SSDI Continuing Disability Reviews: More to Come?
If you are receiving Social Security disability benefits (SSDI), the Social Security Administration (SSA) is supposed to periodically review your medical condition to make sure that you are still considered disabled per Social Security rules. This review is called a Continuing Disability Review (CDR).
Although these reviews were to have been competed along with other workloads including retirement, survivor, Medicare, and new disability claims, many had been deferred due to staffing and budgetary limitations. Due to increasing workloads and budget restrictions a significant portion of the CDR workload had been deferred for many disability beneficiaries. In 2012 Congress earmarked approximately $1.4 billion for program integrity funding. Most of the $1.4 billion will be used to work the 1.5 million CDR claims in the current backlog.
When a person is initially determined to be "disabled" and eligible for SSDI, their claim is identified for a later medical review to determine if medical improvement had occurred. The timing of the review is established on the following criteria:
- Medical Improvement Expected (MIE): Approximately 1 - 2 years after the disability approval.
- Medical Improvement Possible (MIP): Approximately 3 - 5 years after disability approval
- Medical Improvement Not Expected (MINE): From 5-7 years after disability approval
SSA has an obligation to re-evaluate the medical conditions to determine if there has been medical improvement.
The type of review is determined by the potential for medical improvement. Beneficiaries with conditions unlikely to improve, or are progressive in nature, or are closely approaching retirement age are least likely to have a full medical review. Beneficiaries that are younger with impairments with potential improvement are more likely to have the full medical review.
The claims that are more likely to have a“full” medical review are those where medical improvement had previously been determined as either "expected" or “possible”. The volume of claims in the CDR backlog has been increasing annually since 2002. It now seems that SSA may have resumed working the CDR claims as evidences by an increasing number of current SSDI beneficiaries reporting having received notice.
After the CDR review is completed some beneficiaries will receive a notice of proposed termination of their SSDI benefits. The beneficiary has 15 days to request benefit continuation while they appeal the decision to terminate benefits. If appealed within the 15 days, SSA will continue SSDI benefit payments. SSDI representation may be advantageous for those who feel that their condition has not improved sufficiently for them to return to work.
If you are currently receiving SSDI benefits you may wonder what can you expect. If you are a younger person (under age 50) and have a medical condition that is either expected to improve, or could possibly improve, you are most likely to be selected for a full medical review. SSA will be looking to see what medical evidence is available and make a determination whether medical improvement has occurred.
Under the law, a disability beneficiary is found no longer disabled only if the evidence shows both:
Medical improvement related to the ability to work; and,
Ability to engage in SGA. (Substantial Gainful Activity)
If SSA determines that medical improvement has occurred, they will propose cessation and termination of your disability benefits. You may appeal their determination and you may also request benefit continuation during your appeal. Benefit continuation must be requested within 15 days of the date on the notice.
If you receive a Notice of Cessation or Notice of Termination you may contact GENEX Disability for a FREE consultation regarding your appeal and benefit continuation options.