Continuing Disability Reviews

Once you received your Social Security Disability benefits, you thought it was over.  You waited a long time to get before the judge, you presented Social Security with the right evidence, provided great testimony, and shortly after, you received your benefits check.  Unfortunately, it may not be over.

By law, the Social Security Administration must review your case every three years to ensure that you are still disabled under the rules (if your condition is not expected to improve or you are over age 55, the Continuing Disability Review, or CDR, as it’s called, may be less frequent).  I have received many calls from clients upon receiving a notice of CDR, often with a bit of confusion as to why they have to prove their disability again.  While it can be frustrating, and certainly confusing, there is good news.

The Process

First, a CDR places the burden on Social Security to show that you are no longer disabled.  Whereas during the initial claim, it is your responsibility to prove to Social Security that you are disabled, a CDR reverses the burden.  Here, it is their burden to show that your condition has improved such that you can now work.

This determination is made based on the Medical Improvement Review Standard (MIRS), which has two parts.  First, your disabling medical condition(s) must have improved and second, the improvement must relate to your ability to work.  This essentially means that your condition must have improved enough that Social Security thinks you can work again.  (To that end, if you have been working part-time while disabled and you begin making more than the Substantial Gainful Activity amount, a CDR might be triggered).

Most people do not lose their benefits under a CDR.  However, it is important that you have continued your medical treatment, that those records are available, and that the records reflect that your condition has not improved, or has worsened.  The best thing you can do is to cooperate with Social Security at this point.

You will receive one of two forms: the short-form or long-form CDR.  The short form is 2 pages and is Form SSA-455; the long form is about 13 pages and is SSA-454-BK.  If you have received the short form, then Social Security most likely does not believe that your condition is one that will improve.  If you have received the long form, however, Social Security is likely looking for a more extensive analysis, as it believes, for any number of reasons, that your disability may have improved.

Additionally, you may be asked to attend a consultative examination, or CE, by a doctor chosen by Social Security.  Social Security will pay for this visit, so you don’t have to worry about paying out-of-network rates or coming up with the money for another visit.  Normally, however, you are only sent to a CE when Social Security feels that it does not have enough information to reach a decision, or if information you provided conflicts (which is another reason to carefully and completely fill out the Social Security forms).

Will My Benefits Stop?

If Social Security ultimately determines that you are still disabled, you will continue receiving your benefits, without change (you will continue receiving your benefits throughout the CDR process).  If, however, Social Security determines that you are no longer disabled, your benefits will cease unless you request reconsideration within 10 days of the decision.  You must complete the request for reconsideration form and return it.

In order to continue receiving benefits throughout the appeal process, you must also fill out the Benefit Continuation Election Statement within that 10 day window.  Likewise, if you are found to be recovered after reconsideration, you must request a hearing within 10 days and again request continuing benefits.  If you are still found to have recovered, you can appeal to the Appeals Council, although your benefits will cease as of the date of the decision.  If, however, the Appeals Council remands your case (meaning it sends it back to the judge for a new hearing), your benefits will automatically resume.

Social Security is entitled to repayment of any benefits that you were not entitled to receive.  Thus, if your case is ultimately unsuccessful, but you elected to continue receiving benefits, you may be required to pay that amount back.  However, you may ask for a waiver, so long as your appeals were in good faith and you needed the income for “ordinary and necessary living expenses.”  Likewise, if you forego your benefits during an appeal, you will be entitled to repayment of any past due benefits (often called back benefits) that you were entitled to.

The law and process surrounding Continuing Disability Reviews can be cumbersome and complicated.  If you have received a CDR notice or one of the CDR forms, Thompson Law Offices, LLC is happy to assist you and guide you through the process.  All Social Security consultations are free, whether you are an existing client or not.