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Notes

20 C.F.R. §§ 416.1010–416.1018

8 sections in range

§416.1010. How a State notifies us that it wishes to perform the disability determination function.

20 C.F.R. § 416.1010

(a)
Deemed notice. Any State that has in effect as of June 1, 1981, an agreement with us to make disability determinations will be deemed to have given us notice that it wishes to perform the disability determination function, in lieu of continuing the agreement in effect after June 1, 1981.
(b)
Written notice. After June 1, 1981, a State not making disability determinations that wishes to perform the disability determination function under these regulations must notify us in writing. The notice must be from an official authorized to act for the State for this purpose. The State will provide an opinion from the State's Attorney General verifying the authority of the official who sent the notice to act for the State.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

§416.1011. How we notify a State whether it may perform the disability determination function.

20 C.F.R. § 416.1011

(a)
If a State notifies us in writing that it wishes to perform the disability determination function, we will notify the State in writing whether or not it may perform the function. The State will begin performing the disability determination function beginning with the month we and the State agree upon.
(b)
If we have previously found that a State agency has substantially failed to make disability determinations in accordance with the law or these regulations and other written guidelines or if the State has previously notified us in writing that it does not wish to make disability determinations, the notice will advise the State whether the State agency may again make the disability determinations and, if so, the date and the conditions under which the State may again make them.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

§416.1013. Disability determinations the State makes.

20 C.F.R. § 416.1013

(a)
General rule. A State agency will make determinations of disability with respect to all persons in the State except those individuals whose cases are in a class specifically excluded by our written guidelines. A determination of disability made by the State is the determination of the Commissioner, except as described in § 416.903(d)(1).
(b)
New classes of cases. Where any new class or classes of cases arise requiring determinations of disability, we will determine the conditions under which a State may choose not to make the disability determinations. We will provide the State with the necessary funding to do the additional work.
(c)
Temporary transfer of classes of cases. We will make disability determinations for classes of cases temporarily transferred to us by the State agency if the State agency asks us to do so and we agree. The State agency will make written arrangements with us which will specify the period of time and the class or classes of cases we will do.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 62 FR 38455, July 18, 1997]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 62 FR 38455, July 18, 1997]

§416.1014. Responsibilities for obtaining evidence to make disability determinations.

20 C.F.R. § 416.1014

(a)
We or the State agency will secure from the claimant or other sources any evidence the State agency needs to make a disability determination. When we secure the evidence, we will furnish it to the State agency for use in making the disability determination.
(b)
At our request, the State agency will obtain and furnish medical or other evidence and provide assistance as may be necessary for us to carry out our responsibility for making disability determinations in those classes of cases described in the written guidelines for which the State agency does not make the determination.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 79 FR 33683, June 12, 2014]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 79 FR 33683, June 12, 2014]

§416.1015. Making disability determinations.

20 C.F.R. § 416.1015

(a)
When making a disability determination, the State agency will apply subpart I, part 416, of our regulations.
(b)
The State agency will make disability determinations based only on the medical and nonmedical evidence in its files.
(c)
Disability determinations will be made by:
(1)
A State agency medical or psychological consultant and a State agency disability examiner;
(2)
A State agency disability examiner alone when there is no medical evidence to be evaluated (i.e., no medical evidence exists or we are unable, despite making every reasonable effort, to obtain any medical evidence that may exist) and the individual fails or refuses, without a good reason, to attend a consultative examination (see § 416.918);
(3)
A State agency disability examiner alone if you are not a child (a person who has not attained age 18), and the claim is adjudicated under the quick disability determination process (see § 416.1019) or the compassionate allowance process (see § 416.1002), and the initial or reconsidered determination is fully favorable to you. This paragraph (c)(3) will no longer be effective on December 28, 2018 unless we terminate it earlier by publication of a final rule in the Federal Register; or
(4)
A State agency disability hearing officer.
(d)
In making a determination under title XVI with respect to the disability of a child to whom paragraph (d) of this section does not apply, we will make reasonable efforts to ensure that a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the child's impairment(s) evaluates the case of the child.
(e)
The State agency will certify each determination of disability to us on forms we provide.
(f)
The State agency will furnish us with all the evidence it considered in making its determination.
(g)
The State agency will not be responsible for defending in court any determination made, or any procedure for making determinations, under these regulations.
Notes, amendments, and revision history

Amendments

[52 FR 23928, Sept. 9, 1987, as amended at 56 FR 11021, Mar. 14, 1991; 58 FR 47587, Sept. 9, 1993; 61 FR 11136, Mar. 19, 1996; 62 FR 38455, July 18, 1997; 65 FR 34959, June 1, 2000; 75 FR 62684, Oct. 13, 2010; 78 FR 66639, Nov. 6, 2013; 79 FR 51243, Aug. 28, 2014; 80 FR 63093, Oct. 19, 2015; 81 FR 73028, Oct. 24, 2016; 82 FR 5883, Jan. 18, 2017]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[52 FR 23928, Sept. 9, 1987, as amended at 56 FR 11021, Mar. 14, 1991; 58 FR 47587, Sept. 9, 1993; 61 FR 11136, Mar. 19, 1996; 62 FR 38455, July 18, 1997; 65 FR 34959, June 1, 2000; 75 FR 62684, Oct. 13, 2010; 78 FR 66639, Nov. 6, 2013; 79 FR 51243, Aug. 28, 2014; 80 FR 63093, Oct. 19, 2015; 81 FR 73028, Oct. 24, 2016; 82 FR 5883, Jan. 18, 2017]

§416.1016. Medical consultants and psychological consultants.

