TN 14 (08-92)

DI 40510.155 Conducting Medical Folder Review

A. Policy

All evidence in file must be thoroughly reviewed including the SSA-454-BK which accompanied the HCFA-18.

B. Procedure

In an initial enrollment determination, apply the three criteria for determining “currently disabled” as set out in (DI 40510.040A.3.) to the impairments present at the most recent favorable medical determination, and proceed per steps 1 through 3.

1. Currently disabled

  1. If the individual can be found currently disabled using these criteria, screen in for Premium-HI, prepare an SSA-831-U3 permanent allowance (DI 40510.175) and establish a diary for future medical review per (DI 40510.160).

  2. Route folder to the technician for necessary enrollment action prior to notice preparation.

  3. Route the folder to the typist for preparation and release of the permanent award notice per Exhibit 2, (DI 40510.185).

EXCEPTION: Prepare a temporary allowance and interim award notice for any case in which the claimant alleges a new impairment, and it cannot be established that the previous impairment is still disabling.

2. Not screened in

  1. If the individual cannot be screened in per (DI 40510.155B.1.a.) above, apply the Medical Improvement Review Standard (MIRS) to the evidence currently in file in accordance with (DI 28010.001).

NOTE: Under the MIRS, the focus of the review is the CPD (DI 28010.105). This may not be the same as the most recent favorable medical determination used in (DI 40510.150) and (DI 40510.150B.1.) above.

  1. In the absence of any indication of medical improvement (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 permanent award notice, Exhibit 2, (DI 40510.185).

3. Still not screened in

  1. If the individual still cannot be screened in, instruct the typist to send an interim award notice per Exhibit 3, (DI 40510.185).

  2. Prepare an SSA-831-U3 interim allowance as required by (DI 40510.175).

  3. Initiate a CDR on the DCF per CDR001.016 and follow the process outlined in (DI 40510.165).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0440510155
DI 40510.155 - Conducting Medical Folder Review - 03/29/2013
Batch run: 03/29/2013
Rev:03/29/2013