Friday, September 01, 2006

How often will social security review my disability claim ? (continuing disability review)

Trying to get approved for social security disability or SSI disability benefits can be daunting, due to these aspects (this is by no means a complete list):

1. How long the process takes (which can cause considerable financial repercussions),

2. The poor job the social security administration does with regard to explaining "how things work",

3. The fact that while your case is being processed, your claim will seem to be in limbo (SSA does not provide status updates, just decisional notices).

In fact, the process can be so draining and exhaustive that many claimants, after they've finally won their benefits, will simply want to get the experience behind them and give little thought to how their later actions might affect their benefit eligibility. This, of course, can pose risks. One of those risks has to do with work and how work may affect a recipient's eligibility to receive benefits (I just learned today of an individual who has a $51,000 overpayment which is owed to SSA as a result of unreported earnings).

However, another risk in this area (in the opinion of some disability representatives) has to do with continuing disability reviews, or CDRs.

What is a CDR? Well, after a social security disability or SSI disability claimant is approved and put on benefit receipt, their case is also set for review. Depending on the severity of their condition(s) and the evidence that was available at the time their claim was decided, their claim will typically be reviewed every one, three, or seven years.

To illustrate the differences, a claimant whose case is approved but is "somewhat on the line" may be given a one-year diary date for a review of their disability claim, whereas a person whose condition is such that medical improvement is not expected may be given a seven-year diary date for a review of their disability claim.

When a continuing disability review is conducted, a disability examiner (disability examiners make decisions on disability claims for the social security administration) essentially looks to see whether or not medical improvement has taken place. If the individual's condition has improved, they face the prospect of having their SSD or SSI diability benefits discontinued. If their condition has worsened, or simply stayed the same, their benefits will be continued. The keystone variable, of course, is medical improvement.

The thing is, though, a certain percentage of claimants will stop going to the doctor after they have been awarded benefits, meaning that, by the time their claim is reviewed, there is no preferred means of determining whether or not medical improvement has taken place ("preferred means" equates with records obtained from an individual's treating physician). In other words, how can you gauge an individual's medical eligibility to receive benefits if medical eligibility is based on a review of records...and there are no records?

Can a lack of records at the time of review harm a recipients chances of having their benefits continued? That's debatable, at best, though I've encountered at least one representative who seemed to think so. However, the answer to the question of whether or not a benefit recipient should keep going to the doctor for the sake of a future review may have at least a little to do with whether or not the individual's condition is mental or physical.

Regarding physical impairments, for those who have reached MMI (maxiumum medical improvement), there may be very little reason to keep going to the doctor on a routine basis. And for someone who has been released by their doctor after the doctor has concluded that MMI has been reached, to continue making office visits would seem to be a non-productive use of time (particularly by the doctor).

With mental impairments, the situation may be completely different. If a benefit recipient has schizophrenia, bipolar disorder, anxiety disorder, or any one of a number of other mental conditions, it's not likely that the need for treatment will dissipate after a claim has been won. And most examiners conducting a review of an individual's disability claim would probably find it unusual if treatment had not been obtained for quite some time and records were not available as a result.

Should you keep going to the doctor after you've won your benefits for the sake of future reviews of your claim? Answer: if you need to be seen by a doctor then go, and if you don't need to be seen...then don't go. But treatment should probably not be sought simply for the sake of a continuing disability review (please bear in mind, though, that if you are trying to initially win your benefits, you should be seen regularly so you or your representative can present medical documentation with which to win your claim).

What happens if your claim is reviewed and you do not have current medical records? You will most likely be sent to a consultative exam. However, the findings of CE exams are "very thin", that is to say generally useless. In most cases, other than allowing SSA to fulfill their "recency of medical evidence" requirement, their effect is generally meager.

As an anecdotal contribution to this post, I should mention that many disability examiners have actually remarked that it is difficult to stop someone's benefits if they have not had continued medical treatment simply because without such documentation it is difficult to show that medical improvement has actually taken place. And without medical improvement being demonstrated, a social security disability or SSI recipient cannot have their benefits stopped on the basis of a medical rationale.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Doctor appointment for Social Security Disability
Can I afford a disability attorney for my claim ?
How to claim disability benefits
Applying for disability
Disability and stroke