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HALLEX I-2-101

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-101 PREHEARING CASE ANALYSIS AND WORKUP -- GENERAL

Citations: - 20 CFR §§ 404.935, - 404.941, 404,961, 404.1520a(d)(1)(iii), 410.630 - 410.635, 416.1435, 416.1441, 416.1461, and 416.920a(d)(1)(iii) - 42 CFR §§ 405.701(c) and - 498.47

The Administrative Law Judge (ALJ) or a hearing office (HO) staff person the ALJ designates must review each case before the hearing to determine whether additional evidence is needed for a full and fair inquiry into the matters at issue. If additional evidence is needed, the ALJ or designee should initiate development before the hearing is scheduled. The ALJ should make every effort to obtain all documentary evidence before the hearing, and to receive the testimony of all pertinent witnesses at the hearing.

"Claimant," as used herein, refers to the party to the initial, reconsidered, or revised determination who has requested a hearing before an ALJ, and any other party to the determination, or person whose rights may be adversely affected by a hearing decision. (See - I-2-145, Parties to the Hearing.)

HALLEX I-2-105

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-105 CONDUCTING PREHEARING CASE ANALYSIS AND WORKUP (REVISED 04/95)

When an HO receives a claim file (CF), the HO staff will conduct a prehearing case analysis and workup as follows:

- Determine if the CF is the correct CF and whether any other CFs exist or are needed. (See - I-2-110, Claim Files.)

- Determine if special "critical" case procedures are required. (See - I-2-140, Critical Cases.)

- Determine if any other individual(s) should be made a party(ies) to the hearing. (See - I-2-145, Parties to the Hearing.)

- Determine the issues in the case. (See - I-2-200ff, Issues.)

- Determine if special notices are required. (See - I-2-345, Spanish Language Translations of Forms and Notices, and - I-2-350, Special Notices for Blind Claimants or Recipients.)

- Determine if there is sufficient documentary evidence in the record for a full and fair inquiry into the matters at issue. If additional evidence is needed, discuss it with (or make recommendations to) the ALJ or, if authorized to act on the ALJ's behalf, undertake appropriate development. (See - I-2-500ff, Obtaining Evidence.)

- Determine if a hearing is required and make recommendations to the ALJ (e.g., a hearing is not required if the ALJ can issue a fully favorable decision on-the-record, or if the claimant has waived the right to a hearing). (See - I-2-165, Hearings.)

- Select the proposed exhibits and prepare an exhibit list, if necessary. (See - I-2-115, Exhibits, and - I-2-120, Preparation of Exhibit List.)

- Determine if an interpreter is needed at the hearing. (See - I-2-170, Foreign Language Interpreters, and - I-2-172, Interpreters -- Hearing-impaired Claimants.)

- Determine if expert testimony is needed at the hearing. (See - I-2-534, When to Obtain Medical Expert Opinion, and - I-2-550, When to Obtain Vocational Expert Opinion.)

- Determine if the testimony of any other witness is needed at the hearing. (See - I-2-571, Field Office Employee as a Witness.)

- Prepare a summary of the issues and evidence, providing any relevant comments or recommendations (e.g., as to whether expert testimony at the hearing is needed). (See - I-2-125, Preparation of Summaries of the Evidence.)

- In Appeals Council remand cases, if the ALJ cannot carry out the directive(s) set forth in the remand order, or the directive(s) appears to have been rendered moot, the ALJ may seek clarification. (See - I-2-185, Clarification of Appeals Council Remand Orders.)

- Give the claimant or the representative the opportunity to examine all proposed exhibits. (See - I-2-135, Examination of Proposed Exhibits and other claim file material.)

- Schedule a prehearing interview or conference as appropriate. (See - I-2-175, Prehearing Conference.)

- Schedule a hearing and send a notice of hearing. (See - I-2-310, Scheduling Hearings; and - I-2-315, Notice of Hearing.)

 

 

 

HALLEX I-2-110

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-110 CLAIM FILES (REVISED 04/94)

A. The Claim File (CF)--General

The CF is the official Social Security Administration (SSA) record of a case. When the request for hearing (RH) is received in the HO, the HO staff should immediately obtain the current CF and any prior CF that is required.

B. Obtaining the Current Claim File(s)

When a claimant files an RH in his or her servicing field office (FO), the HO staff usually does not have to take any action to obtain the current CF. If the servicing FO has the current CF, it generally forwards it to the HO along with the RH. If the servicing FO does not have the current CF, it will determine its location, contact the component that has the CF and request that they forward it to the HO, and send to the HO documentation of their request (either a copy of their written request or a report of their telephone contact), along with the RH. If the servicing FO does not do this, the HO staff must contact the servicing FO and request that they take appropriate action and forward to the HO either 1) the CF or 2) information about the location of the CF and the action(s) they have taken to have it forwarded to the HO.

