Action Note

In I-2-520 B.:

• In the parenthetical which follows the “NOTE,” change “I-2-524 E., State Agency Physician…” to “I-2-526, DDS Physician Determines that Requested Tests Would Involve Significant Risk.”

Background

Sections 404.1516, 404.1518, 416.916 and 416.918 of 20 CFR parts 404 and 416 discuss Social Security Administration (SSA) actions if a claimant fails to submit needed evidence, or does not appear at a needed consultative examination (CE). Section I-2-524 of HALLEX describes Office of Hearings and Appeals (OHA) procedures in these situations. We have decided to rewrite the section in order to more clearly communicate SSA policy in this area.

Explanation of Content and Changes

This issuance revises section I-2-524, and adds a new section, I-2-526, in Volume I, Division 2 of HALLEX.

Section I-2-524 discusses refusal by a claimant to submit evidence or undergo a consultative examination (CE). We revised this section in order to more clearly reflect Social Security Administration policy in such cases.

This HALLEX issuance explains that failure to submit needed evidence and refusal to attend a needed CE are both examples of a claimant's failure to cooperate, and we treat both the same for purposes of development and adjudication. However, we adjudicate initial claims differently than cessation cases.

If a claimant fails to submit needed evidence or fails to attend a needed CE, we will first determine if the claimant has a good reason for such failure. If the claimant has an apparent mental impairment, we will consider the effects of the mental impairment when determining if he or she has a good reason. In such a case, we will also ensure that the claimant is aware of the right to representation, and we will attempt to obtain needed evidence from other sources.

In an initial claim, if we conclude that a claimant does not have a good reason for failing to cooperate, we will decide the case based on the available evidence. We will make our decision by applying the sequential evaluation process required by 20 CFR §§ 404.1520 and 416.920.

In a cessation case, if we conclude that a claimant does not have a good reason for failing to cooperate, such failure may be the basis for finding that the claimant's disability ceased.

In rewriting section I-2-524, we removed the instructions which were formerly in subsection E. because those instructions were not related to a claimant's failure to submit evidence or attend a CE. We moved those instructions to a new section, I-2-526.

In new section I-2-524 E., we explain that we determine whether a claimant has a good reason for failing to cooperate the same way we determine “good cause” under 20 CFR §§ 404.911 and 416.1411.

In new section I-2-524 F., we discuss documentation of hearing office development in these cases.

Remove

Remove from Chapter I-2-500:

Table of Contents I-2-501 through I-2-542, dated October 18, 1991, and I-2-544 through I-2-590, dated October 30, 1990 (2 pages); and

I-2-522 A. cont., dated October 30, 1990, through I-2-528, dated October 30, 1990 (4 pages).

Insert

Insert in Chapter I-2-500:

Table of Contents I-2-501 through I-2-590, dated March 09, 1992 (2 pages); and

I-2-522 A. cont., dated March 09, 1992, through I-2-528 B. cont., dated March 09, 1992 (5 pages).

Date: March 9, 1992