TN 14 (08-92)
Based on the Commissioner's decision dated April 25, l988, the retention period for
inactive files on denied or terminated title II RSI and DI cases is 5 years.
Exceptions to this retention period are:
Title II disability folders under ODIO jurisdiction prior to 1979 have been destroyed.
NOTE: Potential entitlement cases for the period from 1979-1984 have been identified to
prevent their destruction on a temporary basis.
Title II RSI and DI folders under PSC jurisdiction prior to l984 have been destroyed.
NOTE: Court cases for 1973-1984 have been saved.
ODIO and PSCs follow normal search procedures to locate the necessary folder(s).
Claims folders are to be reconstructed only after it has been determined that the
original folder is irretrievably lost.
An original folder is considered lost after all possible search methods available
have failed to locate the original folder.
If the folder has been destroyed, in the absence of any indication of medical improvement
(MI), the individual is deemed enrolled for Premium-HI if the individual cannot otherwise
be screened in (see D.3. below).
If the folder is lost:
Obtain a readout and attempt to obtain the necessary folder(s) based on the readout
before screening in.
If the folder cannot be located based on the readout, before continuing with a full-scale
lost folder search:
determine if the individual filed in the proper enrollment period per DI 40510.145B, and
verify cessation reason per D. 2. below.
If the individual filed in the proper enrollment period and was ceased for SGA:
prepare an interim award on an SSA-831-U3 per DI 40510.175.
send an interim award notice per Exhibit 3 DI 40510.185.
Continue with the full-scale lost folder search per DI 40525.020B.
If the folder is located:
Review the original folder to verify eligibility per DI 40510.145.
If not eligible, terminate premium Medicare effective with the end of the month after
the month in which the individual is notified he/she is not eligible.
If the folder is not located:
Do not send to FO for reconstruction.
Obtain current medical evidence of record per DI 40510.165
When the medical evidence is returned, follow DI 40510.155
If the individual still cannot be screened in:
Follow the lost folder reconstruction procedures in DI 40525.075C through DI 40525.075F.
Initiate a CDR per DI 40510.165.
Determine the comparison point decision (CPD), if possible and begin reconstruction
of the prior evidence.
Since current medical evidence has already been obtained, instruct the FO to:
conduct a personal contact interview with the individual and to obtain information
and documents regarding prior medical decisions; and
obtain medical treatment sources for at least the 12 months preceding the CPD.
Determine if the individual filed in the proper enrollment period per DI 40510.145B.
In order to verify a cessation reason, obtain an MBR and SSA-454-BK and review them
in detail. If necessary, obtain an SEQY/DEQY to verify work history.
If the work alleged on the SSA-454-BK is verified by MBR and queries as the reason
for cessation, screen the claimant in for Premium-HI.
Prepare an SSA-831-U3 interim award per DI 40510.175 and route the folder to the appropriate technician for enrollment action.
Send an interim award notice per Exhibit 3, DI 40510.185.
If the work allegations are not supported by the queries and SSA-454-BK as the reason for cessation, contact the claimant by telephone to discuss
the individual's work history.
Attempt to secure a copy of the cessation notice, if the claimant has retained it,
to verify work history, the basis for cessation, etc.
NOTE: In the absence of any compelling reason to believe the prior entitlement did not
end because of work, the claimant will be enrolled in Premium-HI.
If it is determined that the prior entitlement did not end due to SGA, process a disallowance
per DI 40510.150B.l.
To verify a disabling impairment:
Obtain current medical evidence of record. per DI
When the medical evidence is received, follow DI 40510.155B.1.a.
If the medical evidence does not show current severity, in the absence of any indication
of MI, screen in for Premium-HI. Prepare an SSA-831-U3 permanent allowance and establish
a diary for future medical review per DI 40510.160.
Route the folder to the technician to process the enrollment prior to notice preparation.
Request the typist to send the final award notice, Exhibit 4, DI 40510.185.
NOTE: Do not prepare a permanent award for any case in which the claimant alleges a new
impairment and it cannot be established that the previous impairment is still disabling.
In this situation, a temporary allowance is appropriate and will already have been
prepared before requesting medical evidence.