POMS Reference

DI 12010: Hearings Level Review - Initial Claims

A. General

When the FO where the HA-501 Request for Hearing was filed is unable to locate the claims folder within a reasonable period of time (usually 30 days), that FO must initiate folder reconstruction. Expedited action is important to avoid a further delay in the appeals process.

In the San Francisco Region, the FO which received the hearing request, rather than the Regional Office ("RC" or "ORC"), is responsible for coordinating efforts to locate the folder, deciding when reconstruction is necessary and initiating steps to accomplish it.

B. FO Actions

The FO will follow the instructions in GN 03105.010 - GN 03105.040 and GN 03105.050 - GN 03105.070 to search for folders and initiate reconstruction. The FO will develop the non-medical portion of the file and send it to the Hearing Office (HO) under cover of the Reconstruction Folder Flag (Exhibit 1).

As soon as the FO has obtained the pertinent medical history and release forms, this material will be forwarded to the DDS under cover of the Request for Medical Reconstruction Flag (Exhibit 2). Local arrangements between the FO and DDS may be made to further expedite medical reconstruction.

Once the FO has referred the medical reconstruction request to DDS and informed the HO of the referral, the HO is responsible for follow-up with DDS.

C. DDS Actions

DDS will follow instructions in POMS DI 20502.030 for handling reconstruction requests. DDS will advise the HO of any delays in expected completion of the reconstruction. Once medical reconstruction is complete, DDS will forward all material directly to the HO. The RO does not need to be notified.

EXHIBIT 1 — San Francisco Region APPEALS PROCESSING

RECONSTRUCTION FOLDER FLAG

TO: ______________________ DATE: _________________

(Hearing Office)

______________________

______________________

CLAIMANT/APPELLANT NAME ______________ SSN: _________________

I. RECONSTRUCTION OF NON-MEDICAL EVIDENCE

_____ Enclosed is the __(RSI, DIB, SSI)______ reconstructed non-medical evidence.

II. RECONSTRUCTION OF MEDICAL EVIDENCE

_____ The request for medical reconstruction was forwarded to the ____________________________ DDS on ________________.

(DDS branch name, city & state)                               (date)

Questions concerning the reconstruction of this medical evidence should be directed to ______________________ at telephone number __________________.

(name of DDS contact)                              (DDS telephone number)

FROM: _________________________________

(FO contact person and title)

_________________________________

(FO name and office code)

_________________________________

(telephone number)

(REPRODUCE LOCALLY)

EXHIBIT 2 — San Francisco Region APPEALS PROCESSING

REQUEST FOR MEDICAL RECONSTRUCTION FLAG

TO: ________________________ DATE: ____________________

(DDS)

________________________

(ADDRESS)

________________________

A REQUEST FOR HEARING WAS FILED ON _______________________ BY

(date)

______________________________, ______________________________.

(name) (SSN)

WE HAVE BEEN UNABLE TO LOCATE THE FOLDER AND MUST RECONSTRUCT THE EVIDENCE.

PLEASE IMMEDIATELY BEGIN RECONSTRUCTION OF THE MEDICALS FOR:

___________________________________________________________

(TYPE OF CLAIM: TITLE II, XVI, CONCURRENT, COMMENTS)

ENCLOSED ARE:

_____ MEDICAL RELEASE FORMS

_____ SSA-3368

_____ OTHER FORMS APPROPRIATE TO THIS TYPE OF CLAIM

_____________________________________________

_____________________________________________

THIS RECONSTRUCTION MUST BE COMPLETED WITHIN 30 DAYS OF THE DATE THAT THIS REQUEST IS RECEIVED. WHEN COMPLETED, IT MUST BE FORWARDED DIRECTLY TO THE HEARING OFFICE AT: ___________________________________________________________

(address)

___________________________________________________________

(HO Telephone number)

QUESTIONS CONCERNING THE EVIDENCE TO BE RECONSTRUCTED SHOULD BE DIRECTED TO THE HEARING OFFICE.

FROM: __________________________________

(signature and title of FO person)

________________________________

_________________________________

(FO telephone number)

(REPRODUCE LOCALLY)