Chapter: I-3-2
Subject: General Workup and Analysis Procedures
This transmittal updates Chapter I-3-2 to memorialize existing Appeals Council level guidance and procedures for adjudication of cases involving allegations of consultative examination (CE) provider and other expert misconduct, fraud or similar fault, or lack of qualifications.
I-3-2-24 – In subsection A, we added a citation for definition of “party to the hearing.” In subsection B, we added instructions and sample language to include in Appeals Council (AC) action documents when there was information relating to a person who is not party to the claim(s). In subsection C, we updated instructions to include an allegation of fraud or similar fault as a circumstance in which information not related to the claimant might be intentionally submitted with a request for review. We also added a new subsection, C.3, to provide procedure for handling information submitted about a non-party to support a fraud or similar fault allegation, with language for use in AC decisions.
I-3-2-30 – In subsection B, we clarified that the AC will consider whether a referral to the Disability Determination Services (DDS) is appropriate if a claimant or appointed representative alleges a CE provider is disqualified. We also added a cross-reference to a new HALLEX section, I-3-2-31, that details the process for addressing allegations of improperly completed or deficient CE reports or misconduct by CE providers. We removed the NOTE under this subsection. In subsection C. we clarified that the Executive Director?s Office will determine whether a referral to the regional DDS is warranted.
I-3-2-31 – We created a new section titled “Allegations of Improperly Completed or Deficient Consultative Examination Reports or Misconduct by Consultative Examination Providers.” This new section provides instructions to Office of Appellate Operations staff and Appeals Council adjudicators for processing and evaluating allegations concerning CE reports or providers.
Date: March 3, 2025