When an HO receives information from an FO about the location of a CF and action(s) they have taken to have it forwarded to the HO, the HO staff should take the following actions:

1. Diary the case for a period of 10 days.

2. First HO Follow-up

If the HO does not receive the CF within the 10 day period, contact the component that has the CF by telephone and request that they send it to the HO, and then diary the case again for 5 days.

3. Second HO Follow-up

If the HO does not receive the CF from the component that has it within the 5-day period, contact them again by telephone and send them a memorandum to confirm the telephone request. Diary the case again for 5 days.

4. If the component that has the CF does not respond, contact the Regional Office (RO) for assistance. (See E., below.)

C. Obtaining the Prior Claim File(s)

The HO staff should consider whether the evidence in any prior CF(s) is material to the current claim before initiating action to obtain it.

1. If it appears that the evidence in the prior CF is not material to the current claim, the HO staff should recommend to the Administrative Law Judge (ALJ) that no action be taken to obtain the prior CF. (See D. below.)

2. If the evidence in the prior CF is material to the current claim, and the servicing FO has not sent either the prior CF or information identifying the component that has it and showing that they have asked such component to send the CF to the HO, the HO staff should recommend to the ALJ that the HO request the prior CF through the Customer Information Control System (CICS). If the ALJ agrees, and the HO requests the CF in this manner, diary the request for 10 days and follow-up as in I-2-110 B.

D. Examples of Situations When an ALJ May Not Need the Prior Claim File

1. The claimant performed substantial gainful activity after any prior claims were adjudicated.

2. A prior period of disability was terminated because of substantial gainful activity.

3. At least four years have elapsed between the date of the prior notice of initial determination and the date of the new application.

4. The pending request for hearing only concerns an impairment which began after any prior claims were adjudicated.

5. The current evidence indicates that any onset of disability which might be established occurred after the date the claimant last met the disability earnings requirements.

E. Formal Search Procedures and Reconstruction

The Office of the Regional Commissioner (ORC) is responsible for coordinating efforts to locate and obtain CFs and for determining when folder reconstruction is necessary.

If the HO staff has been unable to obtain a CF, notify the OHA RO of the situation immediately. The OHA RO will refer the case to ORC for search or reconstruction.

1. For all cases referred to ORC, the HO will maintain a record of the claimant's name and Social Security number, the claim type and the date the RH was filed. This record will assist the HO staff in making periodic follow-up contacts through the RO to determine the status of the request. Such follow-ups shall occur at least every 20 days or in accordance with the agreement established between the RO and the ORC.

2. If the HO still does not receive the prior or reconstructed CF, or the CF it receives is incomplete, notify the RO and request their assistance in obtaining the missing evidence. The RO will contact ORC again and request that they expedite their action to obtain the missing evidence.

a. If a signed authorization will not be needed to obtain the missing evidence, notify the RO and request their assistance by telephone; then send them a memorandum to confirm the telephone request. (See - I-2-190, Sample 1, Memorandum for Requesting Missing Medical Evidence.)

b. If a signed authorization will be needed, notify the RO and request their assistance by memorandum. Attach a copy of the signed authorization to the memorandum. The preliminary telephone call will not be necessary.

c. Include in the memorandum a description of the missing evidence and any available information which may assist them in obtaining it. Also include:

- In title II and title XVI disabled worker or individual cases, photocopies of Forms SSA-3368 (Disability Report) and SSA-3369 (Vocational Report); and

- In title II disabled widow/widower or title XVI disabled child cases, photocopies of Form SSA-3820 (Medical History and Disability Report).

 

 

HALLEX I-2-115

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-115 EXHIBITS (REVISED 03/92)

A. Selection of Proposed Exhibits

The hearing office (HO) staff will select exhibits and prepare an exhibit list for the ALJ's approval. The criterion for selecting a document as an exhibit is whether the document is pertinent and material to the issues in the case.

NOTE: The documents selected by the HO staff will be considered "proposed exhibits" until the ALJ formally admits them into evidence.

