This section provides procedures for developing recipient allegations about third party liability during an RZ interview.

Opening a “REDETERMINATION with or without RECAPs” event creates a MSSICS “path” which guides the interviewer to the appropriate screens to document allegations and evidence relating to third party liability, as necessary.

Question 12 on the SSA-8202-BK — Since the date on page 1, have you or your spouse had any change in health insurance coverage or other insurance that pays for medical bills? (DO NOT INCLUDE — Medicare. DO INCLUDE- -Insurance, such as accident, automobile, or casualty if it covers medical bills for any reason.)

Question 24 on the SSA-8203-BK — Since the date on page 1, have you (or your spouse living with you) had any change in health insurance coverage or other insurance that pays for medical bills? (Do not include Medicare, but do include insurance such as accident, automobile, or casualty if it covers medical bills for any reason).

Recipients must answer the third party liability questions unless the exception in SI 01730.045C.4.a applies or the eligible spouse is unable to provide the information about their spouse.

If the exception in SI 02305.108E applies, line out question 12 on the SSA-8202-BK or question 24 on the SSA-8203-BK if conducting the RZ on paper forms and do not gather TPL information on the BTPL screen in MSSICS.

Develop allegations about third party liability, as follows:

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  If recipients allege no change in TPL and other information in SSA records agrees, do not develop TPL any further.

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  If recipients allege a change in TPL or no change in TPL and other information in SSA records conflicts, develop per SI 01730.045.

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  If recipients refuse to provide TPL information, follow instructions in SI 01730.045.