Continuing Disability Reviews and the medical improvement review standard

Doctor with patient in officeThe Social Security Administration only grants Social Security Disability benefits to people with disabling conditions expected to last over a year. Many conditions that qualify for benefits are not expected to improve. However, the SSA conducts regular reviews to determine whether each condition is still disabling. A failed review can lead to benefit Loss. Fortunately, these reviews are often less difficult to pass than the initial benefit application.

Evaluation process

When a disability case is due for review, the SSA sends the benefit recipient one of two forms. The Disability Update Report is sent to people with conditions that are not reasonably expected to improve. The longer Continuing Disability Review Report is sent to people whose conditions might change. It is also sent to people whose responses on the Disability Update Report indicate medical improvement.

The CDRR requires more in-depth information. The form asks about medical tests, hospitalizations, treatments and attempted employment within the last year. Applicants can submit medical documentation showing eligibility for SSD along with the CDRR. Otherwise, the SSA will procure medical evidence independently and use the medical improvement standard to evaluate the condition.

If no medical improvement is evident, the disability review is complete. If improvements have occurred, the SSA considers how the changes affect the applicant’s ability to work. If the SSA believes the individual is no longer too disabled to work, the individual will receive notice of benefit discontinuation. If the medical evidence is inadequate to support a decision, the SSA may order a consultative examination with an SSA doctor.

Review timing

The frequency of Continuing Disability Reviews depends on the benefit recipient’s age and condition. Children who receive Supplementary Security Income or child’s SSD benefits have scheduled reviews at age 18. During the review, the SSA determines whether the child meets the adult definition of disabled. Adult reviews are usually scheduled every three or seven years. However, they may be scheduled more frequently if a condition is expected to improve.

Certain situations can trigger a Continuing Disability Review. The following scenarios may provide grounds for a review:

  • Medical evidence indicates the condition has improved.
  • The benefit recipient tells the SSA the condition has improved.
  • The benefit recipient resumes working.
  • Medical advances yield a new treatment for the condition.
  • Someone notifies the SSA that the individual has diverged from the prescribed treatment protocol.

Benefit recipients should always notify the SSA of changes in employment, medical condition or treatment. This can help maintain credibility. It also gives people with improving conditions the opportunity to inquire about transitional programs. For example, a trial work period allows a benefit recipient to try returning to work for a 9-month period without risking immediate benefit loss.

By |2014-10-18T20:40:05+00:00October 18th, 2014|Application process|Comments Off on Continuing Disability Reviews and the medical improvement review standard