The following are examples of jurisdictional, medical and nonmedical documents which are usually selected as proposed exhibits:

1. Jurisdictional Documents

a. The application(s), and any written statement or record of oral inquiry indicating an intent to claim benefits which serves as a protective filing.

b. The initial determination form and the notice of initial determination.

c. In cessation cases, the notice of planned action, the cessation determination form and the initial termination notice.

d. In overpayment cases, the initial notice of overpayment.

e. The request for reconsideration.

f. The reconsideration determination and notice of the reconsideration determination.

g. In Appeals Council remand cases (including remands following claimants' request for review and remands based on court orders), the Appeals Council remand order.

2. Medical Documents

a. Medical analyses, residual functional capacity assessments, and medical judgments by State agency physicians or mental health professionals.

b. Reports of treating physicians, treatment records, hospital reports, and other examination reports.

c. Professional qualifications of all physicians and mental health professionals whose reports, analyses, assessments, or judgments are being entered into the record as exhibits. (See - I-2-130, Professional Qualifications of Physicians and Mental Health Professionals.)

d. Letters from employers or other individuals describing the claimant's impairments and limitations.

3. Nonmedical Documents

a. Birth certificate or other proof of age.

b. Earnings records.

c. Proof of any non-posted wages or self-employment income.

d. Work activity reports.

e. Workers' Compensation and Veterans Administration award information.

f. Form SSA-3368 (Disability Report) or Form SSA-3820 (Medical History and Disability Report).

g. Form SSA-3341 (Reconsideration Disability Reports).

h. Form HA-4486 (Claimant's Statement When a Request for Hearing is Filed and the Issue is Disability).

i. Form SSA-3369 (Vocational Report).

j. Daily activities reports.

k. Pertinent statements by the claimant.

l. Pertinent reports of contact.

m. Evidence of death and relationship (in auxiliary and survivor cases).

n. A written summary of the case, or written statements about the facts and law material to the case, submitted by the claimant or the claimant's representative.

o. Documentation of "every reasonable effort" to obtain evidence from a claimant's medical sources.

B. Documents Not Normally Made Exhibits

1. The request for hearing (RH) form.

2. Miscellaneous working papers, carbon copies, transmittal forms or route slips, intra-departmental communications, and documents pertaining solely to an auxiliary claimant who is not a party to the hearing.

3. Documents classified as "Confidential" by the source (VA, local government unit, etc.) when efforts to obtain release of the restrictions have been unsuccessful. Similarly, any determinations, analyses, etc., which refer to the confidential document, or contain excerpts from it, may not be admitted as evidence.

C. Order of Exhibits

Arrange exhibits in a logical order according to the sequence in which the ALJ will discuss them in the hearing decision. The usual order (from bottom to top) is as follows:

1. Jurisdictional documents

a. The application and any protective filing statement(s).

b. The State agency's initial, reconsidered and/or revised determinations, arranged in chronological order (with the most recent on top) along with the professional qualification statements for all State agency physicians involved in the determinations. (See - I-2-130, Professional Qualifications of Physicians and Mental Health Professionals.)


2. Nonmedical documents

a. The earnings record.

b. The report of the disability interview.

c. The report of the vocational history.

3. Medical documents

Arrange the medical documents in chronological order (from the oldest on the bottom to the most recent on top,) based on the date of the examination or hospitalization rather than the date on which the report was prepared or received.

4. Professional Qualifications

The professional qualifications of physicians, mental health professionals and Vocational Experts involved in the case are placed on the top. (See - I-2-130, Professional Qualifications of Physicians and Mental Health Professionals.)

D. Prior Hearing Exhibits

When a prior hearing decision and the exhibits on which that decision was based are relevant to the current claim, obtain the prior decision, exhibits and exhibit list, and include them as proposed exhibits for the current case along with the following:

1. The certified transcript (if one was prepared).

2. The claimant's request for Appeals Council review of the hearing decision (if one was filed).

3. A copy of the Appeals Council's final action on the prior claim (if any).

4. A copy of any documents related to a civil action (if any), including the final action of the court.

NOTE: Do not renumber the exhibits on which the prior decision was based, but rather number the exhibits on the current claim as Exhibit B-1, B-2, etc.

E. Preparing the Exhibits

1. Prepare and number the exhibits as follows:

a. If the exhibit has only one page, place an exhibit number in the lower right hand corner of the page. If the exhibit has more than one page, place an exhibit number in the lower right hand corner of the first page and, on each subsequent page, place the exhibit number, page number, and total number of pages in the exhibit. For example: Exhibit No. 15, Page 2 of 5.

b. Tape all exhibits smaller than letter size to a sheet of 8 1/2 x 11 inch paper.

c. Combine all initial, reconsidered and revised determinations (SSA-831s and SSA-833s) into one multipage exhibit.

