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What Is A Disability Medical Record Review For Social Security Disability Benefits?

 Social Security Disability

The SSA (Social Security Administration) conducts routine reviews to evaluate the medical condition of people who receive disability benefits. This routine review is called CDR or Continuing Disability Review, and how often this is performed depends on how likely the beneficiary is likely to recover and get back to work. Since medical records are key in this process, medical record review for social security disability firms is an important service. If the beneficiary’s health has not improved and he/she cannot work due to the disability, the benefits will continue. The social security disability review process enables the disabled person to demonstrate that he/she still has a qualifying disability and therefore require the benefits.

Medical Chart Review for Disability Evaluation

The SSA will collect and review all medical records related to the beneficiary’s health condition. In case there is more than one disabling condition, they will consider the combined effect of all the disabilities on the beneficiary’s ability to work. So, how frequent are these reviews? It depends on the nature and severity of the impairment and whether it is expected to improve.

  • If the beneficiary’s health condition is expected to improve, the first review will be 6 to 18 months after the date the person became disabled.
  • If improvement is expected, but cannot be clearly determined, the SSA will perform the review every three years.
  • In case improvement is not expected, the case is reviewed every seven years.

The Medical Review Process

The SSA will consider how the person’s medical condition affects him or her, and whether it has improved. They will want information such as the treating doctors’ names, addresses, and phone numbers; patient record numbers from hospitals and other medical sources that have treated the person since the SSA last contacted him/her; the dates (if the person has worked since the last review), his/her pay received, and the kind of work they performed.

The beneficiary is required to produce all the medical records for a comprehensive medical record review.

The Disability Determination Services in each state makes disability decisions for the SSA. They will ask the doctors, hospitals and other medical sources where the person has received treatment to explain how the medical condition limits the person’s activities, what the medical tests show, and what medical treatments have been given to the beneficiary. In case more information is needed, the SSA may request a special examination or test for which they will pay. A disability examiner and a medical consultant will review all the medical details.

When evaluating whether a person is still disabled, the SSA will consider whether he/she is currently doing substantial gainful activity, whether they still meet or equal a listing in the Blue Book, and whether there are any improvements in his/her condition that could have increased their ability to work. The SSA will also evaluate the person’s compliance with SSA rules, as for instance, if the person has refused to follow some prescribed treatment that could restore his/her ability to work, they may lose their benefits.

The evaluation begins with the beneficiary receiving a form in the mail from the SSA that they have to fill out and send back. These forms can be short or long. The short form/mailer is the Disability Update Report that is used to determine whether the recipient needs a continuing disability review.

Typically, this form contains questions such as the following:

  • How often the recipient visits his/her doctor
  • Whether they have attended any recent trainings
  • Whether there is any improvement in his/her health
  • Whether he/she is following the prescribed treatment
  • Whether the treating doctor has discussed the possibility of the beneficiary returning to work

The SSA will send a letter communicating their decision. If they feel a medical review is not needed at that time, the CDR will be postponed until the next review period. However, if the answers provided do not convince the SSA about the beneficiary’s eligibility for continuing benefits, they may order a full medical review.

The long form or the CDR Form SSA454, is sent to people with a high chance of recovery. People who receive this will have to go through a full medical review. The questions in this instance are more extensive, and includes whether the applicant has worked since his/her last review.

Generally, a person who is still disabled and unable to work needn’t be concerned about losing their benefits.

The wait time to get a reply from the SSA can range from weeks to months, and this depends on the backlog each state is facing with Continuing Disability Reviews. In case the benefits are stopped (cessation), the beneficiary can always appeal.  To appeal, it is essential to send a reply to the SSA within the required time frame. All required information regarding how to appeal is included in the Cessation notice one receives from the SSA.

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