GN 03105.010:
Reconstruction of Destroyed or Missing Paper Claims Folders
Effective Dates: 09/04/2014 - Present- Effective Dates: 01/11/2018 - Present
- TN 4 (09-14)
- GN 03105.010 Reconstruction of Destroyed or Missing Paper Claims Folders
- A. When to reconstruct a current claims folder
- 1. When there is a need for information from a paper claims folder
- Reconstruct missing or destroyed paper claims folders only when information contained in the paper folder does not exist electronically (e.g., in the certified electronic folder) and you need that information to:
- * process a claim, continuing disability review, appeal, or court case; or
- * satisfy the request for folder information from a component, such as the Office of the Inspector General, the Office of Quality Review, or the Office of Quality Improvement.
- The Disability Determination Service (DDS) has jurisdiction of prior Comparison Point Decision (CPD) and medical folder reconstruction. For claims under DDS jurisdiction, see DI 20502.030 and DI 28035.020.
- 2. When a disaster destroys claims folders
- Following a disaster involving destruction of paper claims folders, the regional commissioner (RC) decides whether to invoke disaster procedures. If the RC invokes these procedures, the regional office (RO) will alert the field office (FO) manager(s) in the affected service area(s). For the affected claims:
- * reconstruct folders for:
- * pending claims;
- * claims pending at the Appeals Council level or involving a court case; and
- * claims selected for quality review; and
- * process claims requiring further action following normal Modernized Claim System (MCS) and Modernized Supplemental Security Income Claim System (MSSICS) procedures.
- For more information on disaster management procedures, see GN 00401.001. For more information on processing claims affected by a disaster, see GN 00410.001.
- B. Timeframes for reconstructing claims folders
- 1. State DDS offices
- The state DDS has 30 calendar days for reconstructing the medical portion of disability claims folders. For more information on reconstructing disability claims folders, see DI 20502.030.
- 2. FOs
- Field offices have 15 business days for reconstructing the non-medical portion of claims folders.
- C. Procedures for reconstructing claims folders
- All Title II or Title XVI claims require certain basic documents that relate to a claimant's entitlement or non-entitlement to benefits. For a list of these basic documents, see GN 00301.290. When reconstructing a folder, you may be able to obtain these documents from existing electronic records. If the documents are not available electronically, request them from the claimant or representative.
- 1. Obtaining evidence from existing records
We store claims data and evidence in a variety of electronic files. MSSICS and MCS maintain much of the claims data. We maintain data not captured in MCS or MSSICS on the Evidence (EVID) screen. If we faxed data into the Non-Disability Repository for Evidentiary Documents (NDRED), we can retrieve and view the documents in the Claims File Record Management Systems (CFRMS). Prior to initiating folder reconstruction, identify the information available in these electronic files or records. Do not recreate or request replacement of any documents found in the electronic folder.- We store claims data and evidence in a variety of electronic files. MSSICS and MCS maintain much of the claims data. We maintain data not captured in MCS or MSSICS on the Evidence (EVID) screen. If we faxed data into the Non-Disability Repository for Evidentiary Documents (NDRED), we can retrieve and view the documents in the Claims File User Interface (CFUI). Prior to initiating folder reconstruction, identify the information available in these electronic files or records. Do not recreate or request replacement of any documents found in the electronic folder.
- For information on identifying and viewing the electronic folder, see:
* DI 81005.005 eView Overview;* MSOM INTRANET CFRMS 001.001 Claims File Records Management System (CFRMS) - Overview;* GN 00301.310 The Non Disability Repository for Evidentiary Documents (NDRed) Application—Overview; and- * DI 81005.005 eView Overview;
- * GN 00301.310 The Non Disability Repository for Evidentiary Documents (NDRed) Application—Overview; and
- * MSOM EVID 001.003 Evidence Screen (EVID).
- 2. Obtaining information from claimants or representatives
- If needing evidence or information that is not available in an electronic record, contact the claimant or the claimant’s representative and request only the information that is not available. Assist the claimant in obtaining the necessary documents or information. Pay any charges for obtaining evidence that the claimant previously provided. For information on paying for evidence, see GN 00301.215.
- If we obtained a signed application originally, do not request another signed application for folder reconstruction. Record a statement on the Report of Contact (RPOC or DROC) screen or paper form SSA-5002, that we previously obtained a signed application.
- a. Claimant refuses to cooperate
- If the claimant refuses to take part in the reconstruction efforts:
- * explain to the claimant that cooperating in the reconstruction effort should result in a more accurate and speedier decision;
- * reconstruct as much evidence as possible from MCS, MSSICS, EVID screens, and other SSA records;
- * document efforts made to complete development electronically on the RPOC or DROC screen;
- * forward available material immediately to the requesting office unless regional procedures direct otherwise; and
- * notify the RO when completing these actions if the RO is tracking the reconstruction progress.
- If the claimant subsequently cooperates, proceed immediately with the reconstruction action.
- b. Claimant or beneficiary not located
- To develop the claimant’s address follow the procedures in GN 02605.055. If efforts to locate the claimant are unsuccessful, reconstruct as much evidence as possible without the claimant's participation. Document all efforts to contact the claimant on the RPOC or DROC screen. When completing the reconstruction, forward the material to the requesting office. For claims selected for quality review, notify the requesting assessment office if you suspend benefits.
- 3. Reconstruction of a claims folder with medical development
- Initiate reconstruction of medical development only upon DDS’s request. Work with the DDS to determine what medical evidence it needs. The DDS will redevelop medical evidence if necessary. For further information on folder reconstruction, see DI 20502.030.
- D. FO action after completion of reconstruction
- When completing reconstruction of all necessary documents:
- * annotate "Reconstructed" in bold red letters across the front of the folder jacket;
- * mark each piece of reconstructed evidence "Reconstructed;"
- * annotate any new evidence the claimant submits as "New Evidence;"
- * fax copies of all evidence and information into the certified electronic folder (CEF). If a CEF is not available, fax the information into NDRED. (For more information on the CEF, see GN 04440.010.); and
- * route the reconstructed paper folder immediately to the requesting office, or as directed by regional instructions.
- E. Missing paper folder located during redevelopment
- After initiating folder reconstruction, we may find the original folder. If found by the:
- * Office of Disability Adjudication and Review (ODAR) -- ODAR should telephone the FO immediately to stop reconstruction and, if appropriate, notify the DDS.
- * FO – The FO should telephone the requesting office immediately and send the located folder and any materials already reconstructed to the requesting office.
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