2. Prepare the exhibit list. (See - I-2-120, Preparation of Exhibit List.)

NOTE: Do not write on, highlight or otherwise mark up exhibits except for stamping and numbering them.

 

 

 

HALLEX I-2-120

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-120 PREPARATION OF EXHIBIT LIST

When the proposed exhibits have been selected, arranged in proper order and marked, prepare an exhibit list following the format of - I-2-190, Sample 4, Exhibit List (Final).

If additional evidence is received at or after the hearing, mark the item(s) with the next exhibit number(s). Add the exhibit(s) to the exhibit list under the heading "RECEIVED DURING HEARING" or "RECEIVED SUBSEQUENT TO HEARING," as appropriate.

If the ALJ issues a fully favorable decision, a draft exhibit list may be used in the claim file. However, if the ALJ issues a partially favorable or unfavorable decision, the exhibit list must be prepared in final on Form HA-540 (Exhibits List) and placed in the claim file.

Many HOs prepare the exhibit list only in final form to avoid duplication of effort.

 

 

 

HALLEX I-2-125

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-125 PREPARATION OF SUMMARIES OF THE EVIDENCE

The hearing office staff should prepare a summary of the issues and evidence before the hearing for the Administrative Law Judge (ALJ) to use as a working paper before and at the hearing.

A. Purpose of the Summary

The summary enhances the decision-making process and the quality of the ultimate written decision by facilitating prehearing recognition of:

1. the issues which must be addressed;

2. the need to further develop the record; and

3. the testimony which needs to be elicited at the hearing.

B. Content of the Summary

The summary should include the following:

1. A procedural history of the case.

2. A profile of the claimant, including the claimant's age, education, and work history.

3. In disability cases, a summary of the medical evidence, including relevant allegations, clinical findings, treatment, and opinions expressed by treating and examining sources regarding the claimant's limitations and residual functional capacity to perform various work functions.

4. In non-disability cases, a summary of the allegations and evidence supporting the position taken by each party.

5. A description of any conflicts in the evidence.

6. Recommendations on 1) the need for further development or 2) the presence of witnesses at the hearing.

NOTE: When there is a written statement or record of oral inquiry which may protect the claimant's filing date, the HO staff must refer to it in the summary of the evidence to ensure that the ALJ is aware of the protective filing material.

 

 

 

HALLEX I-2-130

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-130 PROFESSIONAL QUALIFICATIONS OF PHYSICIANS AND MENTAL HEALTH PROFESSIONALS (REVISED 11/94)

A. Professional Qualifications -- General

When an ALJ admits a medical report, analysis, assessment or judgment by a physician or mental health professional [including a Medical Expert (ME)] into the record of a case as an exhibit, or obtains a physician's or mental health professional's testimony at a hearing, the ALJ will also admit into the record a statement of the physician's or mental health professional's qualifications [i.e., a completed Form HA-526, Professional Qualifications (of physician) or Form HA-4390, Professional Qualifications of Psychologist], unless the qualifications are adequately documented on the report, analysis, assessment or judgment, or on another document which is being admitted into the record as an exhibit.

Generally, a physician's qualifications are adequately documented when stationery letterhead or other document identifies his or her medical degree, specialty and Board certification. A mental health professional's qualifications are generally adequately documented when stationery letterhead or other document identifies his or her mental health degree, licence and type of practice.

The hearing office (HO) staff must ensure that the proposed exhibits include all necessary professional qualifications statements and reports.

At the hearing, the ALJ will ask any physician or mental health professional who plans to testify to confirm the accuracy of the statement or report of his or her professional qualifications which will be entered into the record as an exhibit. If there is no statement or report of professional qualifications, or the individual indicates that the statement or report contains an error, the ALJ will "qualify" the physician or mental health professional before he or she testifies by asking questions on the record which will elicit the necessary information about his or her qualifications. (See - I-2-670, Testimony of a Medical Expert, and - I-2-674, Testimony of a Vocational Expert.)

For additional information regarding the professional qualifications requirements for MEs and VEs, refer to the Vocational and Medical Expert Programs Operational Manual. (See also - I-2-538, Obtaining Medical Expert Testimony; - I-2-539, The Medical Expert's Testimony; - I-2-542, Obtaining Medical Expert Opinion Through Interrogatories; - I-2-554, Obtaining Vocational Expert Testimony; - I-2-555, The Vocational Expert's Testimony; and - I-2-557, Obtaining Vocational Expert Opinion Through Interrogatories.)

