TN 19 (02-24)

DI 13015.080 Unable to Locate Medical Folder after Initial FO Search - Detective Work

A. Introduction

It is not possible to cover every possible scenario you might encounter in trying to locate the medical folder.

B. Procedure – Query All Possible Records

Query the following records. If time has elapsed since the records were previously reviewed, changes could have occurred that might provide a new lead:

  • CATS (Class Action Tracking System)

  • DDSQ (MSOM DDS 001.006)

  • FACT (MSOM QUERIES 002.002, SM 00510.050 - SM 00510.320,

  • SM 00535.005 - SM 00535.060),

  • MCS/MSSICS Development Screens (MSOM MCS 002.001)

  • MDW Development Screens (MSOM MDW 001.001)

  • MSSICS/MCS WMS History Queries

  • MSSICS WMS SSI Case Data Query

  • NUMI (Numident Query)( MSOM QUERIES 003.002)

  • OFFLINE CCTL (8028, AR25)(MSOM MSSICS 029.002 and SM 01201.000)

  • OHAQ (MSOM OHA 001.003)

  • PCACS (MSOM PCACS 008.001)

  • QRSL (Query Response Selection List)(MSOM QUERIES 006.002)

  • SSID (Current and ALL prior records)( MSOM QUERIES 003.006)

  • PCACS or Paperless Read Only Query System (PPL ROQS) (MSOM PCACS 008.001)

Using the queries that you obtain, ask yourself some common questions (see DI 13015.080C) to assist in locating the lost folder. Most of the time, the folder is not actually “lost” but is in an unexpected location. The requestor is usually unaware of an issue that is being developed or pursued by another. The list is not all-inclusive but may help you to determine other sources to check for the folder.

Even though you may be searching for a title XVI only folder, review the title II queries including a FACT and Processing Center Action Control System (PCACS). Determine if there was possible entitlement to another type of benefit, or perhaps another claim that could have involved the disability folder, or a title XVI file that may have been misrouted as if it was a title II file.

“No Record” (NIF) query responses are important tools in ruling out possible locations where the file might be.

C. Procedure - Documentation

Document on the SSA-5002 (Report of Contact) all efforts to obtain the folder(s) for follow-up purposes and to inform the next person/component who handles the case in order to reduce duplication of efforts. For an example of how draft a detailed SSA-5002 (Report of Contact), see DI 13015.250.

Keep all pertinent queries in file. Circle/highlight pertinent information, e.g., on the NUMI, circle/highlight any name change. If unable to locate the folder(s), proceed to DI 13015.070.

D. List of Helpful Hints in Narrowing the Search

Once the above queries are obtained, CONSIDER the following:

  1. 1. 

    What is the application (or CPD) date of the file I am looking for?

    Has the individual filed for anything else since that date? (Look for a cross-reference SSN or a current or prior spouse's SSN on the FACT and SSID.) Could the file be attached or incorporated in a subsequent claim? The CPD material may be attached to or incorporated in a subsequent or prior claim. It is not uncommon in concurrent filings for the medical to remain in a technically denied (090) folder.

  2. 2. 

    Was another application filed under a different title or a different type of benefit?

    It is common for title XVI claimants to work in sheltered work and obtain later insured status for title II benefits. Where is the other half of the file (i.e., you have the title XVI but not the title II)? It is common for title II and title XVI folders to be intermingled. For example, a SSI recipient may have filed for title II, such as CDB benefits, which have been denied or terminated (medical could be in the title II folder). See DI 13015.055. Recall the title II folder following normal PCACS procedures.

  3. 3. 

    Has the claimant had involvement with other FOs? How recently did the folder location on the system last update?

    Has the individual moved since the folder location on the system was last updated? Check the TRANS field on the SSID or the history field on the MBR for Change of Address (COA) inputs. Review the address changes reflected in the Address Query of the QRSL. Contact all FOs not previously contacted, that may have had involvement with the claimant, to search that office for the file.

  4. 4. 

    Are the folder location and date – logical?

    For example, if the SSID indicates that the file should be in the DDS, but the date is very old. A DDSQ should be obtained for potential folder movement that is not reflected in the SSI case control system.

  5. 5. 

    Is there more than one file?

    Many times the system overlays the old folder location with the most recent folder location. Remember that there is only one CCTL line even though there may be numerous SSI records (e.g., the same CCTL line shows up on both RN 1x9 and RN 9x9). If the system does not indicate that the prior file is in storage, perhaps it is still in the FO where it was denied (XDO on RN1) or allowed. The DDSQ history section can be useful in these situations. Also see DI 13015.035C.2.b. for an offline SSI case control query (AR25).

