Identification Number:
DI 22505 TN 25
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Development of Medical Evidence of Record (MER)
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 225 – Case Development Procedures
Subchapter 05 – Development of Medical Evidence of Record (MER)
Transmittal No. 25, 09/24/2019

Audience

PSC: DE, DEC;
ODD-DDS: ADJ, DHU;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE;
OCO-ODO: DE, DEC, DPS, DS, RECONE;

Originating Component

ODP

Effective Date

01/06/2020

Background

We are updating our POMS to provide clarified guidance about how to follow up on an initial, written request for evidence or action from the claimant. This updated guidance is the result of a workgroup that we convened to gather suggestions on clarifying and improving these procedures.

Summary of Changes

DI 22505.014 Requesting Evidence or Action from the Claimant or Third party

This new POMS section reflects comments that we received about what an adjudicator must do to make a reasonable effort to comply with a request for evidence or action before the adjudicator may discontinue attempts to develop evidence that requires the claimant’s cooperation. In most instances, the adjudicator is now required to follow up once with the claimant by either telephone or letter. When the claimant requires special handling, the adjudicator must also make a reasonable effort to identify and involve a third party prior to discontinuing attempts to develop evidence that requires the claimant’s cooperation.

We address procedures for following up on an initial, written request for evidence or action.

We clarify instructions for contacting claimants. We outline the steps an adjudicator must take to make a reasonable effort to obtain evidence or action from a claimant to discontinue attempts to obtain evidence requiring the claimant's cooperation.

We specify when an attempt to contact a third party is required.

We added a reminder that the agency's goal is to ensure that adjudicators take the necessary steps to secure all the relevant evidence to make a determination.

 

Conversion Table
Old POMS ReferenceNew POMS Reference
DI 22505.014

DI 22505.014 Requesting Evidence or Action from the Claimant or Third Party

CITATIONS:

44 U.S.C. § 3507, as amended by Section 2 of the Paperwork Reduction Act of 1995; 20 CFR §§ 404.1512 through 404.1519t, and 416.912 through 416.919t

You may need to make an initial, written request that the claimant provide evidence or take action on his or her claim (see DI 22505.006), however, in some cases, the claimant may not comply with your initial, written request. This section explains what you must do to make a reasonable effort to get the claimant to comply with that initial, written request before you may discontinue your efforts to obtain evidence that requires the claimant’s cooperation.

REMEMBER: Our goal is to ensure we take the necessary steps to secure all relevant evidence to make a determination, regardless of whether the claimant cooperates.

A. Follow up once when the claimant does not comply with your initial request for evidence or action

When the claimant does not comply within 10 calendar days from the date of your initial, written request for evidence (e.g., submitting a completed form) or action (e.g., calling a doctor to request they fax a medical record), follow up once by telephone or letter. Give the claimant 10 additional calendar days from the date of your follow-up to comply with your initial, written request, unless the claimant provides a good reason for you to give more time.

For determining with whom to follow up, see DI 23007.005

For the definition of good reason, see DI 23007.001B.

For claimants who require special handling, see DI 23007.001A,

For how to make reasonable effort to identify and involve a third party, see DI 23007.010.

NOTE 1: When the claimant requires special handling and does not comply with your initial, written request for evidence or action in the additional time that you have given, you must also make a reasonable effort to identify and involve a third party.

NOTE 2: When there is FO documentation in the file that the claimant refused to identify a third party, do not attempt to identify a third party, see DI 11005.022B.

NOTE 3: When you have already stopped attempts to get the claimant to attend a consultative examination (CE) appointment in accordance with DI 22510.019, do not attempt to obtain the claimant’s cooperation in providing additional evidence or taking additional action. Make a determination using the sequential evaluation process, see DI 23007.015.

1. Follow up by telephone

When you follow up by telephone, you may either:

NOTE: When you do not speak to the claimant, applicant, appointed representative, or third party, and you cannot leave a message, follow up once by letter, see DI 22505.014A.2.

a. You speak to the claimant, applicant, appointed representative, or third party

Do the following during the conversation:

  • Provide your contact information and explain the purpose of the call.

  • Explain that the claimant must comply with your initial, written request for evidence or action. State that if the claimant does not comply with your initial, written request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

  • When you need evidence, attempt to obtain it over the telephone. When you cannot obtain the evidence over the telephone, give the claimant 10 additional calendar days from the date of your telephone call to comply with your initial, written request for evidence, unless there is a good reason to give more time.

  • When you need action, give the claimant 10 additional calendar days from the date of your telephone call to comply with your initial, written request for action, unless there is a good reason to give more time, and

  • State that if the claimant does not comply with your initial, written request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

Document the date, content of your conversation, and to whom you spoke, on an SSA-5002 Report of Contact, the claims communication section in eCAT, or the DDS worksheet.

For the definition of good reason, see DI 23007.001B.

b. You leave a message

You may leave a message on the voicemail recording system of a telephone number in the claim file that is attributable to the claimant, applicant, appointed representative, or third party. You may also leave a message with an adult who answers a telephone number in the claim file that is attributable to the claimant, applicant, appointed representative, or third party (e.g., the claimant’s spouse or an appointed representative’s assistant).

Include all of the following in the message:

  • Provide your contact information and date that you called. Do not disclose any unnecessary personal information about the claimant, see GN 03316.005D,

  • Explain that the claimant must comply with your initial, written request for evidence or action. Identify the evidence or action that you initially requested in writing and give the claimant 10 additional calendar days from the date of your message to comply, and

  • State that if the claimant does not comply with your initial, written request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

Document the date, and content of your message, and with whom you left it, on an SSA-5002 Report of Contact, the claims communication section in eCAT, or the DDS worksheet.

2. Follow up by letter

Include all of the following in the letter:

  • Your contact information, date of your letter, and the method by which the claimant should provide any requested evidence (e.g. telephone, fax, mail),

  • An explanation that the claimant must comply with your initial, written request for evidence or action. Identify the evidence or action that you initially requested in writing and give the claimant 10 additional calendar days from the date of your letter to comply, and,

  • A statement that if the claimant does not comply with your initial, written request for evidence or action in the additional time that you have provided, you may make a determination based on the evidence in file, which means you may find the claimant is not disabled.

B. When to make a determination based on the evidence in the file

When the claimant does not comply with your follow up attempt as described in DI 22505.014A of this section, make a determination using the sequential evaluation process based on the evidence in file, see DI 23007.015.

EXCEPTION 1: When the claimant has an appointed representative who asked you to communicate directly with the claimant, first contact the appointed representative once by telephone or letter to attempt to obtain the claimant’s cooperation before you make a determination using the sequential evaluation process based on the evidence in the file.

EXCEPTION 2: When the claimant requires special handling, make a reasonable effort to identify and involve a third party before you make a determination using the sequential evaluation process based on the evidence in the file.

For claimants who require special handling, see DI 23007.001A.2.

For how to make a reasonable effort to identify and involve a third party, see DI 23007.010.

REMEMBER: This section applies only to evidence or action that requires the claimant’s cooperation. You still must make a reasonable effort to develop a complete medical history without the claimant’s cooperation, see DI 22505.001A.2., prior to making a determination based on the evidence in the file.


DI 22505 TN 25 - Development of Medical Evidence of Record (MER) - 1/06/2020