B. HO Master File of Completed Professional Qualifications Forms

Each HO maintains a master file of completed professional qualifications forms for physicians and mental health professionals in the HO's service area who regularly submit reports or testify at hearings. If the physician's or mental health professional's qualifications are not adequately documented on the report, analysis, assessment, judgment or other document being admitted into the record, or the ALJ decides a professional qualifications form also should be admitted, the HO staff should check the HO's master file of completed professional qualifications forms to determine whether it contains a completed professional qualifications form for the individual.

If the HO's master file contains a completed professional qualifications form for the individual, the HO staff should photocopy the form and make it a proposed exhibit.

If the HO's master file does not contain a completed professional qualifications form, the HO staff should obtain the professional qualifications and complete a Form HA-526 or HA-4390, as appropriate.

C. Obtaining Professional Qualifications and Completing a Form HA-526 or HA-4390

The HO staff first will try to obtain the physician's or mental health professional's qualifications by consulting the American Medical Association Directory, the Osteopathic Physicians' Handbook, and other appropriate directories and handbooks. If this is unsuccessful, the HO staff should contact the physician or mental health professional directly by telephone and request the information needed to complete a Form HA-526 or HA-4390.

1. Form HA-526, Professional Qualifications (of physician)

Insert the following information:

a. name and current address;

b. medical specialty;

c. type of practice;

d. membership in American Specialty Board (if any);

e. year of license;

f. educational background; and

g. any other pertinent information.

2. Form HA-4390, Professional Qualifications of Psychologist


Insert the following information:

a. name and current address;

b. educational background;

c. date of license;

d. type of practice;

e. number of years of practice; and

f. any other pertinent information.

D. HO Staff Is Unable to Obtain a Physician's or Mental Health Professional's Qualifications

If the HO staff is unable to obtain a physician's or mental health professional's qualifications, the HO staff will:

1. Type the claimant's name and Social Security number on a Form HA-526 or HA-4390, as appropriate.

2. Type the following in the upper right hand corner of the Form HA-526 or HA-4390:

The professional qualifications of (insert the name of the physician or mental health professional) are not listed in (insert the name, year and edition of each directory or handbook searched).

3. Attach the annotated Form HA-526 or Form HA-4390 to the last page of the medical document.

 

 

 

HALLEX I-2-135

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997

I-2-135 EXAMINATION OF PROPOSED EXHIBITS AND OTHER CLAIM FILE MATERIAL (REVISED 04/95)

A. General

The ALJ or the HO staff must provide the claimant or representative, if any, an opportunity before the hearing to examine the CF material which constitutes or will constitute the evidence of record for decision. The claimant or representative have the right to examine all material in the CF, not just the material the HO staff has selected as "proposed exhibits." (See - I-2-115, Exhibits.) Whenever possible, the ALJ or the HO staff will make the CF material available for examination in the HO or an FO to avoid unnecessary photocopying of the material.

NOTE: If the CF contains sensitive or confidential material, the ALJ or HO staff must take appropriate measures to protect the claimant's or other individual's privacy. (See D., below.)

B. Providing the Opportunity to Examine the Proposed Exhibits and Other CLaim File Material

1. If a claimant or representative requests to examine the CF or proposed exhibits before the date of the hearing, inform the requester that he or she can examine the CF and proposed exhibits in the HO.

2. If the requester indicates that he or she will not be able to examine the CF or proposed exhibits in the HO before the hearing, inform the requester that he or she can examine the CF or proposed exhibits in an FO. If the requester agrees to this procedure, send the CF and proposed exhibits to the FO closest to the claimant's residence or the representative's place of business, following the general procedures set forth in - I-2-730 G., Proffer Through the FO.

EXCEPTION: For certain representative firms located in the Kansas City Region, which employ individuals who represent claimants nationwide, send the record to the HO closest to the representative's place of business. See - I-2-195 Exhibit 1 for a list of these representative firms and the HOs that service them.

3. The HO staff must send photocopies of proposed exhibits and other CF material to the requester if the requester is unable to examine the proposed exhibits and CF material in the HO or FO.

NOTE: Although an ALJ may suggest that a claimant or representative come to an HO or FO to review proposed exhibits and CF material, the ALJ cannot require the claimant or representative to do so.

NOTE: An ALJ may request that a claimant or representative clarify whether he or she wants a copy of all CF material (including route slips, file copies of correspondence, etc.) or only a copy of all proposed exhibits. Once the claimant clarifies the request, the ALJ must provide the material requested.

C. Charging Fees for Photocopies

SSA complies with the access provision of the Privacy Act by providing one free copy of CF material to the claimant or the representative when access is for program purposes, such as pursuing a benefit under the Social Security Act. Once SSA has provided a free copy of CF materials, see - I-1-403, Privacy Act, for a discussion of SSA's policy regarding charging fees for copies of CF materials.

