The fact that an enrollment request cannot be located in SSA’s files does not necessarily mean that one was not filed.

An individual may insist that the enrollment request was mailed timely even though SSA has no record of the request.

Generally, the sooner an individual inquires about disposition of the enrollment request after the alleged filing, the more weight can be given to the person’s allegation.

Despite the absence of an enrollment request in SSA’s records, a finding that the individual is effectively enrolled may be made where supported by adequate evidence.

The DO obtains from the individual a signed statement which documents as fully as possible the circumstances surrounding the filing of the enrollment request (i.e., when, how, and where filed, etc.), along with any corroborating evidence available.

It would be appropriate to find that an enrollment was filed as alleged where an individual:

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  says they enrolled during a prescribed enrollment period and furnishes specific information as to the time and manner of filing;

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  has followed up with SSA promptly to question why the enrollment has not been processed (i.e., no later than 3 months after premiums should have been deducted from monthly benefits or premium billing notices sent); and

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  submits corroboration, if available, of filing at the time alleged (e.g., a statement from another person with personal knowledge of the time and manner of filing).

A finding of enrollment would usually not be appropriate where:

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  SSA’s records show that the individual refused SMI at, or shortly after, the time the individual allegedly mailed the enrollment request; or

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  the individual first inquires about enrollment status 4 or more months after coverage would have started, or after incurring substantial medical expenses.

IMPORTANT: A decision on this matter is strictly judgmental. No decision made by SSA or CMS personnel on enrollment or non-enrollment under the circumstances given in this section should be challenged, unless there is evidence that the judgment is incorrect.