TN 3 (02-20)

DI 23007.010 A Reasonable Effort to Identify and Involve a Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence

A. When must you make a reasonable effort to identify and involve a third party

Before you stop attempts to get the claimant to comply with your request, you must make a reasonable effort to identify and involve a third party when all of the following apply:

  • The claim falls into a special handling category,

  • The claimant does not have an applicant filing on his or her behalf or an appointed representative (A child under age 18 requires special handling even when the child has an applicant or appointed representative),

  • The claimant has not already identified a third party on the SSA-3368 Disability Report - Adult, the SSA-3441 Disability Report - Appeal, or theSSA-454 Continuing Disability Review Report,

  • The Field Office (FO) has not documented that the claimant refused to provide a third party, and

  • The claimant has not complied with your follow up request for evidence or action, or does not attend or confirm a consultative examination (CE) appointment.

For claimants who require special handling, see DI 23007.001A.

For when the claimant does not comply with an initial, written request for evidence or action, see DI 22505.014.

For when the claimant does not comply with the initial, written notice of a consultative examination (CE) appointment or does not attend a CE appointment, see DI 22510.019.

B. Making a reasonable effort to identify a third party

When DI 23007.010A above applies, contact the claimant once by telephone or letter to request a third party contact.

When the DDS receives a claim and the FO did not obtain an additional third party, or the FO annotated in the Remarks section "Internet/mailed-in claim - no additional third party contact obtained," you are not required to attempt to identify an additional third party. For the policy to document the third parties at the FO, see DI 11018.005F.1, DI 11005.022B and DI 11005.022C.

When the claimant identifies a third party, make a reasonable effort to involve the third party in accordance with DI 23007.010C.

In addition, when the FO documented that the claimant refused to identify a third party, do not attempt to identify a third party. For the policy to document the refusal at the FO, see DI 11005.002B.

NOTE1: You may ask a claimant that requires special handling to identify a third party at the time you follow up on an initial, written request for evidence or action, or when you attempt to confirm the claimant's attendance at a scheduled CE appointment, see DI 22510.019.

NOTE 2: When a claimant has not identified a third party on the SSA-3368 Disability Report - Adult, the SSA-3441 Disability Report - Appeal, or theSSA-454 Continuing Disability Review Report, and there is no FO documentation that the claimant refused to provide one, you are only required to identify one third party.

1. If you contact the claimant by telephone

Claimant contact by telephone means you either:

  • Speak to the claimant, or

  • Leave a message.

NOTE: When you do not speak to the claimant and you cannot leave a message, you must contact the claimant once by letter.

a. You speak to the claimant

Ask for the name and contact information of a third party. When the claimant asks for more time to provide this information, give him or her 10 additional calendar days from the date of your telephone call. Explain that failure to provide the requested information may result in you making a determination based on the evidence in file, which means you may find that the claimant is not disabled.

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

b. You leave a message

You may leave a message on the voicemail recording system of a telephone number in the claim file that is attributable to the claimant. You may also leave a message with an adult who answers a telephone number in the claim file that is attributable to the claimant (e.g., the claimant’s spouse).

Include the following:

  • Your contact information and date that you called. Do not disclose any unnecessary personal information about the claimant,

  • A request that the claimant provide the name and contact information of a third party,

  • A request that the claimant return your call within 10 calendar days from the date of your message with the information, and

  • An explanation that failure to provide the requested information may result in you making a determination based on the evidence in file, which means you may find that the claimant is not disabled.

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

 

c. You send a letter to the claimant

Include the following:

  • Your contact information and date of your letter,

  • A request that the claimant call you within 10 calendar days from the date of your letter with the name and contact information of a third party, and

  • An explanation that failure to provide the requested information may result in you making a determination based on the evidence in file, which means you may find that the claimant is not disabled.

C. Making a reasonable effort to involve a third party

You make a reasonable effort to involve a third party by contacting him or her by telephone or letter. This is true even when the third party declines to assist the claimant or does not respond to your contact. Document any attempt to involve the third party by telephone on an SSA-5002, the claim communication section in eCAT, or the DDS worksheet. When the FO has identified an additional third party in Section 11 of the SSA-3368 Disability Report - Adult, the SSA-3441 Disability Report - Appeal, or the SSA-454 Continuing Disability Review Report, you must make a reasonable effort to involve the additional third party when the attempt with the other third party was not productive.