Unless the HO maintains a record (i.e., a list and/or description) of the copies provided, the HO, on receiving another request for a copy of the same material, cannot determine whether the HO already provided a copy of that material. Therefore, the HO staff should document the CF when providing photocopies of CF materials to a claimant or representative.

However, because preparing lists or descriptions of released materials and subsequently separating such materials from materials not yet released may outweigh the cost of simply copying all of the materials, the HO may waive fees for subsequent copies. If there is any question whether the HO should charge a fee for a subsequent copy, contact the Regional Office for guidance.

D. Action When the CF Contains Sensitive Material

1. If the CF contains material which may be harmful to the claimant or another person, follow the procedures in - I-2-730 F., Evidence Contains Information Which May Be Detrimental to the Claimant's Health.

2. If the CF contains material which was identified by the source as sensitive or confidential, and efforts to obtain release of the restriction have been unsuccessful, the ALJ may not admit the material into the record as evidence for decision or disclose the material to any other person. (See - I-2-115 B., Documents Not Normally Made Exhibits.)

If possible, the OHA employee who receives a threatening phone call must obtain information to aid personnel in locating the claim file, identifying the individual, understanding the specific nature of his or her complaint, etc.

 

C. Notification of Potential Suicidal/Homicidal Behavior -- No Immediate Threat

1. The gravity and sensitivity of the issue are such that each case must be carefully handled on an individual basis. Critical judgment must be emphasized in these cases, including consideration of the referral of such individuals to community agencies which are available to assist in such situations.

a. If the folder is located in the servicing HO or OHA Headquarters, all details must be recorded on a Report of Contact (RC) and placed in the file to alert future handlers of the case to the potential suicidal/homicidal threat.

b. If the folder is located outside OHA, telephone the component holding the folder, confirm the telephone contact with a written RC which will be forwarded to the component for placement in the folder, and retain a copy of the report for OHA records.

D. Program Responsibilities

1. Expediting claims processing

Regardless of OHA's disposition of such claims, prompt processing of the claim of a person who is threatening violence must be made a top priority. A specific person such as the hearing office manager, regional management officer, or division director must be designated as the person responsible for coordinating timely processing of such cases. If the ALJ or the Appeals Council (AC) renders a favorable decision, the claimant will be promptly informed by telephone. See - I-2-140 for additional information about processing cases involving potential suicide or homicide.

2. Alerting future case handlers.

The circumstances of the threat and the action by OHA in response to the threat must be documented by completing a RC which fully explains such circumstances. A copy of the RC should be prong-filed in the manner of a diary slip to remain readily visible on top of the right side of the folder. Also, an alert must be attached to the front of the file indicating that the case must be expedited because of suicidal/homicidal potential.

3. Special considerations for language used in decisions involving threats of violence. (See - I-2-835 and - I-3-805)

In ALJ or AC decisions involving claimants who have threatened violence, the decisionwriter must be careful to avoid any language that might be upsetting to the claimant. The use of emotionally charged words must be avoided. There may be situations where language which might be upsetting to the claimant is relevant to the ultimate issue of disability, and thus must be included in the decision. If there is a representative in the case, the decision must be sent to the representative. The paragraph in the above-cited sections of HALLEX explaining why a copy of the decision has not been sent to the claimant must be inserted on the form transmitting the decision. Also, a brief letter must be prepared to inform the claimant that a copy of the decision has been sent to the representative.

E. Summary

In handling cases involving potential suicide or homicide, OHA personnel must bear in mind two essential factors.

First, HO and AC personnel must be aware of the possibility of such behavior, and be prepared to respond in a prompt and resourceful manner. In dealing with these cases, establishing and maintaining close contact with appropriate community services and law enforcement authorities are essential for the avoidance of immediate threats of violent behavior, for assistance and advice in the future handling of such cases, and for obtaining appropriate counseling and treatment for the individual.

Second, OHA personnel must show the utmost consideration, compassion, and patience in dealing with the potentially violent individual. Indications of violent potential must be treated as legitimate threats to the safety of the individual, the public, and OHA personnel, and appropriate action or referral must be completed promptly. OHA personnel must explain the appeals process carefully, emphasizing OHA's desire to have all of the information relevant to the individual's claim, and OHA's willingness to assist in obtaining additional or clarifying information.

