Identification Number:
GN 03105 TN 5
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Claims Folder Reconstruction
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 031 – Appeals
Subchapter 05 – Claims Folder Reconstruction
Transmittal No. 5, 04/09/2021

Audience

PSC: CA, CS, DE, DS, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: CR, FCR, FDE, RECONE, RECOVR;
OCO-ODO: CR, CST, CTE, CTE TE, DE, DEC, DS, PETE, PETL, RCOVTA, RECONE, RECOVR;
ODD-DDS: REF;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, DT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

04/09/2021

Background

This is a Quick Action Transmittal. These revisions do not change or introduce new policy or procedure.

Summary of Changes

GN 03105.010 Reconstruction of Destroyed or Missing Paper Claims Folders

In GN 03105.010C.1, we corrected the query name to “MSOM MS 01701.003 .

InGN 03105.010C.2.b, we deleted “or beneficiary.”

In GN 03105.010E, we corrected "Office of Disability Adjudication and Review (ODAR)" to "Office of Hearings Operations (OHO)."

We corrected "ODAR" to "OHO."

 

GN 03105.020 Locating Missing Claims Folders

In GN 03105.020B, we corrected the query name to “MSOM MS 04901.001.”

 

GN 03105.040 Locating and Reconstructing Paper Claims Folders for Hearings

In GN 03105.040A, we deleted “For information on when an ALJ may not need a prior claims folder, see HALLEX I-2-1-13.”

In GN 03105.040B.3, we corrected “nonmedical” to “non-medical.”

 

GN 03105.050 Regional Office (RO) Paper Folder Location and Reconstruction Procedures

We corrected "Office of Disability Adjudication and Review (ODAR)" to "Office of Hearings Operations (OHO)."

We corrected "ODAR" to "OHO."

 

GN 03105.060 Reconstructing a Paper Folder for Appeals Council (AC) Review or Pending Civil Action

We corrected "Office of Disability Adjudication and Review (ODAR)" to "Office of Hearings Operations (OHO)."

We corrected "ODAR" to "OHO."

 

GN 03105.070 FO Folder Retrieval Checklist — Exhibit

We corrected “ODAR” to “OHO.”

We corrected “followup” to “follow-up.”

 

GN 03105.010 Reconstruction of Destroyed or Missing Paper Claims Folders

A. When to reconstruct a current claims folder

1. When there is a need for information from a paper claims folder

Reconstruct missing or destroyed paper claims folders only when information contained in the paper folder does not exist electronically (e.g., in the certified electronic folder) and you need that information to:

  1. a. 

    process a claim, continuing disability review, appeal, or court case; or

  2. b. 

    satisfy the request for folder information from a component, such as the Office of the Inspector General, the Office of Quality Review, or the Office of Quality Improvement.

The Disability Determination Service (DDS) has jurisdiction of prior Comparison Point Decision (CPD) and medical folder reconstruction. For claims under DDS jurisdiction, see DI 20502.030 and DI 28035.020.

2. When a disaster destroys claims folders

Following a disaster involving destruction of paper claims folders, the regional commissioner (RC) decides whether to invoke disaster procedures. If the RC invokes these procedures, the regional office (RO) will alert the field office (FO) manager(s) in the affected service area(s). For the affected claims:

  1. a. 

    reconstruct folders for:

    • pending claims;

    • claims pending at the Appeals Council level or involving a court case; and

    • claims selected for quality review; and

  2. b. 

    process claims requiring further action following normal Modernized Claim System (MCS) and Modernized Supplemental Security Income Claim System (MSSICS) procedures.

For more information on disaster management procedures, see GN 00401.001. For more information on processing claims affected by a disaster, see GN 00410.001.

B. Timeframes for reconstructing claims folders

1. State DDS offices

The state DDS has 30 calendar days for reconstructing the medical portion of disability claims folders. For more information on reconstructing disability claims folders, see DI 20502.030.

2. FOs

Field offices have 15 business days for reconstructing the non-medical portion of claims folders.

C. Procedures for reconstructing claims folders

All Title II or Title XVI claims require certain basic documents that relate to a claimant's entitlement or non-entitlement to benefits. For a list of these basic documents, see GN 00301.290. When reconstructing a folder, you may be able to obtain these documents from existing electronic records. If the documents are not available electronically, request them from the claimant or representative.

1. Obtaining evidence from existing records

We store claims data and evidence in a variety of electronic files. MSSICS and MCS maintain much of the claims data. We maintain data not captured in MCS or MSSICS on the Evidence (EVID) screen. If we faxed data into the Non-Disability Repository for Evidentiary Documents (NDRED), we can retrieve and view the documents in the Claims File User Interface (CFUI). Prior to initiating folder reconstruction, identify the information available in these electronic files or records. Do not recreate or request replacement of any documents found in the electronic folder.

