Effective Dates: 12/30/2024 - Present

Identification Number:
DI 22505 TN 47
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Development of Medical Evidence of Record (MER)
Type:POMS Full 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. 47, 12/30/2024

Audience

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

Originating Component

ODP

Effective Date

Upon Receipt

Background

The Office of Disability Policy updated this section to be consistent with DI 26535.042, a new section that provides definitions of individuals and entities with whom we correspond and send notices and outlines who must receive correspondence when multiple parties are authorized to act on behalf of a claimant or are designated to assist a claimant.

Summary of Changes

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

We updated this section as follows:

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    Clarified that we will make a reasonable effort to secure relevant evidence;

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    Simplified instructions for who we will contact by referencing DI 23007.005;

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    Removed references to the applicant;

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    Removed a note about when the DDS does not need to attempt to identify a third party;

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    Clarified where to document a conversation in DCPS;

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    Streamlined and clarified what the DDS may say when contacting the claimant or one of their contacts by telephone, and when leaving a voicemail message;

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    Added instructions to verity the claimant's or their contact's identity during telephone contact;

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    Added instructions to also send a letter when the DDS leaves a voicemail message for the claimant or one of their contacts;

  • •

    Eliminated outdated references to the Electronic Claims Analysis Tool (eCAT).

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

The Disability Determination Services (DDS) may need to request that the claimant provide evidence or take action on their claim. Generally, DDS makes the initial request by letter. However, DDS may make the initial request by telephone. In some cases, the claimant may not comply with the initial request. This section explains what DDS must do to make a reasonable effort to get the claimant to comply with that initial request (whether by letter or telephone) before discontinuing efforts to obtain evidence that requires the claimant’s cooperation.

REMEMBER: Our goal is to ensure we make a reasonable effort 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 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 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 claims requiring special handling, see DI 23007.001A.

NOTE 1: When the claimant requires special handling and the claimant does not comply with your initial 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 DI 23007.010.

NOTE 2: When you stopped your attempts to get the claimant to attend a consultative examination (CE) appointment in accordance with DI 22510.019, do not further attempt to obtain the claimant’s cooperation in providing additional evidence or taking additional action. Make a reasonable attempt to obtain evidence available without the claimant's cooperation and make a determination using the sequential evaluation process, see DI 23007.015.

1. Follow up by telephone

IMPORTANT: If someone other than the claimant or one of the required contacts answers the phone, or if you leave a voicemail message, leave only enough information so they know to return the call. Do not disclose any unnecessary personal information about the claimant or their disability claim.

a. You speak to one of the required contacts

When you speak to the contact, do the following during the conversation:

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    Verify the claimant's or third party's identity prior to discussing any details of the case (see DI 39567.210 and GN 00203.020).

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

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    Explain that the claimant must comply with your initial request for evidence or action. State that if the claimant does not comply with your initial 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 action, give the claimant 10 additional calendar days from the date of your telephone call to comply with your initial request for action, unless there is a good reason to give more time, and

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    State that if the claimant does not comply with your initial 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, the content of your conversation, and to whom you spoke, on an SSA-5002 (Report of Contact) or a Case Note in the Disability Case Processing Systems (DCPS), and "write to" the case development worksheet (CDW).

For information on contacting a represented claimant by telephone, see DI 31001.010.

For examples of a good reason for non-cooperation, 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. You must also mail the required contact(s) a call-in letter following the instructions in DI 22505.014A.2., in this section

Include only the following in the voicemail message:

  • •

    Provide your contact information and date that you called, and,

  • •

    Request the contact return your call within 10 calendar days from the date of your message.

Document the date, the content of your message, and with whom you left it, on an SSA-5002 or a Case Note in DCPS, and "write to" the CDW.

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 request for evidence or action. Identify the evidence or action that you initially requested 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 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 in 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 (AR) who asked you to communicate directly with the claimant, first contact the AR 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 claim 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 claims requiring special handling, see DI 23007.001A.

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 every 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 47 - Development of Medical Evidence of Record (MER) - 12/30/2024