Are Disability Reviews Needed to Maintain Disability Benefits?

doctor looking at records in officeThe Social Security Administration does not stop reviewing eligibility for disability benefits once an application is approved. Some applicants must go through Continuing Disability Reviews (CDR) at certain times so the SSA can find out if a medical condition has improved.

Below, the Appleton Social Security Disability attorneys of Sigman Janssen explain what you need to know about CDRs for your disability benefits. If you need help with your disability claim, get a free, no-obligation case review with our legal team – call today.

How Could a CDR Lead to Benefits Being Cancelled?

CDRs are conducted by the SSA to determine a claimant’s disability after benefits have started. The findings of a CDR may cause disability benefits to be cancelled

Types of CDRs

An individual who receives disability benefits may be asked by the SSA to complete a CDR. There are two forms of CDR that may be requested:

Work Review

During a work review, the SSA looks at a beneficiary’s past and current SSDI earnings. The SSA does so to determine if the claimant earns more than the SGA (substantial gainful activity) limit, set at $1,220 per month. If earnings total more than this amount, benefits will be cut off.

One’s work activity or earned income may also cause the SSA to request a medical review. A medical review is not required based solely on work activity if:

  • The beneficiary has received disability benefits for a minimum of 24 months, or
  • The beneficiary participates in the Ticket to Work program

Medical Review

A medical review is done to see if a beneficiary meets the SSA’s medical requirements for the continued payment of disability benefits. If the SSA finds that the beneficiary has experienced substantial medical improvement that allows him or her to work, benefits can be terminated.

The following four criteria must be found during a medical review for benefits to be terminated:

  • The beneficiary’s medical condition has improved enough to allow him or her to engage in substantial gainful activity.
  • Advances in technology or medical/vocational therapy, or participation in vocational therapy have benefited the beneficiary and allowed him or her to perform substantial gainful activity.
  • The beneficiary’s impairment is found to be less disabling than once thought based on new or improved diagnostics, allowing him or her to participate in substantial gainful activity.
  • The earlier disability determination was an error, based on previously recorded or new related evidence.

Updates to the SSA’s disability criteria cannot cause benefits to stop. Reviewers cannot deliver their own judgment – the original adjudicator’s judgment stands. This makes it more difficult for benefits to be terminated based on a medical review.

How the SSA Decides When to Do a Review

Most adult disability beneficiaries will be set to undergo a CDR every three to seven years. The frequency is determined by how likely it is that the beneficiary’s condition will improve. If the beneficiary is expected to experience medical improvement, it is possible that a CDR will be requested sooner than three years. Those who suffer a permanent condition may undergo CDRs less frequently than every seven years.

For children who receive disability benefits, claims are reviewed once the beneficiary reaches age 18. At this point, the child’s disability is evaluated under the standards set forth for adults who are disabled.

In the case of newborns who receive disability benefits because of low birth weight, claims are reviewed before the one-year mark.

In addition to regularly scheduled CDRs, the SSA may request a CDR if any of the following occur:

  • The beneficiary goes back to work.
  • The beneficiary informs the SSA of an improvement in his or her condition.
  • Medical evidence shows that the beneficiary’s condition has improved.
  • A third party informs the SSA that the beneficiary is not following treatment protocols.
  • A recently introduced treatment for the beneficiary’s disabling condition has been introduced.

Get Help from Sigman Janssen Today

The attorneys at our firm can answer your questions about applying for disability benefits and eligibility requirements. We can also help you appeal if your benefits were stopped or taken away after a Continuing Disability Review.

For assistance with your disability claim, request a free, no-obligation consultation with our legal team today. We charge no upfront fees and payment is only due if we recover compensation for you.

Call (877) 888-5201 or fill out our Free Case Review form now.