For information on identifying and viewing the electronic folder, see:

  • DI 81005.005 eView Overview;

  • GN 00301.310 The Non Disability Repository for Evidentiary Documents (NDRed) Application—Overview; and

  • MSOM MS 01701.003 Evidence Screen (EVID).

2. Obtaining information from claimants or representatives

If needing evidence or information that is not available in an electronic record, contact the claimant or the claimant’s representative and request only the information that is not available. Assist the claimant in obtaining the necessary documents or information. Pay any charges for obtaining evidence that the claimant previously provided. For information on paying for evidence, see GN 00301.215.

If we obtained a signed application originally, do not request another signed application for folder reconstruction. Record a statement on the Report of Contact (RPOC or DROC) screen or paper form SSA-5002, that we previously obtained a signed application.

a. Claimant refuses to cooperate

If the claimant refuses to take part in the reconstruction efforts:

  • explain to the claimant that cooperating in the reconstruction effort should result in a more accurate and speedier decision;

  • reconstruct as much evidence as possible from MCS, MSSICS, EVID screens, and other SSA records;

  • document efforts made to complete development electronically on the RPOC or DROC screen;

  • forward available material immediately to the requesting office unless regional procedures direct otherwise; and

  • notify the RO when completing these actions if the RO is tracking the reconstruction progress.

If the claimant subsequently cooperates, proceed immediately with the reconstruction action.

b. Claimant not located

To develop the claimant’s address follow the procedures in GN 02605.055. If efforts to locate the claimant are unsuccessful, reconstruct as much evidence as possible without the claimant's participation. Document all efforts to contact the claimant on the RPOC or DROC screen. When completing the reconstruction, forward the material to the requesting office. For claims selected for quality review, notify the requesting assessment office if you suspend benefits.

3. Reconstruction of a claims folder with medical development

Initiate reconstruction of medical development only upon DDS’s request. Work with the DDS to determine what medical evidence it needs. The DDS will redevelop medical evidence if necessary. For further information on folder reconstruction, see DI 20502.030.

D. FO action after completion of reconstruction

When completing reconstruction of all necessary documents:

  1. 1. 

    annotate "Reconstructed" in bold red letters across the front of the folder jacket;

  2. 2. 

    mark each piece of reconstructed evidence "Reconstructed;"

  3. 3. 

    annotate any new evidence the claimant submits as "New Evidence;"

  4. 4. 

    fax copies of all evidence and information into the certified electronic folder (CEF). If a CEF is not available, fax the information into NDRED. (For more information on the CEF, see GN 04440.010.); and

  5. 5. 

    route the reconstructed paper folder immediately to the requesting office, or as directed by regional instructions.

E. Missing paper folder located during redevelopment

After initiating folder reconstruction, we may find the original folder. If found by the:

  1. a. 

    Office of Hearings Operations (OHO) -- OHO should telephone the FO immediately to stop reconstruction and, if appropriate, notify the DDS.

  2. b. 

    FO – The FO should telephone the requesting office immediately and send the located folder and any materials already reconstructed to the requesting office.

GN 03105.020 Locating Missing Claims Folders

You may need to locate a prior claims folder for processing of a current action, such as an appeal, a court case, or a continuing disability review. The Seattle Region hosts an Automated Folder Location (AFL) website, which can assist you in locating electronic and paper folders. If you cannot locate the folder, reconstruct the folder as instructed in GN 03105.010. Document all queries utilized and all efforts made on the AFL site’s “unable to locate” form or Report of Contact (RPOC or DROC) screen.

Comparison Point Date (CPD) folders for pending electronic continuing disability reviews may not require reconstruction as explained in DI 81010.242.

A. Locating electronic folders

To determine if an electronic folder exists, the AFL website provides tabs for searching eView, the Claims File User Interface (CFUI), and the Non-Disability Repository for Evidentiary Documents (NDRED).

For an overview of eView, see DI 81005.005.

For information on NDRED, see GN 00301.310.

B. Locating paper folders

If a paper folder exists, the AFL system will present a worksheet showing all potential locations for the folder. Also, consider searching:

  • previous names;

  • beneficiary’s and representative payee’s previous addresses (the folder could be in an FO servicing a previous address);

  • cross-referenced Social Security numbers;

  • concurrent folders;

  • pending files;

  • closed files; and

  • boxes awaiting shipment.

To request a folder from the storage facility, use the Processing Center Action Control System (PCACS) for a Title II folder and automatic recall (AR33) for a Title XVI folder. For information on PCACS, see MSOM MS 04901.001. For information on AR33, see SM 01201.055.

GN 03105.040 Locating and Reconstructing Paper Claims Folders for Hearings

A. Field Office (FO) procedure for locating claims folders

When a claimant files an HA-501 (Request for Hearing), the FO generally forwards the hearing request and claims folder to the hearing office (HO). However, if the claims folder is not in the FO, follow instructions in GN 03105.020 to locate the folder. Based on the folder’s location, follow the appropriate instructions in GN 03103.080.

