TN 9 (12-07)

DI 33015.005 Claimant/Representative Review of Claims Folder

A. Policy

The regulations in 20 CFR 404.916(b)(3) and 416.141(b)(3) provide that a claimant and/or his or her representative may review the evidence in the claims folder, either on the date of the disability hearing or at an earlier time at the claimant’s, or his or her representative’s, request. Only material relating to the claimant may be reviewed. For information concerning disclosure of medical records to a representative, see Authority of Representative, GN 03910.025 and Disclosure to Legal Aid groups and Private Law Firms, GN 03305.015. Potentially adverse effect material is to be removed prior to the claimant's review, unless the claimant is accompanied by the representative. (See Adverse Effect, DI 33015.050.)

B. Procedure

1. Offering claimant/representative opportunity to review claims folder

The Disability Hearings Officer (DHO) will offer the claimant or his/her authorized representative an opportunity to review the claims folder prior to the hearing. The DHO will advise the claimant/representative in the hearing notice that if he/she needs to look at the case file before the hearing date, he/she will need to contact the DHU or SSA office in his/her area to arrange another time or place to review the file. For suggested notice language, see Language for Disability Hearing Scheduling Notice for Domestic Claims-Exhibit, DI 33010.080 or for foreign claims see Language for Disability Hearing Scheduling Notice for Foreign Claims – Exhibit, DI 33010.085.

NOTE: If the claimant/representative requests to review the folder in the Field Office (FO) before the hearing, the DHO should burn a CD of the Certified Electronic Folder (CEF) and mail the CD with the paper folder to the FO. If the folder and a CD have been mailed to the FO, the DHO may want to keep an additional copy of the CD for the hearing.

2. Preparing the claims folder for review -- DHO responsibilities

The electronic Continuing Disability Review (eCDR) process introduces an electronic component to CDR hearings. Although some folders will be totally electronic, the Comparison Point Decision (CPD) evidence for many CDRs will be contained in a paper folder.

NOTE: The DHO must ensure that any Personal Identifiable Information (PII) on a laptop computer, Compact Disc (CD) or paper folder is kept secure.

a. If both the CDR and the CPD folders are contained in the CEF, the DHO will:

  • Burn a CD containing only the evidence used to make the medical decision from the blue or back yellow sections of the CEF. Do not burn any potential adverse effect material onto the CD (see Adverse Effect, DI 33015.050). The CD should be a “read only” CD. Refer to  “Copying a Certified Electronic Folder (CEF) to CD - DI 81001.035, for detailed instructions on burning a CD.

    Provide an area which affords privacy with a workstation/laptop that only has access to the CD. See Arrival of Claimant/Representative at Disability Hearing Unit (DHU), DI 33015.001.

  • • If the claimant/representative requests the CD, provide it to them at no charge. See Claimant or Representative Requests a Copy of the Claim Folder, DI 81001.030. If the claimant/representative does not request the CD, destroy the CD (see Document Retention and Destruction for instructions on how to destroy the CD and other sensitive materials, DI 81020.055 E.)

NOTE: Provide a paper copy of the medical evidence ONLY if there is no means of viewing the evidence electronically or if the claimant/representative requests a paper copy.

b. If the CDR folder is a CEF and the CPD folder is paper, the DHO will:

  • Burn a CD containing only the evidence used to make the medical decision from the blue or back yellow sections of the CEF. Do not burn any potential adverse effect material onto the CD (see Adverse Effect, DI 33015.050). The CD should be a “read only” CD.

  • Have the CPD paper folder available for the claimant/representative to review.

  • Provide an area which affords privacy where the modular disability folder (MDF) can be reviewed and a workstation/laptop that