BASIC (06-07)

Introduction

Even though it is an uncommon occurrence, claims sometimes have to be reconstructed. The reconstruction can be at the initial, reconsideration, hearing level or Appeals Council levels (GN 03105.010).

There is no need to recreate or request replacement of any electronic folder documents.

NOTE : Documents from pre-IDA (Independence Day Assessment) certification folders become “official” via the reconstruction process even if the electronic folder was not the official folder at the time the case was created.

If there is no electronic folder, the extent to which a folder must be reconstructed is affected by the level of adjudication, whether or not the determination/decision has been made or input, type of determination/decision, and whether the case has been appealed. The following guidelines are to be used in folder reconstruction.

NOTE : Follow DI 26510.001 for completion of Form SSA-831 (Disability Determination and Transmittal).

1. Case lost before adjudication or before input of determination/decision

The folder must be fully reconstructed. The field office (FO) must obtain, as applicable, an SSA-3368 (Disability Report-Adult), SSA-3369 (Work History Report), SSA-3820 (Disability Report-Child), SSA-827s (Authorization to Disclose Information to the Social Security Administration (SSA)), SSA-821 (Work Activity Report-Employee), and complete an SSA-831/SSA-833/SSA-832 (Cessation or Continuance of Disability or Blindness Determination and Transmittal). The disability determination services (DDS) must redevelop necessary medical and vocational evidence.

2. Allowance/continuance input by both DDS and FO

The folder must be partially reconstructed. It should contain non-disability information critical to an allowance depending on the type of case (application, earnings record, and income and resources (I&R) development). The FO may contact the DDS by telephone and request a copy of the determination (SSA-831/SSA-833/SSA-832, if available, or documentation of allowance code and onset date) and any medical evidence the DDS may have available (e.g., copies of tele-recorded consultative examinations). It is not necessary to obtain a new SSA-3368, SSA-3820 and SSA-3369-BK and redevelop medical and/or vocational evidence.

3. Claim denied/ceased--no appeal pending

Full reconstruction is not necessary. The FO should contact the DDS by telephone and request a copy of the decisional SSA-831/SSA-833/SSA-832 (or information about the determination and a statement that the SSA-831/SSA-833/SSA-832 cannot be located). No further DDS action should be necessary.

4. Claim denied/ceased--appeal requested or pending

Complete folder reconstruction is necessary (see 1. above) unless the denied/ceased claim was electronic. If the case is lost between initial and reconsideration levels, the FO will take an SSA-3368 instead of the SSA-3441 (Disability Report-Appeal) to facilitate redevelopment of medical evidence. The FO will also take an SSA-3369 if the individual lists more than one job on the SSA-3368.

5. Continuing Disability (CD) Issue Raised

If a CD issue is raised and the folder is lost, the attempt to locate the file must be documented on a SSA-5002 (Report of Contact) (see DI 13015.080). Follow DI 13015.070 and send the case to DDS as a lost folder Continuing Disability Review (CDR). The DDS will attempt to conduct the CDR without the original folder. Per DI 28035.000, the DDS will advise the FO if full reconstruction is necessary. (See DI 28035.015 and DI 28035.020)

6. Cancellation of reconstruction actions

In some cases, the original claims folder is located during the reconstruction process. At that point, reconstruction efforts are discontinued. The component that has located the original file will inform the component that has requested the reconstruction. If the DDS is reconstructing a folder lost prior to adjudication, the DDS telephones the FO to discontinue non-medical development. Any new medical evidence that may be obtained during reconstruction is associated with the original folder and evaluated for its effect on the original determination.