Medical Improvement Review Standard
Assuming you haven’t returned to work, Social Security will first determine if there has been medical improvement in your condition. If the answer is no, the continuing disability review process is complete, and your benefits will not be affected.
If the answer is yes, the SSA will then decide if the medical improvement affects your ability to work. If it does not, you will continue to receive benefits. But if the SSA comes to the conclusion that your condition has improved to the point where you can return to work, you will be notified that your benefit payments will stop and will be given the chance to appeal the decision. How the SSA makes this decision is governed by guidelines that can be confusing for more information on your chances that the SSA will find you have medically improved, see our article on the medical improvement review standard.
If the SSA feels that the evidence is insufficient to make a decision, or if there are inconsistencies between what you report and your medical evidence, you could be sent for a “consultative examination,” which is an examination by a doctor that is paid for by the SSA.
Appealing A Termination Of Benefits
If your benefits are stopped, you can appeal the decision and request that your claim be re-heard in front of an Administrative Law Judge . And if you are denied benefits at your CDR, you can ask that they be continued until your hearing. However, if the hearing judge agrees with the CDR, you may have to repay these benefits. For more information, see our article on the continuation of disability benefits during appeal.
How Long Will It Take For Ssa To Pay Me
As a rule, it takes one to two months for back benefits to be paid and monthly benefits to begin in a Social Security disability case in which no SSI application was ever filed.
But these are only general rules. In some cases, it takes as long as 3 months for back benefits to be paid. When it takes more than 90 days for back benefits to be paid in a Social Security disability case, it may mean that there has been a bureaucratic mix-up somewhere in the system. In that case it will be necessary to take some sort of action to deal with the delayed benefits.
If 90 days pass from the date of the decision and I am still not paid my back benefits, is there anything that can be done to speed up payment?
It is possible that your attorney may be able to do something if you are not paid after 90 days. Be sure to telephone your attorney to explain that you havent gotten paid after about three months. It may be necessary at that point to contact the payment center.
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Please Answer A Few Questions To Help Us Determine Your Eligibility
The Social Security Administration is required to periodically review the case of every person who is receiving Social Security Disability or Supplemental Security Income disability benefits. This process is called a “continuing disability review” and is intended to identify recipients who might no longer qualify as disabled. If, during a CDR, Social Security finds that your medical condition has improved enough so that you can work, your Social Security benefits will end.
In general, it is much easier to pass a continuing disability review than it is to be granted benefits in the first place.
Be Prepared For Periodic Continuing Disability Reviews
Be Prepared for Periodic Continuing Disability Reviews
Whether you receive Social Security Disability Insurance benefits, Supplemental Security Income benefits, or both, you should be prepared for periodic continuing disability reviews.
The Social Security Administration is required by law to perform regular reviews of disability recipients to see if they continue to be eligible for disability benefits. There are two different types of reviews which may be conducted:
- Continuing Eligibility Reviews where the SSA looks at your medical condition to determine if you are still disabled according to the SSAs definition.
- Redeterminations where the SSA reviews your technical eligibility, including your finances, resources, and income, to determine whether or not you still meet the basic technical requirements for eligibility under SSDI and/or SSI regulations.
For the majority of beneficiaries, the schedule for Continuing Eligibility Reviews is on a three-year cycle, while redeterminations are typically conducted once every six years.
Keep in mind that changes in income, living arrangements, assets, and other factors can also prompt a redetermination. Such changes can also trigger a reevaluation of your monthly SSI payment amount as well.
Your specific disability and symptoms determine when a Continuing Eligibility Review will occur. In some instances reviews may be conducted sooner or later than the standard three-year cycle:
To be prepared for periodic reviews, you should:
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Cdr Standard For Denying Benefits
What could cause you to “fail” your Social Security disability re-evaluation? Your disability benefits can be taken away only if the evidence shows that:
- you have had medical improvement “as it relates to your ability to work,” and
- you now have the ability to engage in substantial gainful activity .
Medical improvement. The main test used in the CDR is the medical improvement review standard . Your condition must show medical improvementthat is, the severity of your impairment must have lessened. The medical improvement must be related to your disabling impairment, not just to any condition you have. There are a couple of situations that indicate an individual has had medical improvement. The claims examiner could determine you have medically improved after reviewing your current medical records or the examiner could say you have had medical improvement if you have returned to regular employment.
“Related to your ability to work.” Not only must the claims examiner find that your disabling condition has medically improved, but he or she must also find that the improvement is related to your work in other words, that it has resulted in an increase in your residual functional capacity .
What Should I Say At My Hearing
You and your witnesses should explain how your disability keeps you from working and affects your daily activities. Your witnesses can either answer your questions or speak directly to the judge about you. The ALJ will ask questions of you and your witnesses.
The judge will make a written decision and mail it to you within a few months. If it is not favorable, it will tell you how to appeal to the Appeals Council.
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What Is A Cdr For Disability
A Continuing Disability Report is a report that the SSA might ask you for to check for proof that you are still disabled. The SSA requires that you constantly meet the definition of disability while receiving disability benefits, and any instance when they cannot confirm you still meet the definition might lead to disability suspension.
The SSA typically goes back and reviews cases every few years. In cases where there is little expectation of recovery, the Administration might wait longer to review your case instead. As part of that review, they may request you to perform a CDR. This could involve seeing a doctor to check your condition as well as filling out paperwork to prove you are still disabled.
