend a CE appointment determination if the claimant does not provide a good reason for failing to attend the CE appointment; see determination instructions in DI 23007.010G in this section.

If no one answers the phone, or if you reach a busy signal, a recorded message, voicemail, an answering machine, or another person:

• leave a message for the claimant to call you; (NOTE: When leaving a message, disclose only information necessary for the claimant to return the call) and

• make a second attempt to reach the claimant at a different time of day on a different day.

If the telephone number is not in service, or if you do not reach the claimant on the second attempt, send a call in letter.

Document the case development summary worksheet with the details of the development undertaken; see case development summary instructions in DI 20503.001E.

NOTES: If you do not reach the claimant on the first attempt, you may send the call in letter before making your second attempt. If you reach the claimant before he or she receives the call in letter, ask him or her to disregard the call in letter.

c. Send the claimant a call-in letter

If the claimant does not have a telephone or you did not reach the claimant by telephone, send the claimant a call in letter. For sample call-in letter, see NL 00705.735.

Indicate in the letter that if the claimant does not respond within 10 calendar days after the date of the letter, 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.

Allow 10 calendar days from the date of the call in letter for the claimant to respond. NOTE: Local procedures may allow additional time to account for mail delivery and processing.

If the claimant calls-in:

• ask for the reason for missing the CE appointment;

• reschedule appointment, if the claimant provides a good reason for failing to attend the CE appointment; or

• process the failure to attend a CE appointment determination, if the claimant does not provide a good reason.

NOTE: For examples of good reasons to miss a CE appointment, see DI 23007.010E. in this section;

If the claimant does not call-in, process the failure to attend a CE appointment determination, see determination instructions in DI 23007.010G. in this section.

Document the case development summary worksheet with the details of the development.

E. Good reasons for not attending a CE appointment

Examples of good reasons for failure to attend a CE include:

• personal illness,

• death or serious illness in the family, and

• transportation problems.

NOTE: The items in this list are only examples. You must exercise judgment and take into account the facts of each claim.

F. Claimant fails to attend a CE appointment for the second time

If the claimant fails to attend a CE appointment rescheduled under the procedures in DI 23007.010D.3., process the failure to attend a CE appointment determination.

G. Failure to attend a CE appointment determination

If the claimant fails to attend a CE appointment, you may discontinue development that requires evidence from or action by the claimant (e.g., consultative examinations and claimant forms completion).

You must:

• review the file again to determine if you need the evidence;

• develop medical evidence of record (MER) from other medical sources;

• make every reasonable effort as explained in DI 22505.001A.2;

• complete development of functional evidence indicated by the facts of the case if the available MER substantiates mental impairment;

  See details:

  DI 22511.007, Sources of Evidence

  DI 22511.009, Sufficiency of Evidence

  DI 22511.011, Contacting Claimants and Collateral Sources

• document the case development summary worksheet with the details of the development undertaken; see case development summary instructions in DI 20503.001E;

• make a disability determination based on the evidence in file; and

• send a personalized disability notice (PDN) if you cannot make a fully favorable determination.

NOTES:

• Medical consultant or psychological consultant review is not necessary if there is no medical evidence.

• The PDN must include an explanation that you requested that the claimant attend a CE appointment, but the claimant failed to attend the CE appointment, and we made a determination based on the evidence in file.

• If the claimant contacts you prior to the release of the PDN, provides a good reason for not attending the CE appointment, and expresses a willingness to attend a rescheduled CE appointment, reschedule the CE appointment.