This procedure applies to all disability claims filed by Mexican residents with the following eight Texas FOs: Harlingen, Brownsville, Eagle Pass, El Paso, El Paso Downtown, Laredo, McAllen, Odessa, and Del Rio.

The FOs above will obtain the same disability applications and forms from Mexican residents as required for all disability applicants (see DI 11005.016). In addition to the routine procedure, the Claims Representative (CR) will explain to the claimant that the FO may assist OIO in obtaining medical evidence to expedite the process, but that the final determination will be made by OIO.

 

Ask the claimant to contact the claimant's medical source(s) to obtain the evidence of record. If it appears the claimant is unable to do so, the CR should request the MER from the medical sources. Also explain that if sufficient evidence of record is not available, the FO may ask the claimant to have a special examination conducted by a physician or psychologist in the United States (U.S.).

NOTE: When the interviews are conducted in the FO, generally assume travel to and from Mexico are not a problem. However, if the claimant insists that the claimant cannot return to the U.S. for a CE, include the following on a report of contact:

1. a. 

   The principal city or town in Mexico closest to the claimant's residence and the name of the state where located;

2. b. 

   Approximate distance from the border;

3. c. 

   Name of the Foreign Service Post (FSP) serving the claimant's area of residence; and

4. d. 

   Any obstacle to travel.

If the claimant insists that the claimant cannot return to the U.S., request MER as outlined in DI DAL11010.540 B.4.a and transfer the claim to OIO. If OIO determines a CE is necessary, they will arrange for it through the FSP. Because going through the FSP can be a very lengthy process, it should be made clear to the claimant that it is to the claimant's advantage to provide as much medical evidence as possible and/or agree to return to the U.S. for a CE.

Use judgment when developing non-disability issues. Follow the deferred development procedures in DI 11010.025.

Refer to DI 10505.025 D for instructions on evaluating work activity outside the U.S. If the work is not SGA, or is no longer SGA, complete an SSA-820 or SSA-821 and continue medical development as outlined below. If the claimant continues to engage in SGA and there is no possibility of a closed period, prepare and sign an SSA-831 for the SGA denial per DI 11010.205. Prepare but do not release the notice and forward the case to OIO following the mailing instructions in DI DAL 11010.540B.6.a.

The FO will use the third party draft to pay for MER and CE reports. Since the OIO CAN and SOC are used, the funds are not charged against the FO's local budget.

The CR must ensure the draft is documented with:

1. a. 

   For MER, a copy of the request for MER over the manager's signature (only managers have procurement authority). A photocopy of a completed letter from Exhibit 1 or 2 will suffice.

2. b. 

   For CEs, a copy of the letter to the CE provider authorizing the CE (Exhibit 3).

3. c. 

   For MER and CEs use the CAN and SOC for OIO - CAN=4005113; SOC=2533.

4. d. 

   For MER/CEs, provide a statement by an SSA employee that the evidence was received.

MER/CE invoices should be paid promptly to maintain a good ongoing relationship with MER/CE providers.

Once OIO has made a disability determination, the medical folder will be returned to the FO. For awards, complete all non-medical development such as auxiliary applications. Mail the allowance to PC8. If the case was a denial, file the case for the appeals period.

If FO action is needed to complete adjudication of the case, process through EC if possible. If not, prepare an SSA-101 for an allowance or an SSA-3428 for a denial. On manual actions, input a 1418 to show folder movement to PC8 (do not use the V22 DDS code).

The above process is for initial claims only. Handle reconsiderations filed by residents of Mexico as follows:

• •

  Obtain the usual reconsideration forms and send via express and follow the mailing instructions shown in DI DAL11010.540B.6.a. The FO will not initiate any medical development unless contacted by OIO to do so.

• •

  Folder movement will be made to V22.

Exhibit 1a

Request to Medical Source for Medical Evidence of Record (MER)

(English Version)

(1)        Patient: (4)         

         SSN: (5)

          DOB: (6)

         Sex: (7)            

Patient/Clinic No.: (8)       

______________ (2) _______________

_____________________________

_____________________________

Dear (3) :

Your patient has applied for disability benefits through the Social Security Administration. The Office of International Operations, Baltimore, Maryland, is responsible for determining whether the claimant is eligible for benefits. We are assisting the claimant in obtaining available medical evidence.

