Why Does a Social Security Disability Claim Come Under Review?

Navigating Social Security Disability Benefits claims can be a challenge. When someone finally gets the letter that they are going to start receiving benefits, it can be tempting to relax and celebrate. At the same time, it is important to remember that continuing disability reviews (CDRs), also known as continuing benefits reviews, may happen. There are two types of reviews that might be triggered.

Medical ReviewsSSDI-Benefits-Reviews

From time to time, individuals receiving Social Security Income SSDI may come under what’s called a medical review. The purpose of this review is to determine whether or not someone still meets the medical criteria to continue receiving disability benefits. During this process, a reviewer cannot substitute his or her judgment for the original adjudicator. Therefore, it is harder to terminate benefits than to continue them.

A medical CDR based on work activity alone cannot be required if someone:

  • Has received disability benefits for at least 24 months OR
  • Is participating in the Ticket to Work program.

Even though someone may not have to undergo a review based on work activity, he or she may still need to undergo a medical review based on condition.

The Frequency of Medical Reviews

The frequency of medical CDRs is based on the severity of the medical condition. The Social Security Administration assigns individual reviews ranging from every six months to every seven years. This assignment is based on the likelihood of experiencing medical improvement. The various categories are:

  • Expected: The case is typically reviewed within six to 18 months after benefits start.
  • Possible: The case will typically be reviewed no sooner than three years.
  • Not Expected: The case will typically not be reviewed before five to seven years.

Disability Update Reports

Individuals may receive a Disability Update Report questionnaire instead of a full medical review. This questionnaire is a self-report on someone’s current health status. It will address medical improvement, any recent medical care, employment, and possible work training activity. 

If someone is showing signs of improvement in this questionnaire, a full medical review may be triggered. If someone’s health has not improved, it is likely that no action will be taken. Specifically, the Social Security Administration must identify one of the following criteria to terminate benefits:

  • The claimant has improved medically and can engage in gainful employment
  • Advances in medical or vocational therapy or technology allow the claimant to return to work
  • New medical technology has uncovered that the impairment is not as disabling as previously thought and the claimant can return to work
  •  This earlier determination was an error based on evidence in the record or newly obtained evidence related to the original determination

In addition, the Social Security Administration can also terminate benefits under any of the following conditions:

  • The claimant is currently working
  • The first determination was obtained through fraud
  • The claimant either cannot be located or is not participating in the review process
  • The claimant is not following the advice of medical professionals

It is important to note that someone who does not participate in the review process may lose his or her benefits.

Rely on the Team at Match & Farnsworth in Salt Lake City, Utah

During the continuing benefits review process, everyone should trust a trained attorney who has experience in Social Security law. At Match & Farnsworth, our lawyers and staff are committed to providing all clients with the representation they deserve. Our goal is to get to know all of our clients personally, which allows us to best advocate for their needs. To learn more about how we can help you, please contact us today!

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