How Social Security Decides if You Still Have a Qualifying Disability
Legally Reviewed and Edited by: Terry Cochran
When you receive a letter from the Social Security Administration (SSA) informing you they will be reviewing your medical condition; you may be surprised or upset. You may have concerns about navigating the review process regarding your disability and ability to continue receiving benefits.
Learn what to expect through the review process if you receive a letter. A Social Security lawyer at Cochran, Kroll & Associates P.C. can help ensure you file all required paperwork with the SSA, so you receive the benefits you are entitled to without interruption.
How Often Does Social Security Review Your Case?
Federal law requires the SSA to periodically review the medical conditions of all beneficiaries to verify you still qualify for benefits. The review process allows you to demonstrate you still qualify for benefits and considers all evidence of your condition.
These reviews are called Continuing Disability Reviews (CDR). You will learn about the first medical review in your award notice. The SSA will then contact you to review your case at these intervals.
- 6 to 18 months: If you expect your condition to improve, the SSA evaluates your case 6-18 months after the initial incident resulting in injury occurs.
- 3 years: The SSA examines your case every 3 years if improvement is possible but unpredictable.
- 7 years: If there is no improvement in your condition, they will review your case every 7 years.
What is the Process for the SSA to Review a Child’s Disability?
The Social Security Administration conducts a CDR every 3 years for your child who receives disability benefits and whose medical condition is expected to improve.
A child’s representative payee must submit documentation that the child has received medical care during the CDR. Before the child reaches the age of 18, the SSA evaluates their current medical condition to determine if it makes them eligible to receive benefits based on adult criteria.
What Happens During the Social Security Review Process?
The SSA sends one of these two forms to assess your disability.
SSA-455 (Disability Update Report) Form
The SSA-455 tracks any changes in your condition, such as your medical treatment and improvements to your health since your last review. In addition, they will ask whether you have discussed returning to work with your doctor.
SSA-454 (Continuing Disability Review Report) Form
This form involves more detailed questions regarding your disability and work activities since your last evaluation. It includes questions about the doctors, clinics, and hospitals you have seen in the past 12 months. The form also asks about your daily activities, such as driving, shopping, and bathing, and how they affect your disability.
What Happens When I Complete My Disability Review Form?
Your local Social Security office forwards your case to the state’s Disability Determination Services. Your most recent medical records and daily activity responses in your form are compared to your case file, including your prior medical records and application for disability benefits. They also assess your residual functioning capacity, which is your ability to function in a work environment despite physical and mental limitations.
If they need more information about your medical condition, they may order you to go under a medical review paid by the SSA. They will let you know the time, place, and date of the examination. A disability examiner and a medical consultant will review all the evidence collected as part of your CDR.
What is My Chance of Being Denied Benefits After My Disability Review?
As a result of reviewing your form and your case file, the SSA may decide you are not disabled, and as such, you will no longer receive disability benefits. They may deny you further benefits for the following reasons:
- You have reached retirement age: Social Security Disability Benefits end when you reach full retirement age and begin receiving retirement benefits. If you were born between 1955 to 1959, your full retirement age is 66.
- You no longer have a disability: The SSA will consider your medical records that detail any new health issues and treatments. A medical review can reveal if there have been improvements in your condition. The SSA may deny your disability benefits when your medical condition improves, so you are no longer disabled.
- You engage in substantial gainful activity: A substantial gainful activity (SGA) is any work activity that generates over a specific amount of income per month. The work activity can be a full-time or part-time position. It is considered substantial if the work activity involves major physical or mental activity or both.
Social Security benefits include a work incentive program that lets you test your ability to work with your disability. The program also helps the SSA determine whether your work activity is SGA by using earnings thresholds.
You can work for 9 months without limiting your earnings during the trial period. Afterward, you can continue to work during an extended eligibility period of 36 months. However, the earnings you receive cannot be over $1,350 a month as of 2022. Crossing this threshold results in you losing your benefits.
There are special rules for those who are blind, such as a higher SGA threshold if they earn over $2,260. If you earn too much to qualify for disability benefits, you may be eligible for a disability freeze. When you freeze your disability, the SSA doesn’t calculate your future benefits for the years you had little or no earnings due to your disability.
Get Help When From a Social Security LawyerYou Apply for Disability Benefits
You have 60 days from the date you receive the decision letter to file a written request to appeal the decision if you are still eligible for disability benefits. Whether you have been refused the continuation of your disability benefits or plan to apply for disability benefits, attorneys at Cochran Kroll & Associates, P.C., can help you receive the benefits you deserve.
Our contingency fee basis means we only get paid if we win your case, so there is no financial risk to you to get started. Call our law firm today at 866-MICH-LAW and schedule your no-obligation, free case evaluation.
Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.