DI 29025.005 Potential Adverse Effect Situations
A. Operating guidelines – review of folder
Because claimants generally review the evidence in their file prior to the disability hearing, it is important that material with a potentially adverse effect be identified.
B. Definition - adverse effect
Adverse effect can occur if direct access to a medical report by an individual is expected to:
Disrupt the doctor – patient relationship;
Interfere with the patients’ medical management;
In some way prove detrimental to the health, safety, and well being of the subject individual and/or members of his or her family.
C. Adverse effect material identified
Take the following actions when adverse effect material is identified:
1. Contact the medical source
Consider contacting the reporting physician to discuss the report and inform him or her that the report may be reviewed by the claimant.
Find out if the claimant is aware of the contents of the report or whether the physician believes that disclosure of the “exact” contents could adversely affect the claimant.
If the claimant is aware of the contents of the report, no further action is necessary.
If the claimant has not had prior access to the report and the physician agrees that disclosure would be detrimental to the patient:
Request the physician consider rephrasing that portion which may be potentially adverse while not changing the actual objective and factual history, clinical facts and the assessment of the ways in which the impairment restricts activities, and
Document the conversation on a Report of Contact (RC) and place in the claims folder.
2. Contact with physician is impractical or unproductive
If contact with the physician is impractical or unproductive, and a representative has not been appointed:
Telephone the field office to obtain a representative who may be authorized to review the material in question (see Providing Access to Medical Records GN 03340.035B.), and
Document the call on a Report of Contact (RC) and place in the claims folder.
3. Other adverse effect material
A third party report could also have an adverse effect on the claimant. All third party reports in the file must be reviewed for potential adverse effect. If a third party report is identified as potential adverse effect material, treat it as you would potentially adverse effect medical evidence and see DI 29025.005D.
D. Folder disposition – potentially adverse effect material identified
When dispatching folders to the Disability Hearings Unit (DHU):
Place potentially adverse effect material in a separate envelope in the claims folder, and
Send to the attention of the DHU Supervisory Hearing Officer via an SSA-408 annotated, “Potentially Adverse Effect Material Involved. Review Prior to Claimant's Appearance.”