Disability is alleged because of (9) .

This is not a request that studies be performed if they have not been performed already. Please furnish a narrative report and/or copies of your records for the period (10) to (11) , to include the following: __________(12)_________________________________________

_____________________________

We would also like to have a statement, based on your medical findings, of the claimant's ability to perform work-related physical activities such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, and traveling. When there is a mental impairment, please indicate your opinion regarding understanding and memory, sustained concentration and persistence, social interaction and adaptation.

If there is a charge for this service, please enclose an itemized statement with the records. The Social Security Administration is authorized to pay up to $18.00 for copies of medical records and/or narrative report.

Thank you for your prompt attention to this request. If you have any questions, please call

   (13)    at (14) .

Sincerely yours,

District Manager

Enclosure (15)

Exhibit 1b

Fill-ins for Request for MER (Exhibit 1a)

1. Date.

2. Name and address of treating source.

3. Salutation.

4. Claimant's name.

5. Claimant's Social Security number.

6. Claimant's date of birth.

7. Claimant's sex.

8. Patient or clinic number assigned by the treating source, if any.

9. Impairment(s) alleged by claimant.

10. Earliest date for which medical evidence is requested as determined below:

Show the later of:

a. 12 months prior to the application date or

b. Alleged date that impairment first bothered the claimant (item 1 of the SSA-3368 or item 38 of the SSA-3820).

11. Latest date for which medical evidence is requested as determined below:

Show the earlier date of:

a. Date insured status or prescribed period expired or

b. The current date.

12. If the SSA-3368/3820 indicates any tests were performed by this treating source, enter them here. If no tests are alleged, show "no tests specified at this time."

13. CR's name.

14. Telephone number for CR.

15. Enclose a self-addressed mailing label to return records to the FO. If the treating source is in the U.S., use a business reply envelope; if in Mexico, use a non-franked reply envelope.

Exhibit 2a

Letter to Medical Source Requesting Medical Evidence of Record (MER)

(Spanish Version)

(1) . Paciente: (3)

Dirección: (4)

SSN: (5)

Fecha de Nacimiento: (6)

Sexo: (7)

(2)

_____________________________

_____________________________

_____________________________

Estimado Doctor:

Su paciente ha solicitado beneficios del Seguro Social de los Estados Unidos por incapacidad para trabajar. Esta agencia está encargada de obtener información médica para determinar si tiene derecho a recibir beneficios. El paciente indica que está incapacitado por padecer (8) .

Favor de preparar un resumen clínico y/o enviar copias de sus expedientes médicos correspodientes al período de (9) a (10) .

Solicitamos únicamente información ya existente. No queremos que se efectúen estudios especiales para el informe ya que el paciente tendrá que pagarlos.

Favor de incluir los datos:

___________ (11) __________________

_____________________________

Si se cobra para el servicio de copiar, tenga la bondad de incluir la cuenta detallada con las pruebas de archivo. La Administración del Seguro Social de EE.UU. pagará hasta 15 dólares por copias de archivos medicales o de reportes narrativos del médico.

Le agradecería su pronto atención a esta petición. Si tiene cualquier preguntas, llame por

(12) a (13) , por favor.

Atentamente,

Gerente de Distrito/Ramo

Adjunto (14)

Exhibit 2b

Fill-ins for Request for MER (Exhibit 2a)

1. Date.

2. Name and address of treating source.

3. Claimant's name.

4. Claimant's address.

5. Claimant's Social Security number.

6. Claimant's date of birth.

7. Claimant's sex.

8. Impairment(s) alleged by claimant.

9. Earliest date for which medical evidence is requested as determined below:

Show the later of:

a. 12 months prior to the application date or

b. Alleged date that impairment first bothered the claimant (item 1 of the SSA-3368 or item 38 of the SSA-3820).

10. Latest date for which medical evidence is requested as determined below:

Show the earlier date of:

a. Date insured status or prescribed period expired or

b. The current date.

11. If the SSA-3368/3820 indicates any tests were performed by this medical source, enter them here. If no tests are alleged, show "No necesitamos ningun otro examen ahora" (We do not need any other exam now).

