Social Security is required to periodically review all claims after awarding SSDI and SSI benefits
Once you have been approved and begin to receive Social Security Disability benefits, whether you are receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), the Social Security Administration (SSA) will periodically review your case to re-determine if you qualify to receive these benefits. All claimants are subject to a Continuing Disability Review (CDR) every 1 to 7 years, depending upon the likelihood for improvement in their condition(s).
When you are selected for your CDR, SSA will notify you by mail. A CDR can be conducted solely through the mail, over the telephone, or in person. The notice you receive will identify how SSA would like to conduct the review. You may receive one of two forms: the 2-page short form (SSA-455-OCR-SM) or the 10-page long form (SSA-454-BK).
The short form is for claimants whose condition(s) are unlikely to improve, where the long form is for those who SSA believes condition(s) may have improved. Once submitted, the short form is read by a computer and only reviewed if unusual information is detected. The long form is similar to your initial disability application and will be reviewed by an employee within SSA.
SSA may request updated medical records. Records may come from you, but SSA can also access records themselves. They will generally review medical records from the last 12 months, but can look at all information since the time you were approved.
What Are They Looking For?
When reviewing your claim, SSA wants to know two things:
1) Have your medical conditions improved?
2) Are you able to engage in Substantial, Gainful Activity (SGA)?
These questions help determine whether or not your disability benefits will continue. Have your conditions changed? Do these changes affect your ability or inability to work? Have you returned to work? Are you earning at or above the SGA level of $1,090 per month? If the answers are no, your benefits will continue. If SSA finds the answer to one or more of these questions to be yes, your claim may be sent for further review.
Medical Improvement Review Standards (MIRS)
Disability Determination Services (DDS) is responsible for reviewing medical records and work history for the initial application and reconsideration phases of the disability process, as well as for CDR cases. They will review your updated medical records and may send you to a consultative examination (CE) with one of their doctors if additional information is needed. They are looking to see if your medical conditions have improved and if you have an increased Residual Functional Capacity (RFC). They will compare your prior RFC to your current RFC and determine if they believe you are capable of engaging in SGA. If they determine your current conditions allow you to engage in SGA, your CDR will be denied.
What If I Am Denied?
If your CDR is denied, you can appeal the decision. During this time, you can ask for your benefits to continue while you wait for a Hearing before an Administrative Law Judge (ALJ). However, if the ALJ agrees with the CDR denial, you will be responsible for repayment of all benefits received following the initial CDR date.
A CDR can be conducted at any time. If SSA is notified (by you, a third party, or medical resources) your medical conditions have improved, you have returned to work, or new treatment is available for your condition(s), a CDR may occur. SSA is required to review all medical and non-medical requirements regarding your disability case, except under the following situations.
Group I Exceptions
• You begin working over the SGA level of $1,090 per month
• You receive vocational training qualifying you for work you were previously not qualified for
• New treatment or medical evaluations show you are not disabled
• An error was found in your original determination
Group II Exceptions
• You committed fraud on your original disability claim
• You fail to cooperate with the CDR
• SSA can not locate you
• You failed to follow your treatment plan
Under the above circumstances, SSA may discontinue your benefits without further explanation.
Like adults, children are subject to disability reviews on a regular basis. SSA wants to know if your child has shown medical improvement and ensure they are receiving the necessary treatment. If a child’s condition(s) is no longer considered “marked” or “severe”, their benefits may cease.
At the age of 18, all child benefits are ceased for a CDR to re-evaluate their condition(s) under adult standards.
While we can not help with your CDR, we can provide information and support regarding your situation. If your CDR is denied and you would like to file a new application to receive disability benefits, contact us now. We are ready, willing, and able to help you!