Social Security Disability Benefits (SSDI) and Supplemental Security Income (SSI) are the two major income sources for disabled Americans who cannot work and earn an income. To determine eligibility for these benefits, the applicant’s medical records are reviewed with the support of medical records services. The SSA (Social Security Administration) periodically reviews the case of every person receiving these benefits, and this process is known as a “continuing disability review” or CDR. The review aims to identify those recipients who might no longer qualify as disabled. If the CDR finds that the beneficiary’s medical condition has improved sufficiently so that he/she can work, their social security benefits will end. CDRs are performed at different intervals for different recipients, based on their age and medical condition.
Here are some facts to know about CDRs.
Fact 1. There are 2 types of CDRs, Work CDR and Medical CDR. Under a work review, the SSA considers your earnings to determine if you are earning more than substantial gainful activity (SGA), i.e. more than $1,090 per month. If yes, your benefits may be terminated. In a medical review, the objective is to find out if you meet the medical requirements to collect disability benefits. Under the MIRS (Medical Improvement Review Standard), SSDI benefits cannot cease due to updates in SSA disability criteria. Reviewers cannot substitute their judgment for that of the original adjudicator. On account of these restrictions, it is difficult for the SSA to terminate eligibility. You don’t have to undergo a medical continuing disability review based on work activity alone if you
- Have received disability benefits for at least 24 months
- Are participating in the Ticket to Work program
If a beneficiary qualifies for protection from a medical CDR based on work activity, they will still have to undergo a regularly scheduled medical CDR.
Fact 2. How often medical CDRs are conducted is based on the severity of your condition. Individual review schedules ranging from every 6 months to every 7 years based on the likelihood that the beneficiary will experience medical improvement. If medical improvement is “expected,” the case will be reviewed 6 – 18 months after the benefits start. If improvement is “possible,” it will be reviewed no sooner than 3 years, and if improvement is “not expected,” the case will normally be reviewed no sooner than 5 to 7 years.
Fact 3. If you fail to respond, it could result in the termination of your benefits. Beneficiaries may be sent a Disability Update Report Questionnaire instead of a notice that you will undergo full medical review. You have to complete the report on whether your health status has improved, and also provide information regarding recent medical care, and employment or training undergone. In case you report work activity or improvement, it could trigger a full medical review. If you fail to complete and return the questionnaire, that could also trigger a full medical review. A full medical review is deferred if you do not report any work activity or improvement in medical condition.
Fact 4. Only if the SSA finds sufficient evidence of medical improvement that allows you to engage in substantial employment, will they terminate your benefits. Typically, no action is taken if your disability prevents you from working and your health condition has not improved.
Fact 5. Your benefits may be terminated if you are engaging in substantial gainful activity; or have obtained the prior determination fraudulently; you cannot be located; or you fail to cooperate in a CDR without a good reason; or do not follow prescribed medical treatment.
Fact 6. You can appeal a CDR decision. If the SSA determines that you are no longer disabled and discontinues benefits, you can appeal the decision within 60 days. For this use the form SSA-789-U4 from the local Social Security field office. Have a face-to-face hearing with a disability hearing officer who will make the decision on the appeal.
Fact 7. Even if you are no longer considered medically eligible, you may be able to continue receiving benefits. This is possible if you participate in an approved vocational rehabilitation program, whether public or private, before your eligibility ended and the SSA determines that the program is likely to increase your permanent independence and self-sufficiency.
Fact 8. Even if you become ineligible under a work review, you may be able to restart the benefits. Sometimes you may become ineligible for SSDI benefits due to work at the SGA level, in which case you can request to reinstate the benefits at a later time, without filing a new application. This is possible if you become unable to work and earn SGA because of the same medical condition or a related one. File the request for reinstatement with Social Security within 60 months from the month your benefits are terminated.
Fact 9. You can request provisional benefits during the appeal process. If you do this, the SSA may provide up to 6 months of provisional benefits (including Medicare) while your case is being reviewed. You don’t have to repay provisional benefits even if the appeal is denied. If you want the benefits to continue while the case is being reviewed, make sure that the Request for Reconsideration is submitted within 10 days of receiving the denial. Include a specific request for continuation of benefits during the appeal.
Fact 10. The SSA will not schedule you for a medical CDR if you are participating in the Ticket to Work program. You will have to assign your Ticket to an approved service provider before you receive intimation of a medical continuing disability review. If a medical CDR had been scheduled before you assigned your Ticket, you will have to undergo the disability review.
Medical records and all documentation including X-Ray reports, blood test reports, EKGs and so on will have to be reviewed, which makes solutions such as medical review services very significant. Any updated medical evidence must be submitted to the SSA for review. A disability attorney can provide the necessary support for those who have been notified of a CDR. If the SSA determines that you are no longer disabled and decides to terminate your benefits, you have the option to appeal the CDR decision.