VB 00901.012: Denial of SVB Claim for Failure to Cooperate or Submit Essential Evidence - Initial Claims
Effective Dates: 07/11/2014 - Present
- TN 1 (10-00)
- VB 00901.012 Denial of SVB Claim for Failure to Cooperate or Submit Essential Evidence - Initial Claims
- A. Policy
- 1. General
- SSA denies a claimant's SVB claim if the individual fails to cooperate or submit essential evidence necessary to make a determination of SVB entitlement. Before denying an SVB claim for failure to cooperate or submit essential evidence, every reasonable effort must be made to obtain the evidence necessary to make an SVB entitlement determination. This policy also applies if the SVB claimant's prospective representative payee, who is the legal guardian, fails to cooperate.
- 2. Exceptions
- A claimant's entitlement to SVB will not be denied based on "failure to cooperate" if:
- * A third party or prospective representative payee who is not the SVB claimant's legal guardian fails to provide the requested evidence, or
- * Another denial reason can be used to deny the claim.
- B. Procedure - Servicing FO and CPS
- 1. Closeout
- Send a closeout letter in VB 05001.014 or VB 05001.015 specifying the information/evidence needed and advising the individual that failure to submit the information/evidence can result in denial of the SVB claim. Allow 30 days from the date of the closeout letter for the individual to respond.
- 2. Denial
- If no response is received by 30 days after the date of the closeout letter (or the claimant has clearly indicated a lack of interest or cannot be located):
- * Document all contact attempts and efforts made to obtain the requested evidence including a statement describing what the claimant said or did which led to the conclusion that he/she would not make a reasonable effort to furnish the necessary evidence.
- * Deny the SVB claim for “failure to cooperate.”
- * Prepare the formal denial notice in VB 05001.017 using the blank paragraph to explain that the SVB claim is being denied because the individual has not cooperated or assisted SSA personnel in obtaining essential evidence necessary to establish entitlement to SVB.
- * Send the formal denial notice to the claimant.
- NOTE: If the claimant's whereabouts is unknown, send the notice to the claimant's last known address.
- * Input the information (date and reason for denial of the claim) on the San Francisco Intranet site at http://sfnet.sf.ssa.gov/title8.
- Do NOT establish an SSR if one does not exist or input SVB denial information to an established SSR.
- 3. Special Considerations
- * Develop for a new payee if the prospective representative payee (who is not the legal guardian) cannot be located or fails to cooperate.
- * Distinguish between the uncooperative claimant who fails to submit available evidence and the cooperative claimant who simply cannot furnish sufficient evidence because it is not obtainable or none exists. If a cooperative claimant is unable to provide the necessary evidence, do not deny the SVB claim for “failure to cooperate.” Instead, use the entitlement factor not sufficiently established as the basis for the SVB denial.
C. Procedure – FSP in Manila only
- Follow the procedures in VB 00901.012B.1. If no response is received by 30 days after the date of the closeout letter (or the claimant has clearly indicated a lack of interest or cannot be located), prepare documentation showing all contact attempts and efforts made to obtain the requested evidence. Include a statement describing what the claimant said or did which led to a conclusion that he/she would not make a reasonable effort to furnish the necessary evidence.
The Regional Federal Benefits Officer (RFBO) in Manila has the authority to formally deny a claim for SVB and if he or she chooses to process an SVB denial they should follow VB 00901.012B.2. Denials not processed in the FSP are processed by the Palms Springs CPS (see VB 00901.011C.). Fax the SVB claim and related materials to the Palm Springs CPS before mailing all materials to the CPS. Retain a copy of all SVB-related claims material in the FSP. D. Procedure – All other FSPs FSPs do not have the authority to process a formal denial of an SVB claim. If a claimant fails to cooperate with the FSP in its development efforts on an SVB claim, the FSP will:
- * Prepare documentation showing all attempts made to contact the individual to obtain the evidence. (Make sure the individual's name and SSN are shown.)
- * Fax and then mail the documentation to the requesting CPS or FO.
x← This means that the line was removed and was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.