TN 30 (06-24)

DI 40510.142 Locating Folders

A. Policy - folder retention

1. Folder retention period

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.

2. Exceptions

Exceptions to this retention period are:

a. ODIO jurisdiction

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.

b. PSC jurisdiction

Title II RSI and DI folders under PSC jurisdiction prior to l984 have been destroyed.

NOTE: Court cases for 1973-1984 have been saved.

B. Policy - folder not available

1. Folder search

ODIO and PSCs follow normal search procedures to locate the necessary folder(s).

2. Lost folders

  1. a. 

    Claims folders are to be reconstructed only after it has been determined that the original folder is irretrievably lost.

  2. b. 

    An original folder is considered lost after all possible search methods available have failed to locate the original folder.

3. Destroyed folders

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).

C. Procedure - lost folders

1. Search efforts

If the folder is lost:

  1. a. 

    Obtain a readout and attempt to obtain the necessary folder(s) based on the readout before screening in.

  2. b. 

    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.

  3. c. 

    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.

  4. d. 

    Continue with the full-scale lost folder search per DI 40525.020B.

2. Folder located

If the folder is located:

  1. a. 

    Review the original folder to verify eligibility per DI 40510.145.

  2. b. 

    If not eligible, terminate premium Medicare effective with the end of the month after the month in which the individual is notified they are not eligible.

3. Folder not located

If the folder is not located:

  1. a. 

    Do not send to FO for reconstruction.

  2. b. 

    Obtain current medical evidence of record per DI 40510.165 B.2.

  3. c. 

    When the medical evidence is returned, follow DI 40510.155 B.1.a.

  4. d. 

    If the individual still cannot be screened in:

  5. e. 

    Determine the comparison point decision (CPD), if possible and begin reconstruction of the prior evidence.

  6. f. 

    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.

D. Procedure - destroyed folders

1. Verifying enrollment period

Determine if the individual filed in the proper enrollment period per

DI 40510.145B.

2. Verifying cessation reason

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.

a. Work verified as reason for cessation

  • 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.

b. Work not verified as reason for cessation

  • 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.

3. Verifying disabling impairment

To verify a disabling impairment:

  1. a. 

    Obtain current medical evidence of record. per DI 40510.165B.2.

  2. b. 

    When the medical evidence is received, follow DI 40510.155B.1.a.

  3. c. 

    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.

  4. d. 

    Route the folder to the technician to process the enrollment prior to notice preparation.

  5. e. 

    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.

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DI 40510.142 - Locating Folders - 06/28/2024
Batch run: 06/28/2024