These cases must receive the personal attention of OHA personnel form beginning-to-end to avoid causing or contributing to violent behavior. A specific person must be assigned to each of the cases to assure that it receives priority handling, and that these individuals are referred to an appropriate community service and/or physician, as necessary. At all stages, OHA's actions must be fully documented and included in the claims files.

HALLEX I-2-137

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division II: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

June 30, 1994

Current through March 1997

I-2-137 CLAIMANT THREATENS VIOLENCE

The guidance provided in this section supplements the general instructions contained in SSA's Administrative Instructions Manual System (AIMS), General Administration Manual (GAM), Chapter 12, Protection of Employees.

A. General

In the face of any life-threatening or potentially life-threatening situation, OHA personnel involved or alerted must act immediately to protect the life and safety of the claimant, as well as the safety of the public and OHA personnel. Personnel should deal with such situations as emergency events, following the instructions in this section using common sense and good judgment to defuse violent threats. Indications of suicidal, homicidal, or other violent potential should be treated as legitimate threats to the safety of the claimant, the public, and OHA personnel and/or property. Appropriate action or referral must be completed immediately. Because such behavior is usually sudden and unpredictable, precise instructions on handling cases involving such threats are difficult to formulate. General guidelines can be set forth, but the specific circumstances of each individual case will determine the action taken.

While the causes of such extreme behavior may be numerous and complex, it is generally agreed that such behavior is often a plea for help. OHA personnel should keep this in mind when dealing with such behavior. Suicidal or homicidal potential may be identified in several ways. In most instances, such information will come from the individuals themselves, either by their words or their actions. It may also come from other sources, such as family, friends, legal representatives, medical personnel, the DDS, the local FO, law enforcement authorities, etc.

When any OHA employee becomes aware that a claimant or other individual has shown a potential for violence and that, based on the total information on hand, he or she appears to pose a present threat to his or her own person or to others, this information must be conveyed immediately to the appropriate personnel and authorities. In all such cases, the servicing FO should be notified. The FO's familiarity and proximity to the claimant means that the FO may ultimately be the component that is confronted by the claimant, regardless of the level of appeal or the physical location of the file.

There are two basic situations which OHA personnel must be alert to: (1) an immediate threat, that is, the claimant or other individual is on-site or on the telephone and is threatening violence; or (2) there is no immediate threat but the information indicates a need to alert all subsequent handlers of the claim to the potential for violence.

B. Immediate Threat of Suicide, Homicide, or Other Violent Acts

An immediate threat exists when OHA personnel becomes aware, either through face-to-face or telephone contact with the individual, that a life-threatening action is imminent.

1. Individual is on-site and threatening violence.

The foremost concern in such an emergency situation is for the safety of everyone involved. All OHA offices, including hearing offices, regional offices, and all components of OHA Headquarters, must establish emergency procedures to minimize the exposure to possible danger. One specific person in each office or component (preferably an individual accustomed to acting with authority and handling responsibility, such as an RCALJ, HOCALJ, HOM, or a division or branch chief in Headquarters) must be designated as the person to whom the individual will be referred, with the explanation that this person is the one who can best help them. Another person must be designated to quickly clear the office of all other staff and the public, and to immediately request assistance from appropriate authorities. For each of these responsibilities, at least one other person must be assigned to act as an alternate in case of leave or other absence on the part of the designee.

The local police and/or building security personnel must be contacted and provided with all available details, including the individual's description and his or her location in the office, the nature of the threat, the observed or alleged weapons in the individual's possession, and the number of people in the office with the individual. Many police departments have units specializing in such sensitive referrals. All OHA offices must maintain an up-to-date list of referral sources (suicide prevention hotlines, crisis intervention centers, etc.) staffed by people who are trained to deal with potential suicides or homicides. The names and numbers of such units and local police number, must be recorded as emergency numbers on all OHA telephones. Depending on the circumstances, it may also be appropriate to contact the individual's treating physician, spouse or relatives, or representative payee for assistance in pacifying the individual.
The threatening individual will often believe that he or she is surrounded by a hostile environment. OHA personnel must not attempt to dispute the individual's contentions, and must avoid any action that my increase their level of agitation. Instead, the individual must be supported with an attitude of personal concern and cooperation.

Experience with individuals who threaten violence indicates that, in general, the longer such an individual can be occupied, the less likelihood there is that the threat will be carried out. Thus, OHA personnel must, above all, listen to and talk with such individuals. Although the individual may initially be severely agitated and hostile, this level of excitement may not be sustained for long. In general, these individuals must be given reassurances and simple statements as to what will be done and when. Disputes and contradictions must be avoided and the individuals allowed to do as they wish to the extent possible. With respect to the claim at issue, personnel must emphasize OHA's desire to have all relevant information.

