When is your disability reviewed?

by Tim Moore, Disability Representative in North Carolina

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When is your Social Security Disability Claim reviewed?

In the smallest percentage of cases, a review can happen a year after an approval has been made. This hardly ever happens. Most claims are reviewed every several years and nearly all claimants continue receiving their benefits after the review is completed.

(Read if you live in North Carolina)

Why are reviews conducted?

Social Security periodically reviews all disability recipients to determine if they are still eligible to receive disability as defined by the rules and regulations of the Social Security administration. Two things affect disability eligibility and that is medical improvement and work activity.

How does Social Security know when disability claims need to be looked at again?

Social Security has a system of medical diary dates that it uses to review an individual’s eligibility to continue receiving disability benefits. These reviews are known as Social Security Disability reviews or continuing medical reviews (CDR for short). Since I mentioned Social Security’s medical diary date system, I will explain what is meant by a medical diary date.

Social Security generally establishes review dates (for periodic medical reviews of someone’s case) in the following categories:

1. Improvement likely

2. Improvement possible

3. No improvement possible

An Improvement likely diary indicates that Social Security will review your case at some point prior to three years. A medical Improvement possible diary indicates that Social Security will review your claim every three years or so. And a No improvement possible diary signifies that Social Security will review your claim every seven years or more.

Going back to work can trigger a review of your claim

Is your case reviewed only according to these time frames? No, a review can occur if it is “triggered”. What might trigger a Social Security Disability review other than an established diary date? Work activity often triggers work-continuing reviews that may lead to a medical review to establish medical improvement.

Social Security has access to the earnings that are being reported yearly to the Internal Revenue Service from employers and tax returns. If a work alert is established for your disability case, SSA will notify you that your disability eligibility is being reviewed. Of course, if you report that you have returned to work or another individual reports that you are working, your work activity may be reviewed to determine if it is substantial gainful activity (if you are working at more than the substantial gainful activity level, this means you are earning more than the limit that is allowed for you to continue receiving disability benefits).

Going back to work can make Social Security rethink your disability status

What does the performance of substantial gainful activity indicate to Social Security? Potentially the performance of substantial gainful activity indicates medical improvement. However, the mere performance of substantial gainful activity does not always indicate that medical improvement has taken place. But it can possibly lead to a suspension of disability eligibility or even termination of one’s disability benefits.

If there is no work activity being performed by you and your medical diary date is due (meaning that your case has come up for review), Social Security will still periodically review your disability from a medical standpoint.

How does Social Security conduct your review?

How does Social Security conduct a Social Security Disability review (continuing medical review)? When it is time for your medical review, Social Security will contact you by mail to schedule an office or telephone appointment, or perhaps they will just send the forms you need to fill out and return (Of course, if you have difficulty filling out the forms you should contact the claims representative who sent your forms to you and they can help you fill them out, either by phone or in person.).

Once Social Security has obtained a medical update, they will develop a complete twelve-month medical history from the information that you have provided and determine if there has been any medical improvement.

A review is usually nothing to worry about

Generally, there is no need to worry about a medical continuing review if you have not experienced an improvement in your medical condition or have not returned to work at a level that Social Security considers to be substantial gainful activity.