Identification Number:
DI 12026 TN 5
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 120 – Appeals Processing
Subchapter 26 – Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI
Transmittal No. 5, 07/28/2020

Audience

PSC: CS, DE, DEC, DTE, ICDS, IES, ISRA, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, ERE, FCR, FDE, RECONE, RECONR, RECOVR;
OCO-ODO: BET, 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, DRT, FR, OA, OS, RR, TA, TSC-CSR;
OHO/OAO: OHAAC, OHACO (SAWDY), OHAHOs, OHAROs;

Originating Component

ODP

Effective Date

07/28/2020

Background

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

Summary of Changes

DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

  • We added the words, 'by telephone,' to the end of the subheading in this section

  • We added the words, 'by phone,' at the end of the lead in sentence in this section

  • We underscored the words, 'has not filed an appeal,' in the third sentence of this section

 

DI 12026.015 Field Office (FO) Actions when an Individual Disagrees with the Medical Cessation or Adverse Medical Reopening Determination

An individual who disagrees with the medical cessation or adverse medical reopening determination may want an explanation of the determination or wish to file an appeal and call, write or visit the FO.

IMPORTANT: When the individual calls the Social Security Administration (SSA) for an explanation, advise him or her that a telephone conversation does not establish a request for appeal and does not protect the appeal filing date. All appeal requests must be submitted in writing.

A. Review the individual’s SSA case folder

Before interviewing the individual, review his or her case folder. Establish the type of determination the individual would be appealing (for example, medical, nonmedical or a combination of determinations).

B. If the individual writes to the FO

After receiving a notice of the initial determination, any writing submitted by the individual or his or her appointed representative, which clearly states a disagreement with the medical cessation or adverse medical reopening determination, establishes a request for reconsideration. For more information on what constitutes a request for reconsideration, refer to GN 03102.100 The Reconsideration Process.

For all written requests for an explanation, call the individual or use the document processing system (DPS) to send an SSA-2708 (Field Office Call/Come In Request), to arrange a personal interview. Make sure to save a copy of the SSA-2708 in the online retrieval system (ORS). For telephone conversations with the individual, follow the instructions in DI 12026.015C in this section.

When sending an SSA-2708:

  • Ask the individual to call or come into the office for an interview,

  • Explain that the SSA-2708 sent to the individual, does not establish a new or reconsidered determination,

  • Explain the right to appeal, the time limit for filing an appeal, and, if appropriate, good cause for late filing of an appeal, and

  • Do not attempt to explain the medical basis for the determination.

C. If the individual telephones the FO

Review the individual’s SSA case folder. If the individual wants to conduct the interview during the call, follow the instructions in DI 12026.015D in this section and proceed to conduct the interview by telephone. If the individual does not want to have the interview conducted during the call, ask the individual to come into the office for an interview and take the following actions:

  • Explain that we do not consider the telephone conversation a request for an appeal and the call does not protect the appeal filing date. Explain that all appeal requests must be submitted to SSA in writing;

  • Explain the right to appeal, the time limit for filing an appeal and if appropriate, good cause for late filing of an appeal;

  • Document or update any new contact information for the individual (for example, address, telephone number(s) or third-party information, if applicable);

  • Determine when the individual wishes to come into the FO to file an appeal, and

  • Document the telephone conversation on an SSA-5002 (Report of Contact), and add this form to the Disability Related Development (blue) section of the electronic or paper folder.

D. Conducting the interview with the individual by telephone

When you conduct the interview with the individual by phone:

  • Discuss the reasons for the determination (for example, “you missed a scheduled exam,” “the Disability Determination Services (DDS) determined you are no longer disabled,” “the DDS was unable to contact you,” etc.), the individual’s disagreement with the determination, and his or her appeal rights.

  • If the individual wants to file an appeal, explain the DDS disability hearing process, and his or her rights and responsibilities with respect to the hearing process following the procedures in DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination.

  • Make sure the individual understands that he or she has not filed the appeal until the appeal forms are completed and submitted in writing;

  • Document the interview conversation on an SSA-5002 and add this form to the Disability Related Development (blue) section of the electronic or paper folder.

E. References

  • DI 12026.020 Field Office (FO) Responsibilities When an Individual Wants to Request Reconsideration of a Medical Continuing Disability Review (CDR) Determination

  • DI 81010.135 Storing Non-Medical Evidence in the Electronic Folder (EF)

  • GN 03102.100 The Reconsideration Process


DI 12026 TN 5 - Reconsideration - Disability Hearing for a Medical Cessation/Adverse Medical Reopening Determination - Title II and Title XVI - 7/28/2020