TN 3 (06-23)

DI 40505.120 Third Party Report(s) May Initiate a Continuing Disability Review

A. Operating policy for third party reports

If a third party reports that an individual is not disabled, is not following required treatment, or has returned to work, and the report:

  • Is from someone in a position to know; and

  • Indicates a real possibility of cessation.

Then, we must investigate the situation.

B. Procedure for medical development

1. Third party report raises a medical issue

Develop for medical evidence to:

  1. a. 

    Determine if the report raises a Continuing Disability Review (CDR) issue. If cessation is unlikely, annotate the report “NAN - DI 40505.120” (that is, No Action Necessary – Third Party Reports).

  2. b. 

    Determine whether the Office of Disability Operations (ODO) has done a medical CDR in the last 6 months.

  3. c. 

    Determine if there is a clear CDR issue. If ODO has not done a CDR in the last 6 months, explain the issue on an SSA-847-U3 Social Security Administration Request for Case Action, or on an SSA-5526-U3 Request for Assistance - Disability, and forward the folder to the FO for CDR development. Do not start a CDR unless a report indicates cessation is very likely, or case was diaried as a Medical Improvement Expected (MIE).

2. Third party report of work

Perform a medical folder review (MFR) to determine whether an individual continues to have a disabling impairment when:

  1. a. 

    He or she has completed 7 or more trial work period (TWP) months;

  2. b. 

    He or she has entered, or will enter, an extended period of eligibility (EPE) or extended Medicare eligibility period; or

  3. c. 

    He or she files for premium health insurance (HI) for the working disabled.

For additional instructions regarding a medical folder review (MFR), see DI 40510.040, Medical Folder Review.

To Link to this section - Use this URL:
DI 40505.120 - Third Party Report(s) May Initiate a Continuing Disability Review - 06/28/2023
Batch run: 06/28/2023