I-2-5-14.Obtaining Medical Evidence From a Medical Source

Last Update: 4/15/15 (Transmittal I-2-138)

When an administrative law judge (ALJ) needs additional information about a claimant's impairment(s), he or she will determine whether the information may be available from a medical source. If the ALJ determines that the information may be available from a medical source, he or she will attempt to obtain the information by following the procedures below.

A. Completing Form SSA-827, Authorization to Disclose Information to the Social Security Administration (SSA)

Form SSA-827 serves as the official form for obtaining a claimant's written consent to release information to SSA. SSA in turn forwards a properly signed and dated SSA-827 to a claimant's medical providers when requesting medical evidence.

Only the “2-2003” or newer versions of the SSA-827 are acceptable for use. The authorization (whether wet-signed or electronically signed) on the SSA-827 is valid for 12 months from the date signed. If the authorization has expired, the hearing office (HO) must obtain a new signed and dated SSA-827.

NOTE:

Only claimants residing in Puerto Rico may use an SSA-827-SP, the Spanish version of the form. To view or print form SSA-827 translation sheet in Spanish, see the SSA-827-SP. Instructions for filling out an SSA-827 in other languages are available at http://www.ssa.gov/multilanguage/.

1. Instructions for Obtaining an Electronically Signed SSA-827 Using the eAuthorization Click and Sign Process

Adult claimants may file for Social Security disability benefits or appeal a determination online at www.socialsecurity.gov. In addition to completing an i3368, Internet Benefit Application/Internet Adult Disability Report, or i3441, Internet Disability Report - Appeal, the claimant will be prompted to complete and electronically sign an SSA-827, and electronically submit it to SSA along with the i3368 or i3441. Claimants who do not sign the electronic SSA-827 must submit a wet-signed, paper SSA-827.

2. Instructions for Obtaining an Electronically Signed SSA 827 Using eView eAuthorization Process

In situations where attestation is permitted, HO staff will contact the claimant by telephone or in person. For represented claimants, HO staff will follow the instructions in Program Operation Manual System (POMS) GN 03910.050.

To obtain a signed SSA-827, HO staff will take the following actions:

  • · Verify the claimant's identity by confirming information on the Numident per POMS GN 00203.020A.2. If HO staff cannot confirm or has any doubt as to the claimant's identity, staff will not continue with the electronic signature process. Instead, HO staff must obtain a paper SSA-827 with a wet signature from the claimant.

  • Access the SSA-827 eAuthorization screen in eView.

  • Provide the claimant the opportunity to review the SSA-827. For telephone contacts, provide a copy of the SSA-827 in advance (such as by mail) or direct the claimant to a copy of the form online (available here: http://www.ssa.gov/online/ssa-827.pdf).

    NOTE:

    If the claimant has not had the opportunity to review the SSA-827, do not continue with the electronic signature process. Instead, obtain a paper SSA-827 with a wet signature from the claimant.

  • Read the scripted language on the SSA-827 eAuthorization screen in eView.

  • Indicate the claimant's intent to authorize disclosure by selecting “Yes” or “No.”

    • If “No,” select the reason for declining and provide the claimant the opportunity to complete a paper SSA-827 with a wet signature.

    • If “Yes,” attest to the claimant's intent to authorize disclosure by clicking the “Attest, Submit, and Print” button.

    NOTE:

    The electronically signed SSA-827 will be automatically uploaded to the electronic folder. HO staff will not need to fax the form into the electronic folder.

  • Mail a printed copy of the electronically signed SSA-827 to the claimant for his or her records.

3. Instructions for Obtaining a Wet-Signed SSA-827

Generally, to promote efficiency and reduce potential delays, HO staff will use the eAuthorization whenever possible rather than obtaining a wet-signed SSA-827. However, when needed, HO staff will provide a standard version or personalized version of the SSA-827 to the claimant and representative, if any, with a request that the claimant return it signed and dated. HO staff can generate an SSA-827 by one of the following methods:

  • Document Generation System (DGS). Go to DGS, click on the “Correspondence” tab then the “Prehearing” tab, and then “PH1i827.”

  • Portable Document Format (PDF). See http://www.ssa.gov/online/ssa-827.pdf.

  • eView. Open the electronic folder and select “Print Forms” in the upper right hand corner. Once that screen opens, the SSA-827 is pre-selected. Unselect the checkbox entitled “Generate Associated Barcode for the SSA-827 Medical Release Form.” Select Print and Exit.

Once the form generates, HO staff will print and mail the form to the claimant for signature and dating. A copy must be sent to the appointed representative, if any.

NOTE 1:

To be valid, an SSA-827 must include the claimant's signature and the date of signing. Do not instruct claimants to provide an undated SSA-827. Return any undated SSA-827s to the claimant for dating.

