By Jennifer L. Foster, RN, Attorney-at-Law
The Social Security Administration (SSA) is required to periodically review the case of every person who is receiving Social Security Disability (SSD) or Supplemental Security Income (SSI) disability benefits. This process is called a “continuing disability review” and is intended to identify recipients who might no longer qualify as disabled. If, during a CDR, Social Security finds that your medical condition has improved enough so that you can work, your Social Security benefits will end. The frequency of a CDR is usually based on the age of the recipient and/or their medical condition. If the claimant’s case went before an Administrative Law Judge (ALJ), many times the ALJ will recommend an appropriate time for review if benefits are awarded.
CDRs for Adults
Most cases are set for review every three or seven years, depending on the likelihood that your condition will improve. If a claimant has a condition that is expected to medically improve, a CDR may be conducted even sooner than three years. For example, if one of the reasons you are disabled is because you needed a surgery to fix your impairment but didn’t have health insurance or money to have the surgery done, your health might be restored once it is performed. There are many other instances in which your condition may genuinely improve and allow you to go back to work. On the other end of the range, Social Security beneficiaries whose condition is not expected to improve or are disabled due to a permanent condition (such as a lost limb or impaired intellectual functioning) may have their claim reviewed even less than every seven years. But even those with permanent disability conditions are subject to CDRs.
CDRs for Children
SSA will do a CDR approximately every 3 years if the child’s condition is expected to improve. However, they may also do a CDR if the child’s condition is not expected to improve. Children who are receiving SSI disability benefits will automatically have their claims reviewed when they turn 18. The standards that must be met for an adult to be considered disabled are different than those for a child, so at age 18, the child will be evaluated under the adult standards. Newborns who receive SSI due to a low-birth weight will have their claim reviewed prior to the one-year mark.
Other ways to trigger a CDR
In addition to the regularly scheduled CDRs, the SSA may conduct a continuing disability review in any of the following situations:
• You return to work.
• You inform the SSA that your condition has improved.
• Your medical evidence indicates that your condition has improved.
• A third-party informs the SSA that you are not following your treatment protocol, or
• A new treatment for your disabling condition has recently been introduced.
Continuing Disability Review Process
If your Social Security claim is up for review, the SSA will notify you by mail. You are encouraged to submit any updated medical evidence to the SSA, although the SSA may also obtain this on their own. In general, the SSA will be reviewing the period of 12 months prior to the notice, although the agency can look at evidence from any time after you were initially granted benefits.
Medical Improvement Review Standard
Assuming you haven’t returned to work, Social Security will first determine if there has been medical improvement in your condition. If the answer is no, the continuing disability review process is complete, and your benefits will not be affected.
If the answer is yes, the SSA will then decide if the medical improvement affects your ability (or inability) to work. If it does not, you will continue to receive benefits. But if the SSA comes to the conclusion that your condition has improved to the point where you can return to work, you will be notified that your benefit payments will stop and will be given the chance to appeal the decision.
If the SSA feels that the evidence is insufficient to make a decision, or if there are inconsistencies between what you report and your medical evidence, you could be sent for a consultative examination which is an examination by a doctor that is paid for by the SSA.
SSA will also review your income, resources, and living arrangements to ensure you still meet the non-medical requirements, if you are receiving SSI benefits.
One of the most important things that you can do if you are receiving benefits is to always be forthcoming with information to the SSA. Keep seeing your doctors as you need to and stay compliant with treatment. Keep track of visits to doctors and hospitals so that you can provide evidence to the SSA if you are involved in a CDR.
The disability process can be a very difficult and lengthy process. In the midst of a health crisis, you are dealing with enough; let me fight this battle for you! Contact the Law Office of Jennifer L. Foster, PLLC at 731-506-4006 or 901-866-9495 to discuss which legal strategies will get you the benefits you deserve, or visit us online at www.tndisabilitylaw.com.
The information in this article is for general information purposes only. Nothing in this article should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship.