Social Security Disability Benefits Overview
Disabled individuals may be eligible for Social Security disability benefits if they have a disability that prevents them from working. The Social Security Administration, the government agency which administers these benefits, requires that the disability or medical condition prevents an individual from working or engaging in substantial gainful activity (SGA), and is expected to last longer than one year or result in death.
The two forms of benefits administered by the SSA are:
Social Security Disability Insurance (SSDI):
SSDI is a program that is paid into by workers out of their paychecks. To be eligible for SSDI benefits, the applicant must have paid into the Social Security system by working enough hours over the years to qualify.
Supplemental Security Income (SSI):
SSI is a needs-based program that is available for people who haven't worked enough hours to receive SSDI benefits. Recipients are means tested and they must fall below specific income and asset limits to receive SSI.
What is a Continuing Disability Review?
The SSA can conduct a Continuing Disability Review (CDR) which is used to determine whether a person receiving Social Security disability benefits still meets the medical requirements or otherwise is still eligible for having their payments continued. This can involve making a determination on whether the person's condition can still qualify as a disability or whether their condition has improved.
Why Does The SSA Conduct A CDR?
The SSA can examine whether an individual meets ongoing eligibility, apart from the original approval. They will explore whether a recipient's condition has improved or the condition is severe enough to last at least one year. For recipients of Supplemental Security Income (SSI), the review may include non-medical factors such as checking on whether they had any changes in income, assets, or living arrangements.
If a child is receiving disability benefits, the SSA may review whether the child still meets the standard for receiving benefits or will meet the adult standard for disability benefits when, or as they approach, the age of 18.
When Does the SSA Decide to Review a Disability Recipient?
The SSA may schedule a CDR if it is believed that a recipient's condition is likely to improve, the review may occur within the first 6-18 months after approval for benefits. If an improvement is seen as possible, the SSA may conduct a review every 3 years. In cases where improvement is not expected, there may be a review every 5 to 7 years.
What Does the SSA Review?
When the SSA conducts a continuing disability review, they will send Form SSA-455, the Disability Update Report, or Form SSA-454, the Continuing Disability Review Report. These forms will request updated information on a recipient's medical condition. They will ask for updates on the person's medical condition and treatments, as well as any changes in either. For people receiving SSI, the SSA might request information on earnings, assets, or living arrangements to make sure the individual still qualifies based on financial need.
How to Prepare for a CDR
The best way to prepare for a CDR is to already be prepared when the SSA conducts review. This can be done by taking the following steps:
- Keeping copies of your medical records, including appointment history, prescriptions, and treatments.
- Attend all doctors appointments, follow medical advice, and stay in regular contact with your health care providers.
- Be attentive to SSA requests and respond as quickly as possible.
- Maintain records of any work or income. The SSA allows recipients to work a limited number of hours without losing benefits. ,
- If you receive SSI, you will keep track of any changes to your assets or living situation.
If you don't have ready access to any of this information, you will need to gather it up as soon as possible.
What Happens After a CDR?
After the SSA conducts a CDR, they will notify you with their decision on whether your benefits will continue or be terminated. If the SSA determines that you are no longer eligible for benefits, you will have an opportunity to appeal the decision. The appeal follows the same process as a denial of benefits for an initial claim.
Appealing a Decision to Discontinue Benefits
You will have 60 days to appeal after the SSA discontinues your disability benefits.
There are four levels of the Social Security disability appeals process:
- Reconsideration: Your case will be reviewed by a different SSA examiner who was not involved in the decision to terminate benefits. You will not meet with the examiner but can submit new evidence.
- Administrative Law Judge Hearing: If you appeal the reconsideration decision, you can request a hearing before an administrative law judge (ALJ). You will have the opportunity to speak and explain your situation and submit any updated medical evidence. Representatives and/or witnesses can appear at this stage.
- Appeals Council Review: If you disagree with the ALJ's decision, the next step is to bring your case before the Social Security Appeals Council to review the case. The Council can deny your request, issue a decision in your favor, or send your case back to the ALJ for further review.
- Federal Court: If you don't succeed with the Appeals Council or if they decline to review your case, you can file a lawsuit in federal district court for a final appeal.
Contact a Disability Attorney
If the SSA discontinued your disability benefits after conducting a CDR, denied your initial claim for benefits, or you have questions about applying for the first time, contact Jackson Law for assistance. We have helped many clients to receive the disability benefits they deserve.