Effective Dates: 10/13/2023 - Present Previous | Next

TN 36 (10-23)

DI 22510.016 Claimant Consultative Examination (CE) Notice and Confirmation Procedures

CITATIONS:

20 CFR 404.1516 through 404.1519t , and 416.916 through 416.919t

A. When to schedule a CE appointment

When a CE is needed and the claimant has cooperated with other requests for evidence or action (e.g., forms completion, etc.), schedule the CE. The Disability Determination Services (DDS) is not required to obtain the claimant's agreement before scheduling an in-person CE.

When the claimant has not cooperated with the initial request or the follow up request for evidence or action, do not schedule the CE. However, for cases requiring special handing, when a CE is needed and the claimant has not cooperated with the follow up request for evidence or action, DDS must make a reasonable effort to involve a third party.

For more information on:

B. Written notice of CE appointment

Send the written notice of the CE appointment to the appropriate individuals in accordance with DI 23007.005. For the CE appointment notice, see NL 00705.745.

The CE appointment notice must include the following:

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    Why the CE (and additional tests, if applicable) is needed,

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    An explanation that the Social Security Administration will pay for the CE and may also reimburse some travel expenses if the claimant qualifies,

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    An explanation on payment of travel expenses, if applicable (see DI 39525.005),

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    The name, address, and telephone number of CE provider,

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    The date, time, and type of CE appointment,

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    A reminder to bring a current, valid government-issued identification (ID), preferably photo ID,

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    A reminder to bring all medications in their original containers and any other medical aids (e.g., hearing aids, eyeglasses, contact lenses, assistive device, etc.),

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    The requirement to confirm CE attendance and to respond immediately when the claimant cannot attend the CE appointment for any reason,

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    A request to notify DDS when an interpreter is needed (see DI 23040.001),

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    An explanation that DDS will send a copy of the CE report to the claimant's medical source when the claimant provides written authorization,

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    The following due process language, "If you fail to keep an appointment without notifying us, we may make a decision based on the evidence we already have in file. We may find that you are not eligible, or no longer eligible, for disability benefits,"

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    The DDS contact information for questions, appointment confirmation and rescheduling, and feedback after the appointment, and

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    SSA Publication No. 05-10087 A Special Examination Is Needed for Your Disability Claim.

NOTE: DDS may exclude the CE provider telephone number if the CE provider refuses to share their telephone number with the claimant.

C. Who may confirm a CE appointment

The claimant, applicant, appointed representative (AR), legal guardian, or third party may confirm or refuse the CE appointment, or request to reschedule the CE if a good reason exists.

For more information on:

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    The appropriate individual(s) to contact to confirm a CE, see DI 23007.005.

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    Examples of a good reason, see DI 23007.001B.

D. Confirming the CE appointment

How DDS confirms the CE appointment depends on whether the CE appointment is more than 10 days or 10 days or less from the date of the written notice.

1. The CE appointment is more than 10 days from the written notice

When the CE is not confirmed within 10 calendar days from the date of the initial written notice, make a reasonable effort to confirm that the claimant will attend the CE appointment. When DDS does not make a reasonable effort to confirm, and the claimant fails to attend the CE appointment, DDS must make a reasonable effort to find out why the claimant missed it. When the applicable individual(s) as discussed in DI 22510.016C in this section provides a good reason for missing the CE appointment, reschedule the CE.

a. Attendance is confirmed

When the CE is confirmed within calendar 10 days, document the confirmation on an SSA-5002 (Report of Contact), in the Disability Case Processing System (DCPS), or on the DDS worksheet. For details on what to document when a claimant confirms a CE, see DI 22510.019B.

