If you receive Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits through the Social Security Administration (SSA), you are already familiar with how complex the process can be. Applying for, and being awarded benefits can take a substantial amount of time, and generally requires significant documentation of your disability and functional limitations causing your inability to work.
Once you obtain benefits, that is not the end of the process. The SSA is required to periodically review the case of every person receiving SSD or SSI benefits. This is known as a continuing disability review (CDR). If Social Security finds during a CDR that your impairments have improved to the extent that you are able to work, then you will no longer be eligible to receive disability benefits.
The idea of a CDR may seem daunting, especially after a hard-fought battle to obtain benefits. However, it is generally harder for Social Security to terminate your benefits than to deny them in the first place, so it can be easier to get through a CDR than it was to be granted initial benefits.
For example, in 2014, 937,023 CDRs were completed for people with disabilities, and only 12,305 benefits were terminated as a result.
As a Philadelphia disability benefits lawyer explains, understanding the process and what information the SSA is seeking can help dispel any fears about a CDR.
What Is a Continuing Disability Review?
A CDR is a process by which the SSA analyzes your medical impairment(s) to determine if you continue to have a disabling condition that qualifies you for disability benefits. If the SSA finds that your condition has improved and you are no longer disabled or blind, then your benefits will terminate.
During a CDR, the SSA will review information about your disability. It is required to perform a CDR at least once every 3 years unless you have a medical condition that is expected to improve sooner. If you have a medical condition that is not expected to improve, then your case may only be reviewed once every 7 years. Judges can also set different timelines for review when awarding a case, requesting that the Administration re-review a case in as little as twelve months after an award.
If your condition is not expected to improve, then the SSA will send you the Disability Update Report when your claim is being reviewed. This is a short 2-page report that you are required to complete and return to the SSA. Otherwise, you will be sent the more detailed “Continuing Disability Review Report,” which is 10 pages long.
In the Continuing Disability Review Report, the SSA will request information such as whether you have seen a doctor or been hospitalized in the past year, if you have had any recent tests, and if you have been working. The SSA will also ask for any updated medical evidence from the past 12 months. Generally, the review will cover the previous year, although the SSA can look back to the point when you were initially granted benefits.
Beyond medical information, the SSA will also review your income, living arrangements and living arrangements to make sure that you meet other program requirements. For children, the SSA may perform a CDR at least once every 3 years if they expect the child’s condition to improve. They may still initiate a CDR if they do not expect the child’s condition to improve.
How Long Will a Continuing Disability Review Take?
The length of the CDR process depends in large part on whether you receive the short Disability Update Report or the longer Continuing Disability Review Report. The short-form mailer is a scannable form, and is used as a basis to determine whether or not SSA will conduct a CDR. If you receive a short-form mailer, then you get a response informing you of whether SSA will do a full review of your disability benefits.
However, if you receive the longer Continuing Disability Review Report, then you will be undergoing a CDR. This form will take some time for you to fill out, as you will need to respond to questions about your daily activities, visits with doctors and any tests or trips to the hospital or other medical centers. Once you send in this report, the SSA will conduct a full medical review of your case.
In some cases, beneficiaries who initially received the short-form mailer will be flagged for a CDR. They will then receive the longer Continuing Disability Review Report, and have to undergo a full medical review.
This process typically takes 5 to 6 months or longer. This may occur randomly, and so, just because you receive the longer form rather than the shorter does not mean that Social Security is planning to terminate your benefits.
While some of this process is, indeed, random, SSA determines who receives which mailer based on a system of marking recipients as high, medium or low profile. If you have a “low” profile, you are less likely to show medical improvement and probably will not have to go through a CDR. Profile is determined by looking at a number of factors, such as your impairment, age, recent earnings (if any), and how long you have been earning benefits.
The vast majority of periodic CDRs do not result in a full review. In 2014, 937,023 CDRs were processed by the SSA for people receiving disability benefits. Of those, 683,005 (72.8%) involved mailers only, while just 180,706 led to full medical reviews. As noted above, only a small sub-group of those resulted in termination.
What is the Standard for Evaluating Medical Improvement?
Evaluating “Medical Improvement,” during a continuing disability review is different from the 5-step sequential evaluation process Social Security uses when evaluating whether or not you are disabled.
During a CDR, Social Security will use the Medical Improvement Review Standard (MIRS), except in very few cases where Social Security applies an exception and determines that the individual would not or should not have ever been found disabled in the first place. Interestingly, Social Security was audited with a report issued on June 6, 2019, showing that it was misusing the exceptions (other than failure to cooperate with the review) to improperly terminate several claimants.
While the issues were later corrected on appeal, Social Security was admonished to “ensure new and existing DDS staff are properly trained in the correct use of MIRS exceptions since errors can lead to incorrectly ceasing beneficiaries’ payments and/or unnecessary appeals.” Social Security agreed.
When using the MIRS it is Social Security’s burden to “show that you are currently able to engage in substantial gainful activity before we can find that you are no longer disabled. This means that Social Security must not only determine that you have medically improved, but also that the improvement is related to the ability to work.
In order to reach this conclusion, Social Security will make a “comparison point decision,” where they will compare your limitations at the time of the most recent favorable decision on your claim with your current limitations.
So, for example, if you were found disabled because you could only stand and walk for one hour in an eight-hour day, but now you are able to stand and walk for four hours, and as a result, can now complete a full workday, Social Security may find you have had medical improvement related to your ability to work, and can return to work.
On the other hand, if Social Security finds that you are in less pain, but still can only stand and walk for one hour, then even though you have had medical improvement (you’re in less pain), it is not related to your ability to work, and your benefits would continue.
Because it is Social Security’s burden to prove you are able to return to work, it is harder to lose your benefits than to gain them, since you are initially responsible for proving that you are disabled. That said, disability cessations can happen.
What to do if SSA terminates your benefits
You may elect to have your benefits continued while you appeal but you must act fast! You must appeal and state your desire to continue your benefits within 10 days. If you do not do this, and appeal within the 60-day appeal period instead, Social Security will stop your benefits while you appeal.
You may be able to get this money back if you are successful. On the other hand, if you are not successful in your appeal, you may have to pay the benefits you received while you appealed back to the government. This is why this is a choice Social Security provides, rather than an automatic continuation or cessation of benefits.
Either way, it is critically important that you do not wait to appeal, or to get help appealing if needed.
How a Philadelphia Disability Benefits Lawyer Can Help
Even after you have been awarded disability benefits, there are still hurdles to maintaining your status with the SSA. Learning about the CDR process can help you be better prepared for a periodic review. If you are selected for a longer form report or for a full medical review, a Philadelphia disability benefits lawyer can work with you to help you put together a strong case for continued benefits.
The law firm of Bross & Frankel aggressively advocates for individuals with disabilities. With offices in both New Jersey and Pennsylvania, we are well-equipped to assist clients throughout the Philadelphia metro region. Contact us today at (856) 795-8880, or reach out online to schedule a free claim review.