Social Security has issued a ruling regarding the responsibilities of both the Social Security Administration and the claimant to develop evidence and other information in disability and blindness claims for both SSDI and SSI cases. The ruling applies at all levels of review, including administrative law judge hearings.
Social Security states that the claimant has the primary responsibility to provide evidence in support of disability or blindness claims. The Social Security Act also requires the Social Security Administration to make reasonable efforts to obtain all medical evidence from the claimant’s treating source that is necessary to properly evaluate the claim prior to evaluating medical evidence obtained from a consultative source. Social Security must also develop a complete 12-month medical history when making a disability determination. This means that Social Security will make an initial request for evidence from the medical source, and will follow up with the provider between 10 and 20 days after the request if it has not received the evidence.
Claimants must submit or inform Social Security of all evidence known to them that relates to the disability claim. Claimants must submit or inform Social Security of any written evidence no later than 5 business days before an administrative law judge (ALJ) hearing. The ALJ can ignore evidence submitted less than 5 business days before the hearing unless the claimant demonstrates good cause for late submission. To satisfy the duty to inform, the claimant must provide information specific enough to identify the source of the evidence and the relevance of the evidence.
Representatives have a duty to assist claimants in obtaining evidence. Representatives must also submit or inform Social Security of evidence as soon as they obtain or become aware of it. Representatives should not wait until 5 business days before the hearing to submit or inform Social Security of evidence unless they have a compelling reason for the delay. In addition, representatives cannot inform Social Security of evidence without submitting it unless the representative shows they could not obtain the evidence despite good faith efforts. Violation of these duties can result in referral to the Office of General Counsel for disciplinary action.
At the Appeal Council level, the Appeals Council will not obtain or evaluate additional evidence when deciding whether to grant review unless there is good cause for failure to previously submit it or the case is a SSI claim that is not based on an initial application for benefits (an age-18 redetermination for example). SSR 17-4p (October 4, 2017).