NOTE 2:

If the claimant intends to modify, restrict, or write anything on the form (e.g., adding restrictions to any section), he or she must use the paper SSA-827 with a wet signature.

B. Requesting a Claimant or Representative (if Any) Provide Evidence That May Be Available From a Medical Source

The ALJ or HO staff will ask the claimant or representative to identify the claimant's medical source(s) and provide all evidence that relates to the claim from those sources.

1. HO Procedures to Request Evidence from a Claimant or Representative (if Any)

HO staff will:

  • Diary the case for 30 days, i.e., add a “Development” action to the case in the Case Processing and Management System (CPMS). (See the CPMS Training Manual, Module 7, on the CPMS intranet site for specific instructions on how to establish diaries or use case development in CPMS.)

  • If the claimant or the representative does not provide the evidence by the diary date, the ALJ or HO staff will contact the claimant or representative, preferably by telephone, to determine why he or she has not provided the evidence.

  • Depending upon the reason(s) given, the ALJ may:

    • Extend the time for the claimant or representative to provide the evidence (e.g., if the claimant indicates that a treating source has promised to provide the evidence within a reasonable period);

    • Request the evidence from the treating source or other medical source, either directly or through the State agency (see subsections C and D below); or

    • Obtain the needed information by way of a consultative examination or specific test (e.g., if the claimant or representative indicates that the requested evidence is not available). See Hearing, Appeals and Litigation Law (HALLEX) manual I-2-5-20.

2. When an HO Can Authorize Payment for Medical Records Requested by a Claimant or Representative

When the claimant or representative is unable to provide all available evidence that relates to the claim from the claimant's medical sources, the HO is authorized to pay certain physicians and providers for the reasonable cost of providing existing medical evidence (20 CFR 404.1514 and 416.914). The following procedures apply:

  • A claimant or representative may ask the HO for assistance in obtaining existing medical evidence from a medical source after the claimant or representative has made a good faith effort to obtain that evidence, or is otherwise unable to obtain the evidence for reasons beyond their control. Examples of this include, but are not limited to when:

    • A treating source has not responded to multiple requests for evidence;

    • An unrepresented claimant cannot afford to pay for the evidence;

    • An unrepresented claimant has a physical, mental, educational, or linguistic limitation(s) that prevents him or her from requesting or obtaining the evidence; or

    • A representative who is ineligible for compensation by a claimant, such as a legal services organization, and has no funding to pay for the evidence.

    Unless the capacity of the claimant is in question, when requesting assistance, the claimant or representative generally must provide to the HO documentation supporting the reasons for all such requests.

  • The medical source must be a physician not employed by the Federal government or another non-Federal provider of medical services. (See 20 CFR 404.1514 and 416.914.)

  • HO staff, with ALJ approval, will assist a claimant or representative (if any) in obtaining evidence by requesting it directly from the medical source (see subsection C below).

  • The HO will pay a reasonable amount for the existing medical evidence in accordance with the payment rates established by the appropriate State agency. (See 20 CFR 404.1624 and416.1024.)

C. Requesting Evidence Directly From a Medical Source

HO staff will use the following methods to obtain medical evidence when approved by an ALJ:

1. Telephone Requests

After requesting evidence by telephone, HO staff will complete the following actions:

  • Mail or fax the medical source a signed (either wet or electronically) and dated SSA-827.

  • Prepare a form SSA-5002, Report of Contact (RC), to document the request, and place the RC in the claim(s) file. The RC must show:

    • The name, position or title, and telephone number of the HO staff person making the contact;

    • The name, position or title, and telephone number of the person contacted;

    • The date of the contact; and

    • The substance of the telephone conversation, including identification of the evidence requested, the actions both the requestor and the source will take (e.g., the person making the contact promises to provide the source with a signed and dated SSA-827 to release the evidence), and the time limits for completion of the actions.

  • Diary the case for a follow-up contact. (See subsection C.3. below, Follow-Up Procedures.)

2. Written Requests

When requesting evidence by letter or fax, HO staff will do all three of the following:

  • Enclose a signed and dated SSA-827.

  • Place a copy of the written request (if a fax, include the cover sheet with proof of transmission) in the claim(s) file. To access the Medical Development Letter in DGS, go to DGS, click on the “CE and Evidence Request” tab, then click on the “1J Request for Medical Evidence from Doctor” or “2J Request for Medical Evidence from a Hospital” tab. HO staff may need to modify this letter when requesting evidence from other sources.

  • Diary the case for follow-up. (See subsection C.3. below, Follow-Up Procedures.)

3. Follow-Up Procedures

If a medical source does not provide the requested evidence within 10 days of the HO's initial telephone or fax request or within 15 days of the HO's initial written request (allowing an additional 5 days for mailing), HO staff will contact the source (preferably by telephone) to determine the status of the request. If the ALJ believes that the source may need additional time to respond to the initial request, he or she may delay the follow-up contact for an additional 10 days.