20 C.F.R. § 416.1016

(a)
What is a medical consultant? A medical consultant is a member of a team that makes disability determinations in a State agency (see § 416.1015), or who is a member of a team that makes disability determinations for us when we make disability determinations ourselves. The medical consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all physical impairment(s) in a claim.
(b)
What qualifications must a medical consultant have? A medical consultant is a licensed physician, as defined in § 416.902(a)(1).
(c)
What is a psychological consultant? A psychological consultant is a member of a team that makes disability determinations in a State agency (see § 416.1015), or who is a member of a team that makes disability determinations for us when we make disability determinations ourselves. The psychological consultant completes the medical portion of the case review and any applicable residual functional capacity assessment about all mental impairment(s) in a claim. When we are unable to obtain the services of a qualified psychiatrist or psychologist despite making every reasonable effort (see § 416.1017) in a claim involving a mental impairment(s), a medical consultant will evaluate the mental impairment(s).
(d)
What qualifications must a psychological consultant have? A psychological consultant can be either a licensed psychiatrist or psychologist. We will only consider a psychologist qualified to be a psychological consultant if he or she:
(1)
Is licensed or certified as a psychologist at the independent practice level of psychology by the State in which he or she practices; and
(2)
(i)
Possesses a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the Council on Post-Secondary Accreditation; or
(ii)
Is listed in a national register of health service providers in psychology which the Commissioner of Social Security deems appropriate; and
(3)
Possesses 2 years of supervised clinical experience as a psychologist in health service, at least 1 year of which is post-masters degree.
(e)
Cases involving both physical and mental impairments. In a case where there is evidence of both physical and mental impairments, the medical consultant will evaluate the physical impairments in accordance with paragraph (a) of this section, and the psychological consultant will evaluate the mental impairment(s) in accordance with paragraph (c) of this section.
Notes, amendments, and revision history

Amendments

[82 FR 5883, Jan. 18, 2017]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[82 FR 5883, Jan. 18, 2017]

§416.1017. Reasonable efforts to obtain review by a physician, psychiatrist, and psychologist.

20 C.F.R. § 416.1017

(a)
When the evidence of record indicates the existence of a physical impairment, the State agency must make every reasonable effort to ensure that a medical consultant completes the medical portion of the case review and any applicable residual functional capacity assessment. When the evidence of record indicates the existence of a mental impairment, the State agency must make every reasonable effort to ensure that a psychological consultant completes the medical portion of the case review and any applicable residual functional capacity assessment. The State agency must determine if additional physicians, psychiatrists, and psychologists are needed to make the necessary reviews. When it does not have sufficient resources to make the necessary reviews, the State agency must attempt to obtain the resources needed. If the State agency is unable to obtain additional physicians, psychiatrists, and psychologists because of low salary rates or fee schedules, it should attempt to raise the State agency's levels of compensation to meet the prevailing rates for these services. If these efforts are unsuccessful, the State agency will seek assistance from us. We will assist the State agency as necessary. We will also monitor the State agency's efforts and where the State agency is unable to obtain the necessary services, we will make every reasonable effort to provide the services using Federal resources.
(b)
Federal resources may include the use of Federal contracts for the services of qualified psychiatrists and psychologists to review mental impairment cases. Where Federal resources are required to perform these reviews, which are a basic State agency responsibility, and where appropriate, the State agency's budget will be reduced accordingly.
(c)
Where every reasonable effort is made to obtain the services of a qualified psychiatrist or psychologist to review a mental impairment case, but the professional services are not obtained, a physician who is not a psychiatrist will review the mental impairment case. For these purposes, every reasonable effort to ensure that a qualified psychiatrist or psychologist review mental impairment cases will be considered to have been made only after efforts by both State and Federal agencies as set forth in paragraphs (a) and (b) of this section are made.
Notes, amendments, and revision history

Amendments

[52 FR 23928, Sept. 9, 1987, as amended at 82 FR 5883, Jan. 18, 2017]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[52 FR 23928, Sept. 9, 1987, as amended at 82 FR 5883, Jan. 18, 2017]

§416.1018. Notifying claimant of the disability determination.

20 C.F.R. § 416.1018

The State agency will prepare denial notices in accordance with subpart N of this part whenever it makes a disability determination which is fully or partially unfavorable to the claimant.
Notes, amendments, and revision history

Amendments

[46 FR 29211, May 29, 1981, as amended at 75 FR 33169, June 11, 2010]

Authority

Authority: Secs. 702(a)(5), 1614, 1631, and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 1382c, 1383, and 1383b).

Source

Source: 46 FR 29211, May 29, 1981, unless otherwise noted.

Amendments

[46 FR 29211, May 29, 1981, as amended at 75 FR 33169, June 11, 2010]