12. CR's name.

13. CR's telephone number.

14. Enclose a self-addressed mailing label to return records to the FO. If the medical source is in the U.S., use a business reply envelope; if in Mexico, use a non-franked reply envelope.

Exhibit 3a

Authorization for Consultative Exam (CE)

Doctor: Please perform the listed services below which are hereby authorized. Complete the bottom half of this form, sign it, and attach the form to your report(s) and mail them to the SSA office shown above. This exam will be paid for by the Federal government based on a set fee schedule. ________________________________________________________________

Service Description & Approved Fee Amounts

                                                             (8)

===================================================

Date of Service Description of Service Amount

______________________________________________________________

Pay this Amount $ (10) .

Certification

I, (11) , do hereby certify that I am a (12) . and that I am duly authorized to make this certification for and on behalf of (13) (patient). I further certify that the attached invoice is correct and that it corresponds in every particular with the services contracted for and does not exceed my usual customary fee. I further certify that the amount is true, correct and unpaid. As vendor, I certify there has been no discrimination on the grounds of race, color, national origin or handicap in the performance of this contract..

(14)

Signature

Exhibit 3b

Completion Procedures for CE Authorization Forms (Exhibit 3a)

FO completes these blocks:

1. CE provider's name and address.

2. FO's address.

3. CR's signature (print name below signature).

4. Claimant's SSN.

5. Claimant's name.

6. FO telephone number.

7. Manager's or designee's signature (show "by manager's designee").

8. Description of services requested and DDS approved amounts.

CE provider completes these blocks:

9. Date, description of services performed and fee requested.

10. Total amount of fees charged.

11. Name of person certifying the CE (e.g., Dr. Miguel Adams).

12. Title of person certifying the CE (e.g., M.D.).

13. Name of the claimant.

14. Signature of CE provider (must be original).

After receipt of the CE authorization and the vendor's invoice, prepare a third party draft to cover all requested fees that do not exceed the approved amount(s). Be sure to use the OIO CAN and SOC on the third party draft.

Exhibit 4

Letter to Claimant Requesting Attendance at CE

(English Version)

(Claimant's Name and Address)

Your application for Social Security disability benefits has been received by this agency for consideration. Additional current medical information is needed and a special examination can best provide this information. In order to save time, we have authorized an examination(s) for you by:

( ) You should call the above office(s) for an appointment as soon as possible.

( ) We have made an appointment for you on ________________________ at _____________________________ a.m./p.m.

( ) Type of examination or test: _____________________________.

The examination(s) will be performed at Federal government expense and at no cost to you.

If you fail to make/keep the appointment at the established time, and if you do not notify us of the reason you are unable to appear for the examination(s) by 24 hours before the examination time, we may make a determination based on the medical information we currently have on file (if any). The lack of complete information about your medical condition could cause us to determine you are not disabled or blind.

Be sure to return the enclosed Claimant Response Form before the appointment day. If you have any questions, please call us immediately at ______________.

Sincerely yours,

District/Branch Manager

Enclosures (2)

Exhibit 5

Letter to Claimant Requesting Attendance at a CE

(Spanish Version)

(Name and Address of Claimant)

Su solicitud de beneficios del Seguro Social por incapacidad ha sido recíbido por esta agencia para evaluación. Será necesario conseguir más evidencia médica y la mejor manera de conseguirla es mediante un examen especial. Para ahorrar tiempo, hemos autorizado que sea examinado por:

( ) Deberá llamar a la oficina de este doctor(es) inmediatemente para hacer una cita.

( ) Le hemos hecho una cita para el día ______________________________.

El examen(es) será pagado por el Gobierno Federal y usted no tendrá que pagar nada.

Si no hace su cita o si no acude en la fecha indicada y no nos avisa la razón por la cual no podrá acudir 24 horas antes de la hora de su examen, haremos nuestra decisión basándonos solamente en la información contenida actualmente en su expediente. Es probable que ésto no demuestre que está usted incapacitado o ciego.

POR FAVOR asegúrese de regresar la carta adjunta antes de la fecha ahí indicada para acusar recibo de esta carta. Si tiene preguntas sobre el examen, por favor comuníquese de inmediato con nosotros por telefono al numero _____________________________.