2. Telephone contact with individual or third party--life-threatening action appears imminent.

When a telephone contact is made by the individual or a third party, there is a greater likelihood that an on-site confrontation with a threatening individual can be avoided altogether. This situation will allow OHA personnel time to notify the police and local crisis counselors, alert building security, and clear the office. Even though the individual is not on-site, a threatening phone call must be treated as an emergency situation. Immediate steps must be taken to request police assistance and protect the safety of all parties. Contacting Federal authorities may be an appropriate subsequent action in certain situations, as use of a telephone to make abusive, obscene, or harassing calls may constitute a Federal offense.

If possible, the OHA employee who receives a threatening phone call must obtain information to aid personnel in locating the claim file, identifying the individual, understanding the specific nature of his or her complaint, etc.

C. Notification of Potential Suicidal/Homicidal Behavior--No Immediate Threat

1. The gravity and sensitivity of the issue are such that each case must be carefully handled on an individual basis. Critical judgment must be emphasized in these cases, including consideration of the referral of such individuals to community agencies which are available to assist in such situations.

a. If the folder is located in the servicing HO or OHA Headquarters, all details must be recorded on a Report of Contact (RC) and placed in the file to alert future handlers of the case to the potential suicidal/homicidal threat.

b. If the folder is located outside OHA, telephone the component holding the folder, confirm the telephone contact with a written RC which will be forwarded to the component for placement in the folder, and retain a copy of the report for OHA records.

D. Program Responsibilities

1. Expediting claims processing

Regardless of OHA's disposition of such claims, prompt processing of the claim of a person who is threatening violence must be made a top priority. A specific person such as the hearing office manager, regional management officer, or division director must be designated as the person responsible for coordinating timely processing of such cases. If the ALJ or the Appeals Council (AC) renders a favorable decision, the claimant will be promptly informed by telephone. See - I-2-140 for additional information about processing cases involving potential suicide or homicide.

2. Alerting future case handlers.

The circumstances of the threat and the action by OHA in response to the threat must be documented by completing a RC which fully explains such circumstances. A copy of the RC should be prong-filed in the manner of a diary slip to remain readily visible on top of the right side of the folder. Also, an alert must be attached to the front of the file indicating that the case must be expedited because of suicidal/homicidal potential.

3. Special considerations for language used in decisions involving threats of violence. (See - I-2-835 and - I-3-805)

In ALJ or AC decisions involving claimants who have threatened violence, the decisionwriter must be careful to avoid any language that might be upsetting to the claimant. The use of emotionally charged words must be avoided. There may be situations where language which might be upsetting to the claimant is relevant to the ultimate issue of disability, and thus must be included in the decision. If there is a representative in the case, the decision must be sent to the representative. The paragraph in the above-cited sections of HALLEX explaining why a copy of the decision has not been sent to the claimant must be inserted on the form transmitting the decision. Also, a brief letter must be prepared to inform the claimant that a copy of the decision has been sent to the representative.

E. Summary

In handling cases involving potential suicide or homicide, OHA personnel must bear in mind two essential factors.

First, HO and AC personnel must be aware of the possibility of such behavior, and be prepared to respond in a prompt and resourceful manner. In dealing with these cases, establishing and maintaining close contact with appropriate community services and law enforcement authorities are essential for the avoidance of immediate threats of violent behavior, for assistance and advice in the future handling of such cases, and for obtaining appropriate counseling and treatment for the individual.

Second, OHA personnel must show the utmost consideration, compassion, and patience in dealing with the potentially violent individual. Indications of violent potential must be treated as legitimate threats to the safety of the individual, the public, and OHA personnel, and appropriate action or referral must be completed promptly. OHA personnel must explain the appeals process carefully, emphasizing OHA's desire to have all of the information relevant to the individual's claim, and OHA's willingness to assist in obtaining additional or clarifying information.

These cases must receive the personal attention of OHA personnel form beginning-to-end to avoid causing or contributing to violent behavior. A specific person must be assigned to each of the cases to assure that it receives priority handling, and that these individuals are referred to an appropriate community service and/or physician, as necessary. At all stages, OHA's actions must be fully documented and included in the claims files.

HALLEX I-2-140

Office of Hearings and Appeals

Social Security Administration (S.S.A.)

Department of Health and Human Services

Volume I

Division 2: Administrative Law Judge Hearings

Subject: Prehearing Analysis and Case Workup

Chapter: I-2-100

April 26, 1995

Current through March 1997


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