Responsibility for and Assistance in Verifying Disability for the EAEDC Program

(A) An EAEDC applicant or client is responsible for establishing that he or she is disabled. The Department shall help the applicant or client in obtaining the necessary information and may require the applicant or client to attend an exam required by the agency or organization under contract/agreement with the Department to provide disability evaluation services. (1) The applicant or client must provide the Department: (a) clinical and/or laboratory findings establishing that he or she has an impairment or combination of impairments that substantially reduces or eliminates his or her ability to support himself or herself; and (b) information regarding the various vocational factors as specified in 106 CMR 703.193(C): Physical Impairment and, if applicable, 106 CMR 703.193(D): Mental Impairment. (2) If an applicant or client, without good cause, does not appear for a scheduled medical examination, fails to provide required medical releases, or otherwise fails to cooperate in the disability determination process, the Department or the agency or organization under contract/agreement with the Department to provide disability evaluation services, when required, shall make a determination of disability based on information received from the applicant or client and other available sources. Religious or personal reasons opposing medical examinations or tests do not constitute good cause. (B) The Department and, if applicable, its agents, shall take reasonable steps to help applicants and client in obtaining the information necessary to make a disability determination. (1) The worker and/or an agent of the Department is responsible for: (a) referring an applicant or client to a competent medical authority as defined in 106 CMR 701.600: Definition of Terms if the applicant or client does not have a competent medical authority and, if requested, scheduling an appointment with the competent medical authority; and (b) assisting the applicant or client in completing the Disability Supplement when, such help is requested for by the applicant or client. (2) If the clinical and/or vocational information submitted by the applicant or client is incomplete or ambiguous so that a disability determination cannot be made, the agency or organization under contract/agreement with the Department to provide disability evaluation services is responsible for: (a) gathering the information needed to make a disability determination by contacting any competent medical authority, physician, psychologist, or nurse practitioner and/or hospital identified by the applicant or client, to obtain information on any impairment that may potentially affect the applicant’s or client’s ability to work provided such impairments have been identified by the applicant or client, a competent medical authority or is otherwise evident in the record. The competent medical authority who completed the medical report shall be contacted for additional information and/or clarification and/or, if appropriate, further tests, prior to contacting any other competent medical authority; and (b) arranging for a competent medical authority to examine the applicant or client to obtain additional information or tests, as necessary, to clarify the incomplete or ambiguous clinical and/or vocational information that has been submitted to the Department by and/or obtained by the agency or organization under contract/agreement with the Department to provide disability evaluation services from a competent medical authority.