                                                 Muy atentamente,

                                                      Director

Adjunto: 2 formas

Exhibit 6

Letter to Representative Payee Applicant Requesting Claimant Attend a CE

(English Version)

(Rep payee's name and address)

This letter is about the application for Social Security disability benefits you have filed on behalf of _____________________________. Additional current medical information is needed and a special examination can best provide this information. In order to save time, we have authorized an examination(s) for the person for whom you have filed an application by the following doctor(s):

( )You should call the above office(s) for an appointment as soon as possible.

( )We have made an appointment for the claimant on ______________________ at ______________________ a.m./p.m.

( ) Type of examination or test: ____________________________________.

The examination(s) will be performed at Federal government expense and at no cost to you or the claimant.

If the appointment is not kept at the established time, and if you do not notify us of the reason the claimant is unable to appear for the examination(s) by 24 hours before the examination time, we may make a determination based on the medical information we currently have on file (if any) for the claimant. The lack of complete medical information could cause us to determine that _____________________________ is not disabled or blind.

Be sure to return the enclosed Claimant Response Form before the appointment day. If you have any questions, please call us immediately at _____________.

Sincerely yours,

District/Branch Manager

Enclosures (2)

Exhibit 7

Letter to Representative Payee Applicant Requesting Claimant to Attend CE

(Spanish Version)

(Rep Payee's Name and Address)

Esta carta se refiere a la solicitud de beneficios del Seguro Social por incapacidad que usted hizo a nombre de ________________________________. Será necesario conseguir más evidencia médica y la mejor manera de conseguirla es mediante un examen especial. Para ahorrar tiempo, hemos autorizado que sea examinado por:

( ) Deberá llamar a la oficina de este doctor(es) inmediatemente para hacer una cita.

( ) Le hemos hecho una cita para el día ________________________________.

El examen(es) será pagado por el Gobierno Federal y usted no tendrá que pagar nada.

Si no hace su cita o si no acude en la fecha indicada y no nos avisa la razón por la cual no podrá acudir 24 horas antes de la hora de su examen, haremos nuestra decisión basándonos solamente en la información contenida actualmente en su expediente. Es probable que ésto no demuestre que está incapacitado o ciego.

POR FAVOR asegúrese de regresar la carta adjunta antes de la fecha ahí indicada para acusar recibo de esta carta. Si tiene preguntas sobre el examen, por favor comuníquese de inmediato con nosotros por telefono al numero _____________________________.

Muy atentamente,

Director

Adjunto: 2 formas

Exhibit 8

Claimant Response Form

(English Version)

Claimant: _____________________

SSN: _____________________

Please check the proper box below to let us know whether you will keep the examination or test scheduled for you on         (day, date) at       (time) .

______ I will keep the appointment.

______ I cannot keep the appointment because ___________________ __________________________________________________________ __________________________________________________________

IMPORTANT: Sign, date and mail this form immediately, using the pre- addressed envelope provided or telephone ____________ at ______________.

                         (Claims Representative) (Telephone #)

______________________ _____________________

Your signature Date

Exhibit 9

Claimant Response Form

(Spanish Version)

Reclamante: _______________________

Numero De Reclamación: _______________________

Favor de marcár la caja debajo para informarnos de haber recíbido la noticia de examanación médica para el día ___________, fecha ____________________a las _____________________________.

____ Atenderé la cita

____ No atenderé la cita porque ___________________________________ _______________________________________________________________

IMPORTANTE: Firme, ponga la fecha, y envié por correo inmediatemente, usando el sobre con la direción proporcionada, o llame por telefono al numero _______________________.

_____________________________ ____________________________

Su firma Fecha

 

Exhibit 10

Foreign Claims

Report of Expenditures via Third Party Draft

ATTN: Management and Program Analyst

FAX: 410-966-3196

 

Reporting Period:______________________

FO:_________________________________

Charged to:

SOC: 2533

CAN: 4005113

 

Draft Date Claimant’s Name       SSN      Paid To       Amount

_______________________________________________________

_______________________________________________________

_______________________________________________________

 

Fax the above report to OIO by the 15^th of the month following the end of each calendar quarter. For example, the report of October – December quarter should be faxed by January 15^th.

Exhibit 11

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