If the source does not provide the requested evidence within 10 days after the HO's telephone or fax transmission follow-up, or 15 days after the HO's written follow-up, HO staff will contact the source again to determine the status of the source's action on the request.

If the HO's follow-up contact is made by telephone, HO staff will prepare an RC to document the claim(s) file. The RC must show:

  • The name, position or title, and telephone number of the HO staff person making the follow-up contact;

  • The name, position or title, and telephone number of the person contacted;

  • The date of the follow-up contact; and

  • The substance of the telephone conversation.

If the HO's follow-up is made in writing, HO staff will place a copy of the written follow-up in the claim(s) file. If the HO's follow-up is made by fax, HO staff will place a copy of the written follow-up, cover sheets, and proof of transmission in the claim(s) file.

All follow-up dates must be annotated on the “Development” screen in CPMS.

4. Telephone Reports

If a medical source provides information by telephone, HO staff receiving the information will:

  • Prepare a form SSA-795, Statement of Claimant of Other Person, that clearly describes the information provided, and shows:

    • The HO staff person's name, position or title, and telephone number;

    • The source's name, position or title, and telephone number; and

    • The date and time of the telephone report.

  • Send the original SSA-795, along with a postage paid return envelope, to the source for verification, signature, and return to the HO.

  • Place a copy of the SSA-795 in the claim(s) file. The ALJ will ensure the SSA-795 is added to the record as an exhibit to document the ALJ's and HO staff attempts to obtain evidence.

5. Payment for Reports

The HO is authorized to pay the same amount for reports that the State agency would pay. See POMS DI 39545.600, DI 11010.545, and DI 22505.040.

D. Requesting Evidence From a Medical Source Through the State Agency

1. Request Procedures

When requesting evidence from a treating source or other medical source through a State agency, HO staff will:

  • Complete and send a form HA-72, Request for Medical Evidence Only From State Agency, to the State agency. To access the request, go to DGS and click on the “CE and Evidence Request” tab, then click on the “Request for Medical Evidence Only from State Agency” tab. HO staff will provide the State agency with:

    • The representative's name (if any), address and telephone number;

    • A description of the needed evidence and its location;

    • A signed and dated SSA-827;

    • The name and telephone number of an HO contact; and

    • A postage paid return envelope.

  • Place a copy of the HA-72 and other requested information in the claim(s) file; and

  • Add a development action in CPMS and diary the case for 30 days.

2. Follow-Up Procedures

If the State agency does not provide the requested evidence by the end of the diary period, HO staff will:

  • Contact the State agency (preferably by email) to determine the status of the request;

  • Prepare an RC for the claim(s) file to document the follow-up (if done through written communication or fax, place a copy of the communication or fax cover with proof of transmission in the claim(s) file); and

  • Diary the case for the additional time (up to 30 days) that the State agency indicates it needs.

3. Problem With the State Agency's Response

If there is a problem with the State agency's response (e.g., the State agency does not send any evidence, or sends inadequate or incomplete evidence), HO staff will contact the State agency (preferably by email) and try to resolve the problem. If done through written communication or fax, place a copy of the communication or fax cover sheet with proof of transmission in the claim(s) file.

If HO staff is unable to resolve the problem, and the requested evidence is essential, HO staff will request assistance from the Regional Office. If done through written communication or fax, place a copy of the communication or fax cover with proof of transmission in the claim(s) file.

E. Medical Test Data

Evidence from medical sources frequently includes medical test results that are not accompanied by the background medical test data (e.g., radiologists' reports of x-rays do not normally include the actual x-ray films, and psychological test reports do not normally include “raw” test data such as answer sheets or drawings). However, background medical test data are required for some pulmonary tests and for electrocardiograms. (See 3.00E., 3.00F.1., and 4.00C.2. in the Listing of Impairments.) When background medical test data are not required but a report raises a question about the accuracy of the medical test results reported (or other evidence raises such a question), an ALJ may ask the source to submit the background medical test data. Such requests should be rare and, if they occur, interpretation and evaluation of the background medical test data requires a medical expert (ME). See HALLEX I-2-5-34 B.

NOTE:

Psychological test instruments are available only to qualified testing facilities and personnel. The testing facilities and personnel who use the instruments must purchase them and are not permitted to share them because of copyright restrictions; many tests are too large to copy. Therefore, an ALJ will not request a copy of the test instrument. The ME should be a qualified medical professional who is familiar with the test instrument(s) and can interpret the data submitted for the record. If a report raises a question about the accuracy of the test results reported (or other evidence raises such a question), an ALJ may ask the source to submit the raw test data.