August 14, 2017
It’s no small feat to be approved for Social Security disability benefits. The Social Security Administration (SSA) has five criteria applicants have to meet in order to be approved for disability benefits:
- Financial Eligibility: Having a solid work history if applying for disability insurance benefits (DIB) or having a household income below a certain level if applying for supplemental security income (SSI)
- Medically Determinable Impairment: Having a disabling condition proven by objective medical evidence
- Meets or Equals Condition on Listing of Impairments: Having one or more disabling conditions included on the SSA’s Listing of Impairments
- No Capacity for Past Work: Inability to work previous jobs
- No Capacity for Any Work: Inability to work any job regardless of the field for which the applicant was trained
Because the approval process is so thorough, many applicants are surprised when they hear that their case will be subject to a continuing disability review (CDR). Will they have to prove that they’re disabled all over again?
The good news is that you won’t have to reapply for benefits every time your case is up for review. CDRs are different from applications, appeals, or even hearings. Whereas the SSA has five criteria to approve applicants for disability, it’s just looking for one thing in a CDR: change to a benefit recipient’s medical condition and/or financial eligibility.
Why Your Benefits May Be Revoked
First, the SSA will look at the most obvious indicator of a change in your medical condition and/or financial eligibility: a return to work. If you’re working and engaging in substantial gainful activity (SGA), your benefits will more than likely be terminated.
If you haven’t returned to work, then the SSA will then move their focus to whether or not your medical condition has improved. If it has, the SSA will then evaluate whether or not that improvement has affected your previously-determined inability to work. The SSA will revoke your benefits if it determines that your medical improvement has given you the ability to engage in SGA.
Sometimes, if there are inconsistencies between what you have reported of your condition and any medical evidence provided by your doctors, the SSA will set up a consultative examination for you. This is an appointment with a doctor, paid for by the SSA, in order to determine whether or not your medical condition has actually improved.
When Will My Case Be Reviewed?
Your letter of award may include when you can expect to have your first CDR. Typically, when you have your first CDR depends on how your case has been labeled by the SSA. The SSA labels your case as one of three labels based on your possibility for medical improvement and your age:
Medical Improvement Expected
You must be able to prove that your disabling condition will last more than a year in order to be eligible for Social Security disability benefits. However, there are still disabilities in which medical improvement is not only possible, but reasonably expected.
For example, perhaps you are granted disability benefits because you are a returning soldier suffering from PTSD. Hopefully, with proper treatment, your condition can be expected to improve so that you can one day return to work.
If the SSA labels your case as medical improvement expected (MIE), you can expect a CDR at least every three years, if not sooner.
Age is also taken into account when labeling cases. Because younger people are more likely to improve medically, you will find few cases labeled MIE if the recipient is over the age of 55.
There are times when age trumps whether or not a medical improvement is actually expected. If a child is receiving SSI, they will have their first CDR at age 18 regardless of the state of their disability. If a baby is receiving SSI due to a low birth-weight, they will have their first CDR when they are a year old.
Medical Improvement Possible
In some cases, medical improvement is not expected, but it is possible. For example, if you’re suffering from a certain type of cancer, your condition may improve with continued medical treatment. Some chronic diseases may go into remission and allow an individual to return to work.
If your case has been labeled as medical improvement possible (MIP), you can expect a CDR around once every three years.
Medical Improvement Not Expected
Even if medical improvement is impossible for you because of the nature of your disability, the SSA requires all recipients of disability benefits to undergo regular CDRs. If your condition is highly unlikely to improve, your case will be labeled as medical improvement not expected (MINE).
If your case has been labeled as MINE, you will typically only undergo a CDR once every seven years. Recipients over the age of 55 are much more likely to undergo CDRs every seven years than those under 55 since the cases of older individuals are less likely to improve with age.
Can Anything Change How Often My Case Is Reviewed?
Depending on how your case is labeled, you will likely undergo a CDR once every three to seven years. However, certain circumstances can change your schedule for CDRs.
If you inform the SSA that you are returning to work or that your condition has improved, you will immediately undergo a CDR.
In addition, if you do not inform the SSA of any changes, you may still undergo a CDR. Your doctor may inform the SSA if new medical evidence shows that you are improving even if you do not directly disclose that information to the SSA. Also, if someone informs the SSA that you are not following your treatment regime, you may be subject to a CDR.
Medical breakthroughs can also trigger CDRs. If a new treatment becomes available that may help your disability, the SSA may choose to review your case.
Help from an Indiana Social Security Disability Attorney
Typically, a CDR is nothing to fear. If your condition has not improved and you have not returned to work, you can rest assured that your benefits will not be taken away after a CDR is conducted.
However, for many people, the initial application process for Social Security disability benefits can be daunting. Perhaps you’ve already received a denial and are unsure of how to move forward with an appeal. Maybe you have a hearing date approaching and you have no idea how you’ll convince an administrative law judge that you qualify for disability benefits.
An Indiana disability attorney can help. Call Hensley Legal Group today or contact us online for a free case review.