NOTE: How you contact a third party may depend on the information you have. For example, you contact a third party by telephone when you only have his or her telephone number. Likewise, you contact a third party by letter when you only have his or her mailing address. Do not attempt to look up a third party’s telephone number or mailing address in a telephone book or on the computer unless the third party is a professional at a particular location (e.g., a social worker at a specific clinic).

1. You contact the third party by telephone

Contacting the third party by telephone means you either:

  • Speak to the third party, or

  • Leave a message.

NOTE: When you do not speak to the third party, and you cannot leave a message, you must contact the third party once by letter.

a. You speak to the third party

Do the following during the conversation:

  • State your contact information. Do not disclose any unnecessary personal information about the claimant,

  • Explain that the claimant told you that you could contact the third party for assistance with the claimant’s disability claim, and

  • Explain that the claimant did not:

    • Comply with your initial, written request, or follow up request, for evidence or action, or

    • Attend the CE appointment that you scheduled,

  • When the claimant did not comply with your request for evidence or action, identify the evidence or action that you need. When the third party provides a good reason for giving the claimant more time to comply with your request, give the claimant 10 additional days from the date of your telephone call.

  • When the claimant did not attend the CE appointment that you scheduled, explain the CE process and the claimant’s need to attend. When the third party provides a good reason for rescheduling the CE appointment, reschedule the CE.

  • Explain to the third party that if the claimant does not comply with your requests for evidence or action, or attend the CE appointment, you may make a determination based on the evidence in file, which means you may find that the claimant is not disabled.

Document the date and content of your conversation with the third party on an SSA-5002, the claim communication section in eCAT, or the DDS worksheet.

b. You leave a message for the third party

You may leave a message on the voicemail recording system of a telephone number in the claim file that is attributable to the third party. You may also leave a message with an adult who answers a telephone number in the claim file that is attributable to the third party (e.g., the third party’s spouse). Include the following:

  • Your contact information and date that you called. Do not disclose any unnecessary personal information about the claimant,

  • Explain that the claimant told you that you could contact the third party for assistance with the claimant’s disability claim,

  • Explain that the claimant:

    • Did not comply with your initial, written request, or follow up request, for evidence or action,

    • Did not confirm a CE appointment,

    • Needs assistance getting to a CE appointment, or

    • Did not attend the CE appointment that you scheduled,

  • When you need evidence or action, identify that evidence or action,

  • When you need the claimant to attend a CE appointment, explain the CE process and the claimant’s need to attend,

  • Request that the third party return your telephone call within 10 calendar days from the date of your message, and

  • Explain to the third party that if the claimant does not comply with your request(s) for evidence or action, or attend the CE appointment, you may make a determination based on the evidence in file, which means you may find that the claimant is not disabled.

Document the date and content of your message for the third party on an SSA-5002, the claim communication section in eCAT, or the DDS worksheet.

2. You send a letter to the third party

Include the following:

  • Your contact information. Do not disclose any unnecessary personal information about the claimant,

  • An explanation that the claimant told you that you could contact the third party for assistance with the claimant’s disability claim,

  • An explanation that the claimant:

    • Did not comply with your initial, written request, or follow up request, for evidence or action, or

    • Did not attend the CE appointment that you scheduled,

  • When you need evidence or action, identify that evidence or action,

  • When you need the claimant to attend or confirm a CE appointment, explain the CE process and the claimant’s need to attend,

  • A request that the third party call you within 10 calendar days from the date of your letter, and

  • An explanation that if the claimant does not comply with your request(s) for evidence or action, or attend the CE appointment, you may make a determination based on the evidence in file, which means you may find that the claimant is not disabled.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423007010
DI 23007.010 - A Reasonable Effort to Identify and Involve a Third Party in Claims Involving Failure to Cooperate and Insufficient Evidence - 01/06/2020
Batch run: 02/20/2020
Rev:01/06/2020