If unable to locate the folder, notify the HO that the folder is missing. If the administrative law judge (ALJ) requires a reconstructed claims folder to make a determination, the HO submits a reconstruction request either directly to the FO or through the regional office (RO), depending on procedures established in each region.

 

B. FO procedure for reconstructing claims folders

Upon receipt of an ALJ reconstruction request:

  1. 1. 

    reconstruct the folder following instructions in GN 03105.010;

  2. 2. 

    notify the HO of your anticipated reconstruction completion date;

  3. 3. 

    complete the reconstruction of a non-disability folder or the non-medical portion of a disability folder within 15 business days. Expedited action is necessary to avoid a further delay in the appeal process;

  4. 4. 

    telephone the RO and HO with status if you do not complete development within 15 business days; and

  5. 5. 

    document search actions on the Folder Retrieval Checklist located in GN 03105.070.

For information on the paper modular disability folder, see DI 70005.005 and DI 70010.001.

GN 03105.050 Regional Office (RO) Paper Folder Location and Reconstruction Procedures

A. RO role in claims folder location

1. Field office (FO) unable to locate folder

The RO role in claims folder location includes:

  1. a. 

    receiving notification from FOs when they are unable to locate lost folders;

  2. b. 

    advising and assisting FOs in locating lost folders; and

  3. c. 

    determining when an FO has exhausted efforts to locate a folder.

2. Office of Hearings Operations (OHO) requests folder

The RO role in claims folder location includes:

  1. a. 

    initiating a national folder search, either directly or indirectly, through the servicing FO per regional procedures;

  2. b. 

    giving priority attention to cases covered by court-imposed time limitations; and

  3. c. 

    advising OHO and FO of efforts to locate the file and the expected completion date.

B. RO role in claims folder reconstruction

The RO role in claims folder reconstruction includes:

  1. 1. 

    receiving requests from OHO for folder reconstruction;

  2. 2. 

    giving priority attention to cases covered by court-imposed time limitations;

  3. 3. 

    providing FOs guidance in reconstruction procedures;

  4. 4. 

    establishing appropriate controls to ensure that FOs complete folder reconstruction within 15 business days;

  5. 5. 

    monitoring FO reconstruction efforts and requesting periodic progress updates from FOs; and

  6. 6. 

    providing liaison between OHO and the FO during the reconstruction process.

In the past, all ROs were involved in assisting FOs with locating folders and authorizing folder reconstruction. Now, some regions delegate the decision to reconstruct a paper folder to the FO district manager or a second level manager.

GN 03105.060 Reconstructing a Paper Folder for Appeals Council (AC) Review or Pending Civil Action

The Office of Hearings Operations (OHO) first attempts to locate the claims folder within OHO. If OHO cannot locate the folder and reconstruction is necessary, it will advise the appropriate office on what documents to reconstruct. OHO will request any necessary medical redevelopment from the Disability Determination Services.

Folder reconstruction for the AC usually requires full reconstruction since the AC examines the entire file to determine whether the evidence in the case supports the administrative law judge’s decision. Full reconstruction means printing and including all information and documentation available on the electronic system in the reconstructed folder. For more information on reconstructing claims folders, see GN 03105.010.

GN 03105.070 FO Folder Retrieval Checklist — Exhibit

Identifying data (complete all applicable items):

  1. 1. 

    N/H Name:                    SSN:                 

  2. 2. 

    Appellant Name (if different):                          

  3. 3. 

    Cross reference SSN/BOAN (if any):                

  4. 4. 

    Type of Case (circle one):  Hearing   AC Review   Civil Action

  5. 5. 

    Hearing Request Date:                 

  6. 6. 

    Date HA-501 (HO copy) forwarded to OHO:                

  7. 7. 

    Type of Folder(s) Needed (check all applicable):

    ( ) SSI Aged

    ( ) SSI Blind/Disabled

    •  

      ( ) current folder ( ) prior folder

    ( ) T2 DI B

    •  

      ( )current folder ( ) prior folder

    ( ) DWB

    ( ) RSI

  8. 8. 

    ( ) Other       

    Query Information(show pertinent information and attach copies):

    1. a. 

      PCACS date:                shows:                

    2. b. 

      SSI2 date:                shows:                

    3. c. 

      HA04 date:                shows:                

    4. d. 

      Other type:                 date:          shows:                

    Field Office Actions

    1. a. 

      Component contacted:                

    2. b. 

      Date of initial request:                

    3. c. 

      Date of follow-up request:                

    4. d. 

      Office making referral:                

    5. e. 

      Office contact person:                

    6. f. 

      Office telephone number:                

    7. g. 

      Date referred to ORC:                

 


GN 03105 TN 5 - Claims Folder Reconstruction - 4/09/2021