Generally, the SSA uses CDRs and other reviews to root out fraud and cancel benefits to people who no longer need them. While undergoing a CDR might be inconvenient and stressful, it is an important tool to help the SSA discover recipients who do not need disability benefits. Stopping payments in cases of fraud or cases where the disability has gotten better ensures there are funds left to pay people who truly need disability payments.
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How Does The Cdr Work
The Social Security Administration typically must conduct a CDR every three years. It is possible that you will receive a review sooner than three years if you have a condition that the SSA expects you will be able to recover from in a shorter time period.
In addition to this three-year schedule, certain events may trigger the SSA to conduct a CDR, including:
- Your return to the workforce
- You have told the SSA that your disability has improved
- Medical data show that your disability has improved
- New treatment for your disability is available
This review aims to identify whether someone who is receiving disability benefits still is disabled or blind based on the SSAs standards. The SSA will inquire about recent medical treatment you have received, any medical tests that have been conducted and whether you have been able to return to work.
If You Receive The Mailer Only
About 72% of all disabled adults receive the short-form mailer only. This form, called the Disability Update Report, asks you about whether your health has improved, whether you and your doctor have discussed your ability to work, whether you’ve visited a doctor, clinic, or hospital, and whether you’ve done any recent work, school or training.
Most people who fill out the mailer and send it in will get a letter from Social Security after one to three months saying that Social Security does not need to do a medical review at this time. This means you do not have to go through a CDR at this point and your CDR is deferred until your next periodic review.
Social Security will reset your periodic review interval, which it calls your “medical reexamination diary,” at the same interval it was before you received the mailer. For instance, if Social Security designated you as “medical improvement possible” and gave you a three-year diary when you were approved for benefits, you’ll be sent another mailer or long-form report in three years.
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How Long Can You Collect Social Security Disability Until Review
A continuing disability review is a reassessment that the Social Security Administration conducts every few years to ensure that you are still deserving of disability benefits. The review includes a medical check as well as a redetermination of non-medical requirements such as income limits. If the SSA finds that you are no longer disabled, or if you no longer meet the non-medical requirements of the program, you would stop receiving the benefits.
How Far Back Will My Benefits Go
Your benefits should begin with the month of the date of entitlement in your case. Many people ask why benefits dont begin on the date they were found disabled. Social Security disability benefits never begin on the date one is found disabled because of the waiting period of five full calendar months. Another rule limits payment of back benefits to 12 months before the date of the application. Therefore, your benefits begin either 12 months before the date of application or five full months after the date you were found to be disabled, whichever is later.
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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 , 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 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 Securitys 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.
When Will My Regular Monthly Benefits Begin
Usually regular monthly benefits begin the month after you receive your check for past-due benefits, although occasionally people get a check for regular monthly benefits first. Your check will be sent out to arrive on the second, third or fourth Wednesday of the month, depending on what day of the month you were born. The check will pay benefits for the previous month. Thus, for example, the check for Januarys benefits will come in February.
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How Often Does Social Security Disability Review Your Case
Typically, the SSA conducts a CDR once every three years or every seven years, depending on whether your medical condition is expected to improve. The more likely the improvement, the sooner you can expect a CDR. The agency uses computer-scoring models to determine the likelihood of your medical improvement. It is also possible that the SSA will decide to perform a CDR sooner than three years or later than seven years, depending again on the outlook of your disability.
Should I Have Someone Represent Me At The Alj Hearing
You may have someone like a lawyer or an experienced paralegal represent you. You can also represent yourself. Represented people generally do better. If you want a lawyer with experience in Social Security claims, ask your local bar association or the National Organization for Social Security Claimant Representatives for a referral.
If you will represent yourself, get a copy of your file as soon as possible. Call the hearing office to arrange to copy your file. Social Security will send you a notice that your file is ready for your review. Call the 1-800 number in the top right of the notice to make an appointment.
The papers in your file are the only info the judge has about you. You must present your whole case at the hearing.
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What Are Continuing Disability Reviews
Once the Social Security Administration grants disability benefits to claimants, it is required to periodically review the cases of people receiving Social Security Disability and Supplemental Security Income disability benefits. The process of Continuing Disability Reviews can often be confusing to claimants. A CDR allows the SSA to determine if any of its benefit recipients are no longer disabled and whether they can still qualify for disability benefits.
How often do CDRs occur?CDRs occur at different times depending on the age and medical condition affecting the benefit recipient.
Adult CDRsCDRs for adults are generally set for review every three or seven years. Whether a CDR is scheduled sooner rather than later is dependent upon the likelihood that the recipients condition will improve. If the SSA expects a claimants condition to improve, it may conduct a CDR much sooner than three years. On the other hand, if the SSA knows a claimant to be disabled from a permanent condition, it may conduct a CDR of the recipient even later than seven years.
Child CDRsCDRS for children are automatically scheduled to occur when the recipient turns 18 years old. The standards to be considered disabled as a child are very different than those for an adult. Thus, children must have their claims reviewed when they reach 18 years old because they need to be evaluated under the adult standards for disability benefits.
What Happens If I Dont Reply To The Cdr Notice
If you receive a CDR from the SSA and do not respond to it, then your Social Security disability benefits will be terminated. While getting a CDR can be scary if you are not expecting it, this notice does not mean that you are going to lose your CDR benefits. Instead, it is simply asking for information to verify that your disability is ongoing and you are still unable to work.
The majority of adults who receive a CDR continue to receive their benefits. The best way to make sure that your benefits continue is to respond to the CDR, and submit any evidence requested by the SSA. If you need more time to respond to the CDR, contact the SSA and ask for an extension.
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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 , or reach out online to schedule a free claim review.
Speak with an experienced disability lawyer about your claim today.
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