TN 62 (02-97)

DI 32521.005 Folder Retrieval and Reconstruction of Lost Folders

A. Processs

1. General

Class claims are identified and reviewed under the following process:

  • Central Office (CO) generates alerts for each individual who requests Dixon review.

  • Alerts are released to ODIO and/or NEPSC.

  • ODIO and/or NEPSC retrieves folders and determines when a folder containing Dixon class claim(s) is lost or destroyed.

  • ODIO and/or NEPSC screens folders for class membership and attempts to apply the court-ordered presumptions where the Dixon class claim(s) is screened-in and is lost or destroyed.

  • ODIO and/or NEPSC forwards screened-in folders to the FO for folder update or reconstruction, as appropriate.

  • Once FO development is completed, the folder(s) is sent to the appropriate DDS for Dixon review. In most cases, the review is performed by the New York ODD. (See DI 32502.001 for specific jurisdiction instructions.)

2. ODIO/NEPSC actions

  1. a. 

    ODIO and/or NEPSC receives the Dixon alert and queries, attempts to locate the folders, and associates the folders with the alert package.

  2. b. 

    ODIO and/or NEPSC follows its internal procedures for requesting folders from external locations (except from the DDS or OHA) and follows-up as needed.

  3. c. 

    If the folder(s) housing the Dixon class claim(s) is not located within 120 days of the initial search (or if the folder has been destroyed), ODIO and/or NEPSC declares that the folder is “lost”.

    If the class claim(s) is screened-in based on query information, ODIO and /or NEPSC attempts to apply the presumptions in DI 32521.020. If the presumptions do not apply, ODIO and/NEPSC initiates reconstruction.

  4. d. 

    When only one Dixon folder is involved (i.e., only one Dixon application), ODIO and/or NEPSC prepares a Dixon folder jacket containing the reply form, alert/query package, and documentation of their attempts to locate the folder. If the presumptions in DI 32521.020 do not apply, ODIO and/or NEPSC sends the folder jacket to the servicing FO for reconstruction of the material.

  5. e. 

    When multiple Dixon folders are involved and at least one prior folder is located, ODIO and/or NEPSC sends the available folder(s) to the FO or DDS for processing only if the presumptions in DI 32521.020 do not apply. ODIO and/or NEPSC also includes documentation of its attempts to locate the other folders with the folder(s) being transmitted.

3. FO actions

The FO:

  1. a. 

    Checks its records for information about prior medical decisions and related information.

  2. b. 

    Reviews requests for additional folders and determines whether retrieval or reconstruction of the prior Dixon claim(s) is necessary.

  3. c. 

    Contacts the class member or current representative, for an update of the claimant's medical condition and sources during the class period.

    Obtains an SSA-3368-BK (Disability Report), SSA-827s (Authorization to Release Medical Information to SS), and SSA-821-F4 (Work Activity Report - Employee) or SSA-820-F4 (Work Activity Report - Self Employed) covering any periods of work, as appropriate.

  4. d. 

    Routes the reconstructed folder to the DDS for processing.

B. Procedure - folder retrieval

Apply the following guidelines if other folders exist and are needed to adjudicate the class claim.

1. Folder retrieval necessary

If it is clear that a claim for an earlier Dixon period exists (e.g., from information contained in the DDS folder, queries, or information provided by the claimant, etc.) and ODIO and/or NEPSC has not attempted to retrieve the folder(s) for that period:

  1. a. 

    Determine the application dates of prior filings (i.e., are they before or after the filing date of the folder in the DDS possession).

  2. b. 

    To determine whether the additional folders are needed for adjudication:

    • Compare the application date in the located file against the application dates of the missing folders. (Possible leads are the queries provided by the PC, SSA-16-F6 (Application for Disability Insurance Benefits), SSA-3368-BK, Reports of Contact, etc., contained in the available folder(s).)

    • If the entire Dixon period cannot be adjudicated with the available folder(s), identify the folder(s) needed and return the folder(s) to the FO with a request specifying the application dates and the title of the claim that the FO needs to obtain. (FO will either retrieve or reconstruct the needed folder(s)).

2. Folder retrieval not necessary

Do not retrieve other folders when a fully favorable allowance back to the earliest alleged onset date under Dixon can be made based on the file in the DDS.

C. Procedure - reconstructed folders

If a reconstructed folder is received from the FO or folder reconstruction is not possible, follow DI 32521.015 and DI 32521.030 for reopening and developing these cases.

NOTE: If the class member's Dixon claim(s) cannot be located and the presumptions in DI 32521.020 do not apply, the class member must submit evidence pertaining to his/her condition during the period to be readjudicated. SSA will provide reasonable efforts to assist the class members in obtaining evidence.

SSA IS NOT required to reconstruct the names of doctors or medical centers which the claimant visited when the claimant is now unable to recall that information. SSA IS required to contact ONLY those sources identified by the claimant. If SSA writes to a source requesting a report and no response is received, SSA will make one follow-up by letter (or phone call). If the evidence received from the treating source(s) or other medical source(s) is insufficient for adjudication, SSA will recontact the source(s) for additional information. SSA will not obtain a consultative exam if the request for information is unsuccessful.

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DI 32521.005 - Folder Retrieval and Reconstruction of Lost Folders - 02/13/1997
Batch run: 04/14/2014