  6. 6. 

    Was this an adoption or was initial application concurrent but Title II case denied?

    The disability determination may have been adopted from one title or type of benefit (i.e., HA to CDB) to another. Remember the title II (previously denied) folder could contain the medical evidence, if title XVI folder does not. If the title XVI file does not contain the medical evidence, search for and secure the title II folder.

  7. 7. 

    Could the file be under a different name?

    Check the names on the NUMI against the date of filing on the FACT or the application date on the SSID. Watch for names that are easy to misfile -- like two first names Howard Lee, which could be filed as Lee Howard. Watch out for names with spaces and dashes. Look for files under a woman's maiden name, previous married name, etc. Look for them under every "creative" way they could be filed.

  8. 8. 

    Are there other family members with something going on that might cause the file to be somewhere unusual?

    Watch for complicated family situations. Is there a spouse or ex-spouse involved? Consider if the folders may be joined. Are there auxiliary claimants (usually CDB and DWB) who have something going on that might cause the file for the entire family to be somewhere odd? (For example, a CDB CDR ongoing?) Is there anybody on the record who is overpaid?

  9. 9. 

    Did you obtain an OFFLINE query?

    If you know that the current location on the SSID is incorrect, consult the OFFLINE CCTL 8028/AR: 25. This query gives you up to the last six folder history locations on the system. See SM 01201.050 and SM 01201.110. Where was the file reading in the past? Is it logical that it might still be there?

  10. 10. 

    Did you check the HUN and FUN to be sure the file is NOT actually housed under the SSN of a spouse/parent?

    Check the HUN and FUN on the SSID and the prior record SSID to be sure the file is NOT actually housed under the SSN of a spouse or parent. If there is another number involved query that SSN and locate any files.

    Spouse FYI Search: Currently the SSI Control System (SSICS) only tracks the Housed Under Number (HUN) of the SSI case. A person who was a spouse when they filed, but is currently an individual, may have their DIB data filed in the HUN folder of individual that they were married to at the time of filing. In order to obtain the individual's DIB file, search prior records, and obtain AR33 requests for the HUN of any prior records.

  11. 11. 

    Did you check the SSID for a prior record, etc.?

    Check the RCRD EST line on the SSID and prior record SSID.

    What office established the records and when? Keep in mind that whenever a new record is established, the CFL automatically updates to the office code of the office doing the input that establishes the new record. This does not necessarily mean that they have the file. The file may actually still be in a former location (XDO code).

  12. 12. 

    What offices have been making inputs?

    Look at the transaction lines on the SSID to see what offices have been making inputs to the record. Maybe they have the file.

    • Check MSSICS. If this was a MSSICS case, you should check the WMS History query from the MSSI Menu to see possible additional prior locations.

    • Check MCS WMS history from MCS Menu and MCS Claims Development MCS Menu under the claimant's own SSN and all related SSNs for additional leads.

    • Check the MDW for other possible activities such as work issues, overpayments, personal conferences, etc. that may have required the folder.

  13. 13. 

    What about a PCACS query?

    Check PCACS for a diary. It may have clues to the location of the folder.

  14. 14. 

    Did you check the FACT?

    Check the FACT for a special message.

  15. 15. 

    Did you update MCS/PCACS as to folder movement?

    Since there is no longer a BDIQ, you need to be even more careful about keeping the MCS system up to date when you move a folder around. PCACS tracks folders once they have arrived in the Office of Central Operations (OCO) formerly known as the Office of Disability and International Operations (ODIO), the Program Service Centers (PSCs). Until OCO or the PSC establishes the case on PCACS, the PCACS query will be NIF. Once the PCACS record is established, FOs can use PCACS to reflect movement of the folder from their FO to DDS or to another FO, if the user makes PCACS input to the system. PCACS inputs by the FO will update the location of the file (if the file was reading in a FO location), but it will NOT change the date related to the movement, which can be misleading.

  16. 16. 

    Are you looking for a denial?

    Denials do not reach OCO/ODIO or PCs until at least six months after they are denied. This means there will be a long period of time where PCACS says, "SSN NOT FOUND".

  17. 17. 

    What might have happened to the original file?

    Apply common sense when looking for a medical folder and think through what might have happened to the CPD folder. If you have already searched in a location/component, unless you have a new lead, i.e., name change or another SSN, it is not cost effective to ask the component to look for the same file again.

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DI 13015.080 - Unable to Locate Medical Folder after Initial FO Search - Detective Work - 02/06/2024
Batch run: 02/06/2024