DI 12010.015: Informal Remand of Medical/Vocational Determinations
Effective Dates: 07/16/2010 - Present
- TN 3 (07-10)
- DI 12010.015 Informal Remand of Medical/Vocational Determinations
- A. Policy for informal remand of medical/vocational determinations
- Informal remand is a procedure that provides a prehearing review by the adjudicating component (i.e. the DDS) if there is a strong likelihood of reversal of the reconsideration determination. The field office (FO) may determine whether informal remand criteria apply.
- See also:
- DI 81010.141, Processing Electronic Informal Remands
- B. Identification
- 1. Review
- Take the following steps when new evidence is submitted:
- * Review new evidence submitted by the claimant.
- * Compare the diagnosis and description of the claimant's condition provided by the new medical evidence with the diagnosis and rationale shown on the SSA 831-C3/U3 (Disability Determination and Transmittal)
- * Assess whether the new evidence shows that the claimant's condition has worsened or the claimant has a significant new impairment of which the adjudicating component was not aware.
- 2. Exceptions
- Do not refer a claim for informal remand in the following situations:
- a. Promised evidence is not available
- Do not under any circumstances delay action awaiting the receipt of evidence.
- b. Doubt exists that informal remand procedures apply
- If doubt exists, do not conduct an extensive review of medical evidence. Treat the case as though the informal remand criteria are not met.
- c. The claimant objects to an informal remand
- If the claimant objects to an informal remand, take the following action:
* Forward the case to the Office of Disability Adjudication and Review (ODAR).
- * Annotate the claimant's objection on the route form.
- * If the disability determination services (DDS) is involved, telephone the DDS to advise them of the action.
- C. Claim folder(s) in FO
NOTE: Informal remands ODAR can be processed electronically by the DDS and the Office of Quality Performance (OQP) if the relevant legacy system is upgraded to release 13.0 or later. FO remands are Electronic Disability Collect System (EDCS) exclusions (DI 81010.141A.)
- 1. Informal remand is appropriate
- If the informal remand criteria apply, refer the case for prehearing review as follows.
- * Annotate the HA 501-U5 (Request For Hearing) in the space below the FO address as follows: “DDS/PC (address) Informal Remand Case.” Do not annotate the claimant's copy.
* Distribute the HA 501-U5. Make certain that the location of the ODAR hearing office (HO) is clearly shown on the claim folder(s) copy.
- * Transmit the claim folder(s) to the DDS or processing center (PC) that prepared the unfavorable determination, even if the claimant has moved to another State. Annotate the route slip “Informal Remand of Hearing Case for Your Review.”
- 2. Informal remand is not appropriate
If the criteria for an informal remand are not met, refer the case immediately to ODAR.
- D. Claim folder(s) not in FO
- 1. Action upon receipt
- Determine if an informal remand is indicated. If the criteria are met, notify the HO by sending a photocopy of the HA 501-U5, annotated as in DI 12010.015C.1.a.
- 2. Claim folder(s) in the DDS
- If the claim folder(s) is in the DDS, do not request the claim folder(s). Take the following actions:
- * Annotate the HA 501-U5 that the DDS has been requested to forward the file to the HO if a revised favorable determination is not made.
- * Do not annotate the claimant's copy of the HA 501-U5.
- * Send the claim folder(s) copy of the HA 501-U5 with any materials submitted by the claimant, to the DDS.
- * Annotate the route slip “Informal Remand-Claim Folder(s) in Your Office.”
- * Advise the DDS to notify the FO when the file is forwarded to the HO.
- * Distribute all other copies of the HA 501-U5 as usual.
- * Follow-up on the status of the claim folder(s), if necessary, 15 business days from the date the claim folder(s) is sent.
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