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:
 
DELAYED IMPLEMENTATION TRANSMITTAL (DIT)
DIT's ARE FOR FUTURE IMPLEMENTATION AND DISPLAYED
FOR INFORMATIONAL AND TRAINING PURPOSES ONLY

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

11/04/2019

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 Following Up on an Initial Written Requests for Evidence or Action

This new POMS section reflects comments that we received about what an adjudicator must do to attempt to get a claimant 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. If 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.

This new POMS section:

  • Addresses procedures for following up on an initial, written request for evidence or action.

  • Clarifies instructions for contacting claimants. It also outlines the steps an adjudicator must take to make a reasonable effort to obtain evidence or action from a claimant prior to discontinuing attempts to obtain evidence requiring the claimant’s cooperation.

  • Specifies when an attempt to contact a third party is required.

  • Reminds adjudicators that the agency’s goal is always to ensure that adjudicators take the necessary steps to secure all relevant evidence to determine a claim.

 

DI 22505.014 Requesting Evidence or Action from the Claimant or a Responsible 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 POMS 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 attempt 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 that we take the necessary steps to secure all relevant evidence to determine a claim, regardless of whether the claimant cooperates.

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

If the claimant does not comply within 10 calendar days of the date of your initial, written request for evidence (e.g., submitting a completed activities of daily living 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.

NOTE 1:: 

If 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.

  • See POMS DI 23007.001A for claimants that require special handling.

  • See POMS DI 23007.010 for how to make a reasonable effort to identify and involve a third party.

NOTE 2:: 

If you have already stopped attempting 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 any additional evidence or taking any additional action.

1. Following up by telephone

If you follow up by telephone, you may either:

  • speak to the claimant or his or her proper applicant (see POMS GN 00204.003), appointed representative (see POMS GN 03910.020), or third party (see POMS DI 23007.010), or

  • leave a voice message.

NOTE:: 

If you do not speak to the claimant, proper applicant, appointed representative, or third party, and you cannot leave a message, follow up once by letter (see POMS DI 22505.014A.2.).

a. You speak to the claimant, proper 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 may result in a finding that the claimant is not disabled.

  • If you need evidence, attempt to obtain it over the telephone. If 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. For the definition of good reason, see DI 23007.001B.

  • If 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. For the definition of good reason, see DI 23007.001B, 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 may result in a finding that the claimant is not disabled.

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

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 or his or her proper applicant, appointed representative, or designated 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 or his or her proper applicant, appointed representative, or third party (e.g., the claimant’s spouse or an appointed representative’s assistant).

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

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 the minimization policy in 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 may result in a finding that the claimant is not disabled.

2. You 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 may result in a finding that the claimant is not disabled.

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

If 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 POMS DI 23007.015).

EXCEPTION 1:: 

If 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:: 

If 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.

  • See POMS DI 23007.001A.2 for claimants that require special handling

  • See POMS DI 23007.010 for how to make a reasonable effort to identify and involve a third party.

REMEMBER:: 

This section applies only to evidence or action that requires the claimant’s cooperation. You still must ensure that you 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) - 11/04/2019