NOTE: When the claimant confirms the CE appointment in writing, add the confirmation to the folder. There is no need to document elsewhere.

b. Attendance is not confirmed

When the CE is not confirmed within 10 calendar days, DDS must make one attempt to confirm by telephone contact to ask for confirmation. For claims requiring special handling, you must also attempt one telephone contact to identify and involve a third party. When you are unable to speak to the applicable individual(s) as discussed in DI 22510.016C in this section, and you cannot leave a message, send a call in letter. For additional details on what to do when a claimant does not confirm a CE, see DI 22510.019D.

NOTE: When the claimant, applicant, or AR does not respond to your telephone contact or call-in letter to confirm attendance, cancel the CE appointment unless the claimant requires special handling. When the claimant requires special handling, cancel the CE appointment only when the claimant and third party (when you are able to identify and involve a third party) does not respond to your telephone contact or call-in letter to confirm attendance.

1. You speak to the claimant, applicant, AR, or third party

Do the following:

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    Confirm the claimant will attend the CE, or reschedule the CE when there is a request to do so and a good reason is provided, and

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    Provide a reminder that failure to attend the CE appointment may result in you making a determination based on the evidence in file, which means that you may find the claimant not disabled.

Document the date, content of your conversation, and with whom you spoke, on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet.

2. 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 their applicant, AR, or 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 their applicant, AR, or third party (e.g., the claimant’s spouse or an AR’s assistant).

Include the following information:

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    Your name, title, telephone number and date that you called. Do not disclose any unnecessary personal information about the claimant (see GN 03316.005D),

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    The date, time, and location of the CE appointment,

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    A request that the claimant, applicant, AR, or third party return the call to confirm the CE appointment within 10 calendar days from the date of the message. Explain that failure to do so will cause you to cancel the appointment, and

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    A reminder that failure to attend the CE appointment may result in you making a determination based on the evidence in file, which means that you may find the claimant not disabled.

Document the date, content of your message, and with whom you left it, on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet.

3. You send a call-in letter

Include the following information:

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    Your name, title, telephone number and date of the letter,

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    The date, time, and location of the CE appointment,

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    A request that the claimant, applicant, AR, or third party call you to confirm the CE appointment within 10 calendar days from the date of the letter, and

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    A reminder that failure to confirm the CE appointment will cause you to cancel it and may result in you making a determination based on the evidence in file, which means that you may find the claimant not disabled.

2. The CE appointment is 10 days or less from the written notice (i.e., alternative scheduling)

Alternative scheduling is recommended only when you have difficulty locating the claimant after the passage of time (e.g., a homeless claimant).

a. The claimant does not require special handling

Take the following steps:

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    Use the procedures in DI 22510.016C in this section for confirming the CE appointment.

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    When the claimant misses the CE appointment for a good reason or the claimant calls prior to the CE appointment and agrees to attend a rescheduled CE, reschedule the CE.

NOTE: Do not use alternative scheduling for the rescheduled CE unless the claimant, applicant, or AR requests it.

b. The claimant requires special handling

Take the following steps:

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    When the claimant misses an alternatively scheduled CE appointment, send a call in letter to the claimant and third party asking them to call you within 10 calendar days from the date of the letter.

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    When the claimant or third party responds to the call in letter, discuss how to ensure the claimant will attend the rescheduled CE.

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    When the claimant and third party fails to call you within 10 calendar days from the date of the letter, stop attempts to get the claimant to attend a CE.

NOTE: Do not use alternative scheduling for the rescheduled CE when the claimant or third party asks for more time to confirm attendance.

For more information on:

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    Claimants who require special handling, see DI 23007.001A.

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    How to make a reasonable effort to identify and involve a third party, see DI 23007.010.

E. The claimant fails to attend the CE appointment

Document the missed CE or the reason the claimant will not attend the CE on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet. When the DDS has a missed CE notice, include a copy of that notice in the folder.

1. The claimant does not require special handling

When DDS confirms or attempted to confirm the CE in accordance with DI 22510.016D in this section, and the claimant fails to attend the CE, do not reschedule the CE unless:

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    The claimant, applicant, legal guardian, or AR calls prior to case finalization, and

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    Provides a good reason.

