DI 13005: Medical Issues
TN 11 (01-17)
Sometimes, after learning that an unfavorable determination may occur, some individuals make suicidal or homicidal threats, or otherwise demonstrate that they may become dangerous to themselves or to others. When this occurs during a CDR, the FO must follow the instructions in DI 11005.080 and the instructions in this section.
A. Suicidal or homicidal behaviors issue arises during a face-to-face CDR interview
When a FO identifies a threat of suicidal or homicidal behavior during a face-to-face interview, this situation does not result in an automatic deferral of the CDR. The FO must consider handling this situation under the deferral provisions in DI 13005.020. In these situations, contact the regional office (RO) providing all pertinent details of the suicidal or homicidal behavior in the case, and request assistance in determining if the case applies for a deferral.
1. Disability determination services (DDS) refers the case to the FO with a notice of threat of suicidal or homicidal behavior
The DDS must contact the FO via telephone, upon receipt of the threat in the DDS. The FO must then establish a method to control this information within the office. For example, the FO should:
establish a central location for these cases that relate to referring and retaining the individual; and
assign a specific employee in the office to follow up on these sensitive cases.
To control these cases, the FO must maintain current information in a folder for each case, so the FO interviewer can review the record prior to conducting the interview with the disabled individual.
2. FO identifies potential suicidal or homicidal behavior in the FO when the case is in the DDS
The DDS requires that each DDS appoint a designated authority (the DDS administrator or designee) to coordinate actions in the DDS for a suicidal or homicidal situation. Any case which displays a potential of suicidal or homicidal behavior and the case is in the DDS, the FO (through direct contact either with the DDS or through a RO coordinator) must advise the DDS designated authority by telephone with all pertinent facts and circumstances involving the potential threat. The FO must prepare a SSA-5002 (Report of Contact) reporting the telephone contact. Send the original SSA-5002 to the DDS, and retain a copy for the FO records. For an eCDR, use an electronic SSA-5002 in the EF and add a message or flag to EDCS, see DI 81010.115 and DI 81010.080.
3. FO identifies potential suicidal or homicidal behavior in the FO when the claim folder is in the FO
If the case folder is in the FO:
Record all the details of the threat of suicide or homicide behavior on an SSA-5002 (Report of Contact) and any contacts with the DDS, and
Place the SSA-5002 in the folder.
Annotate any established FO control records to show this information.
NOTE: For an eCDR, complete the SSA-5002 using the instructions in DI 81010.115.
4. FO identifies potential suicidal or homicidal behavior in the FO when the case folder is no longer in the FO or the DDS
If the claims folder is no longer in the FO or the DDS:
determine the current location of the folder,
telephone the details of the situation to the component with possession of the folder,
complete a SSA-5002 (Report of Contact),
send the SSA-5002 (Report of Contact) to the component for association with the folder, and
retain a copy for theFO records.
NOTE: For an eCDR, complete the SSA-5002 using the instructions in DI 81010.115.
B. Optional CDR processing instructions for potential suicidal or homicidal behavior cases
When the FO decides to use the optional CDR procedure, every RO develops a plan for the FO or a DDS physician to contact the medical source of the individual with the potential suicidal or homicidal behavior.
This procedure provides instructions for the FO when the case folder contains the name of the last known medical source. It is not mandatory to follow this procedure. The FO will receive a flag from the PC when a CDR indicates that the individual might potentially display suicidal or homicidal behavior. Experience has shown that medical source can sometimes furnish information on how the individual may react to a CDR.
Under the optional CDR procedure, the FO will ask the medical source for an opinion concerning any negative effects that the CDR may have on the disabled individual. Before initiating personal contact, the FO must contact the source. If the FO decides to follow this procedure for the case, it must comply with regional policy before contacting the medical source or referring the case to the DDS.
When the DDS contacts the individual's source and determines the CDR should continue, the DDS will return the folder to the FO. The FO will complete a personal interview and then return the case to the DDS to complete the medical review. If the DDS determines a CDR would have a negative effect on an individual's mental health or increase potential suicidal or homicidal behavior, the DDS must contact the RO for guidance.
The FO's must follow clear and concise instructions when contacting the medical source, see GN 03305.020. The letter to the physician should be similar to the example below, and the FO must release the letter with a confidential cover sheet, for example the form SSA-1994 (Cover Sheet Confident Medical Info).
Example:
“Our records show that you were the medical source for (HA's Name) in (date). (HA's Name) case is now scheduled for a continuing disability review. Because of the individual's past medical history and since you continue to treat the person we need your assessment as to what impact the initial interview and subsequent contacts by SSA or State agency employees might have on (HA's Name) mental status or suicidal or homicidal potential. Please respond as soon as possible.”
The FO should check the second block on form SSA-1994 and follow-up with the medical source if there is no response within 10 days. During any telephone contact with the medical source, the FO must emphasize that the basis of the inquiry is SSA's concern for the individual's health and well-being.
If the source states that he or she cannot make this judgment, proceed with the CDR in the usual manner. If the source says he or she is no longer treating the disabled individual, the FO should make one attempt to contact a family member or community representative from the case folder who has close contact with the individual. The FO must also attempt to identify the individual's current medical source, and if identification occurs, write to this source. Otherwise, do not make any further attempts and schedule the personal contact.
If the medical source indicates that the personal contact would have negative effects on the individual's mental health or increase potential threat of suicidal or homicidal behavior, the FO should document the case folder and contact the RO for guidance. The FO should consider deferring the CDR in life-threatening situations.
Schedule the personal contact and process the case as usual under the following circumstances:
If the medical source states that there is no current threat of suicide or homicide behavior potential; or
The refusal of the medical source to provide an opinion on the individual's suicide or homicide behavior potential; or
The medical source states that the individual is no longer a patient and is not aware of a current treating source.
In all circumstances before routing the folder to the DDS, the FO must assure full and accurate documentation of the case folder.
C. Summary
It is essential for the FO to keep two major facts in mind when handling cases involving potential suicidal or homicidal behavior. First, the FO must constantly remain alert to the possibility of such behavior and maintain close telephone contact with the DDS, not only for the purpose of initial notification of this type of case, but to keep the DDS advised of any subsequent development and assist when necessary.
Second, the FO must be patient, sensitive, and considerate when dealing with a potentially suicidal or homicidal individual. The FO must thoroughly explain the appeal steps to the disabled individual and explain the benefit continuation provisions in P.L. 98-460.