TN 3 (09-13)

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

A. When an appointed representative’s authority ends

An appointed representative’s authority ends when the representative's services in a particular matter end. Specific events that terminate an appointment and the representative’s authority to act on behalf of the claimant include:

  • the claimant revokes the appointment;

  • the representative withdraws;

  • the agency makes a final determination or decision and the period to appeal the final determination or decision ends;

  • the representative files a fee petition; or

  • SSA suspends or disqualifies the representative (see GN 03970.060).

NOTE: If a previously denied claimant files a new disability claim, he or she must complete a new SSA-1696-U6 (Appointment of Representative) or equivalent written statement of intent for representation and submit it to the field office (FO). This is necessary even if the previous representative is the same as the previous claim.

B. Contacting represented claimants

A represented claimant may continue to participate in the development of his or her claim, through the appointed representative or directly with us.

1. Contact initiated by the claimant

If a represented claimant contacts us or the DDS, we may discuss his or her specific issue. A represented claimant does not need permission from the appointed representative to contact us or the DDS directly.

2. Contact initiated by SSA or the DDS

If the claimant appoints a representative, as a general rule the DDS initiates all contacts in connection with that claim through, or with the permission of, the appointed representative. However, the DDS may contact the claimant directly if:

  • The representative asks us or the DDS to contact the claimant directly;

  • The claimant alleging blindness or a visual impairment elects to receive notices by first class mail with a follow-up telephone call from us or the DDS to read the notices (see NL 01001.000);

  • There is an indication that a representative's appointment may have expired, but the information in our records is unclear or insufficient (see GN 03910.060A);

  • The reason for the contact involves a possible violation by the representative (see GN 03970.010);

  • Our records indicate that the claimant has representation, but there is insufficient or conflicting information about the claimant's representative.

    EXAMPLE: The claimant appointed two representatives at different times and the representatives do not appear to be working together or to be aware of each other’s activities. SSA may contact the claimant directly to clarify the situation.

C. DDS responsibilities

1. Appointed representative asks SSA or the DDS to communicate directly with the claimant regarding a specific issue

If the representative asks us or the DDS to communicate directly with the claimant regarding a specific issue:

  • Prepare an SSA-5002 (Report of Contact) to document that we or the DDS will deal directly with the claimant on the specific issue.

  • Include the SSA-5002 in the file. For paper cases, send a copy to the field office (FO).

  • Post a message in eView to notify the FO of the representative’s request.

2. Represented claimant asks SSA or the DDS to communicate directly with him or her regarding a specific issue

If a represented claimant asks us or the DDS to communicate directly with him or her regarding a particular issue:

  • Prepare an SSA-5002 describing the claimant’s desire to communicate directly with us or the DDS on the specific issue.

  • Include the SSA-5002 in the file. For paper cases, send a copy to the FO.

  • Post a message in eView to notify the FO of the claimant’s request.

IMPORTANT: A represented claimant asking us to communicate directly with him or her regarding a specific issue is not the same as revoking the appointment of representation. Remind the claimant that the representative will continue to have access to all information in the file, which may include information regarding the issue he or she identified.

3. Appointed representative contacts DDS

If the representative contacts the DDS, the actions you take depend on whether or not the DDS issued the personalized disability notice (PDN). To determine the PDN’s date of issue, see DI 81020.130D.

a. Before PDN issuance and case is at the DDS

Take the following actions when an appointed representative contacts the DDS to discuss his or her client’s case before PDN issuance and the case is at the DDS:

  • Identify sources of medical information.

  • Indicate development undertaken or outstanding.

  • Clarify the need for a development request, if necessary.

  • Advise the representative of his or her right to both review or receive copies of material in the claimant's file. Do not disclose disability claim determination information to an appointed representative until claim processing is complete as there may be a possibility of reversal by the Disability Quality Branch.

  • Prepare an SSA-5002 explaining the nature of the request, if the appointed representative makes a request, and the actions taken to comply with the request.

b. After PDN issuance or case is no longer at the DDS

Take the following actions when an appointed representative contacts the DDS to discuss his or her client’s case after PDN issuance or the case is no longer at the DDS:

  • Answer questions related to the disability determination as completely as possible (see DI 31005.005).

  • Refer the representative to the FO for all other questions.

4. Documenting the claims folder

Take the following actions to document the claims folder:

  • Retain copies of all correspondence between the representative and SSA and DDS in the claims folder.

  • Document your telephone and email contacts with the representative either in the claim communications section of the disability determination explanation (DDE), or on an SSA-5002 and include it in the claims folder. This is important for fee evaluation purposes.

5. Representative information or fee-related documents received in the mail or via fax

To ensure proper and timely action on representative information or fee related documents the DDS receives by mail or fax, return the document to the sender following instructions in DI 31001.001B.1.

6. Evidence furnished by representative

Treat evidence provided by a representative the same way as if the claimant provided it. Consider this evidence as part of the total record upon which you base the determination. If a representative previously submitted medical evidence, make contact with the same medical source through the representative.

7. Consultative examination (CE) or other evidence needed

Send duplicate requests to both the representative and the claimant to attend a CE or provide other evidence. This ensures that you make the claimant aware of, and remind him or her about, the examination. If a representative previously submitted medical evidence of record, make contact with the same medical source through the representative.

8. Representative uncooperative

If a representative is uncooperative, proceed with adjudication of the claim:

  • Use normal follow-up procedures and diaries (see DI 22505.000). Do not delay the case beyond the time ordinarily allowed a claimant acting on his or her own behalf. Instead, adjudicate the case on the evidence in the record.

  • Use normal “failure to cooperate” procedures (see DI 23007.000) if the representative refuses to permit the claimant to submit evidence, or causes him or her to miss a CE.

  • Forward the information regarding representatives who routinely fail to cooperate to the FO. We may begin proceedings to suspend or disqualify an individual from acting in a representational capacity if the representative violated his or her affirmative duties or engaged in prohibited conduct.

9. Notices and correspondence

Send duplicate notices and correspondence to both the claimant and the appointed representative, as follows:

  • Send requests for developmental evidence or action (e.g., work history or disability reports, questionnaires, CE scheduling, call-in letters) to the representative and a duplicate to the claimant.

  • Send determination notices to the claimant and a duplicate to the representative.

10. References

  • DI 22505.001 Medical Evidence of Record (MER) Policies

  • DI 23007.000 Failure to Cooperate – Table of Contents

  • GN 03910.040 Appointment and Revocation of Appointment of Representative

  • GN 03910.050 Contacting a Represented Claimant

  • GN 03910.060 When a Representative’s Authority Expires

  • GN 03970.000 Suspension or Disqualification of Attorneys and Other Representatives – Table of Contents

  • NL 01001.000 Special Notice Options for the Blind or Visually Impaired – Table of Contents


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DI 31001.010 - Disability Determination Services (DDS) Responsibilities When an Appointed Representative is Involved - 01/26/2015
Batch run: 01/26/2015
Rev:01/26/2015