When the above does not occur, do not reschedule the CE and stop attempts to get the claimant to attend the CE.

When you did not attempt to confirm the claimant attendance at the CE appointment in accordance with DI 22510.016D in this section:

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    Contact the claimant, applicant, legal guardian, or AR by telephone to ask why the claimant failed to attend the CE appointment (see DI 23007.005).

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    Reschedule the CE when the claimant has a good reason for failing to attend the CE. Otherwise, do not reschedule the CE and stop attempts to get the claimant to attend the CE.

2. The claimant requires special handling

When the claimant requires special handling, make a reasonable effort to identify and involve a third party. After you have done so, only reschedule the CE when the claimant or third party calls you prior to case finalization and provides a good reason for the claimant missing or refusing to attend the CE. If this does not occur, do not reschedule the CE and stop attempts to get the claimant to attend the CE.

For more information on:

  • •

    Claimants who require special handling, see DI 23007.001A.

  • •

    How to make a reasonable effort to identify and involve a third party, see DI 23007.010.

Document the date, time and content of the conversation, and with whom you spoke, on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet.

F. Unusual CE appointment scheduling procedures

These procedures apply to situations when it is difficult to schedule a CE due to unusual circumstances.

Document attempts to schedule a CE appointment using these procedures on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet.

1. The claimant is incarcerated

Determine if one of the following scheduling options are available:

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    The facility's staff medical source (or an outside CE source selected by DDS) can perform the CE at the facility, or

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    The facility will permit the claimant to attend the CE at an outside facility selected by DDS.

Try to accommodate the facility’s preferred date, time, and conditions. When DDS cannot schedule a CE using these procedures, stop attempts to get the claimant to attend a CE.

2. There is no CE in the claimant's immediate area

Schedule the CE appointment at the most convenient location for the claimant.

For information on:

3. The claimant alleges an inability to travel due to health risk

When possible, confer with the claimant’s medical source to determine whether the claimant can travel to the CE. When the medical source advises against it, or the claimant will not agree to attend due to the alleged health risk, when possible:.

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    Schedule an in-person CE at the claimant’s residence, or

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    Schedule a THCE if permitted.

When the DDS is unable to accommodate the claimant's health concerns, stop attempts to get the claimant to attend a CE.

Document your efforts on an SSA-5002 (Report of Contact), in DCPS, or on the DDS worksheet.

4. The claimant or AR requests the AR to attend the CE

When the claimant, applicant, or AR requests that the AR accompany the claimant to the CE, advise the AR to make the request directly to the CE source. Also, advise the AR that the CE source’s decision is controlling.

5. The claimant requests an accommodation(s)

For information on accommodation requests, see GN 00211.001.

G. The effect of stopping attempts to get a claimant to attend the CE

When DDS makes all efforts to notify and confirm the CE in accordance with DI 22510.016A through DI 22510.016E in this section, but the claimant fails to attend the CE, DDS may stop attempts to get the claimant to cooperate. DDS is not required to pursue additional evidence that requires the claimant’s cooperation.

EXCEPTION: This does not apply to claimants who are in situations described in DI 22510.016F in this section. In those instances, you must still pursue all other evidence that requires the claimant’s cooperation.

However, DDS still must ensure that every reasonable effort is made to develop a complete medical history without the claimant’s cooperation in accordance with DI 22505.001A.2 before making a determination based on the evidence in file using the sequential evaluation process.

For more information on:

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    Actions to take before making a determination based on the evidence in the file, see DI 23007.015B.

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    Using the sequential evaluation process to make a determination based on evidence in file, see DI 23007.015C.

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    The appropriate regulation basis code and personalized disability explanation, see DI 23007.015D.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422510016
DI 22510.016 - Claimant Consultative Examination (CE) Notice and Confirmation Procedures - 10/13/2023
Batch run: 10/13/2023
Rev:10/13/2023