When you are approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), that approval is not necessarily permanent. SSA is putting increasing efforts into conducting Continuing Disability Reviews (CDRs) to determine whether you still meet the medical criteria for disability. Members of Congress – both Democrat and Republican – are encouraging SSA to conduct more reviews because the Social Security trust fund is running out of money and they see CDRs as a tool to keep the disability trust fund solvent, and to avoid making difficult political decisions about actually fixing the problem.
In this post, I will explain what a CDR is, how the process works, the strategic decisions you must make if you receive a notice of intent to terminate benefits, and how ongoing medical treatment is your strongest line of defense.
What Is a Continuing Disability Review (CDR)?
A CDR is SSA’s process to determine if an approved claimant now receiving disability benefits continues to meet the medical requirements for disability – in other words are you still unable to reliably perform a simple job. SSA initiates a CDR based on several triggers, such as:
- The passage of a designated review period (SSA puts a code on every claim classifying it as one where medical improvement is likely, possible, or not likely at all. If your claim is coded as “medical improvement is likely’ you will be reviewed often.
- Your age – in my experience claimants over age 50 generally face fewer reviews than those under 50
- A tip or report suggesting medical improvement.
- Your return to work (remember that the IRS shares earnings record information with SSA).
SSA uses two types of reviews:
1. Long Form Review: This involves collecting and evaluating updated medical records. SSA may send you forms like the SSA-454 (Continuing Disability Review Report) and SSA-827 (Authorization to Release Medical Information)*.
2. Short Form Review: A less intensive review using the SSA-455 (Disability Update Report). Based on your responses, SSA may decide to continue benefits without a full review.
What Happens If SSA Moves to Terminate Your Benefits?
If SSA determines that you are no longer disabled, they will issue a Notice of Cessation, which is letter explaining the termination of your benefits. From the date of the notice, you have:
- 60 days to appeal** by filing a Request for Reconsideration of the cessation.
- If you file your appeal within 10 days, you can elect to have your benefits continue during the appeal process by completing form SSA 792.
This decision – whether to continue benefits during appeal or not – is perhaps the most crucial choice you’ll face in the CDR process.
Should You Elect to Continue Benefits During Your Appeal?
Pros of Continuing Benefits:
Ongoing income: Disability benefits often cover essential living expenses like rent, food, and medical care. Electing to continue benefits can provide a financial lifeline while your appeal is pending.
Cons of Continuing Benefits:
No past-due benefits: If you win your appeal after electing continued benefits, there will be no “past due” lump sum for an attorney to receive as a fee. This creates a significant barrier to hiring a lawyer under a traditional 25% contingency fee. More specifically you would have to pay a lawyer several thousand dollars up front to represent you in an overpayment case
Risk of overpayment: If you lose your appeal, you will be responsible for repaying all benefits paid during the appeal period which can add up to tens of thousands of dollars over one to two years. Currently this type of overpayment is dischargeable in bankruptcy but that is not an ideal solution for many people.
Medical Treatment: Your Best Defense Against a CDR Termination
The most effective defense against losing benefits during a CDR is consistent, documented medical treatment. SSA’s decision to continue or terminate benefits is based on whether your condition has medically improved and they need medical records to evaluate that question.
Here’s Why Ongoing Medical Care Is So Important:
1. Creates a Strong Paper Trail: Regular treatment generates continuous, dated records.
SSA uses the term “longitudinal treatment record” when it refers to on-going assessments and treatments of chronic and worsening symptoms, treatment resistance, or permanent limitations.
2. Supports Functional Limitations:
Doctors’ notes, physical therapy evaluations, pain management reports, and mental health notes can all document how your impairments limit your daily functioning.
3. Demonstrates Credibility:
In my experience, SSA is more likely to believe a claimant who actively seeks care than one who goes months or years without treatment. My experience has been that Social Security equates no treatment with no problems. SSA does not care that you can’t afford treatment or that there is nothing that a doctor can do for you – if you do not go to the doctor, SSA will assume that you are not going because your medical problems have resolved.
4. Refutes “Medical Improvement”:
To terminate benefits, SSA must find that there has been medical improvement related to your ability to work. A detailed and thorough medical record showing ongoing or worsening impairments undercuts this conclusion.
5. What You Must Do:
- Don’t skip appointments: Missing care, even for understandable reasons like lack of transportation or money, weakens your case.
- See specialists: The more qualified the provider, the more weight SSA gives their opinions.
- Keep a treatment journal: Note your symptoms, how your conditions affect your activities, and any medication side effects. This information can be shared with your providers and SSA.
- Ask your doctors to complete functional capacity forms. These forms identify specific activity limitations associated with your medical condition and can be very persuasive to SSA. Here are two sources of free FCE forms you can use:
Practical Tips for Dealing with a Notice of a Continuing Review
1. Respond Promptly: Whether you receive a mail-in form or full CDR paperwork, respond quickly and accurately. Failure to respond can result in an automatic cessation.
2. Organize Your Records: Keep copies of all medical visits, test results, prescriptions, and therapy sessions. Being proactive helps your attorney (if you have one) prepare a strong defense.
3. Be Honest: Exaggerating your symptoms can backfire. SSA reviews your activities and may use surveillance or social media to challenge your statements.
4. Understand the Timeline: Reconsideration decisions can take 6 to 12 months. If denied, the appeal proceeds to a hearing before an administrative law judge, which can take another 12 to 18 months. Be prepared for a long process.
How Can an Attorney Help You Avoid CDR Problems?
If you have been approved for disability benefits and SSA has not contacted you about a possible CDR, there is really no need hire a lawyer. As noted above your best course of action would be to continue going to the doctor, keeping a symptom/pain journal and keeping copies of your medical records.
If you are thinking about trying to return to work full time or part time, your attorney can be a good resource for understanding SSA’s trial work period and substantial gainful activity income limits.
I am happy to answer questions from my past clients about post-approval work activity at no charge. This is part of my on-going responsibility to my client base.
I also sometimes hear from disability claimants who I did not previously represent who have questions about CDRs. I try to answer questions from non-clients in blog posts or on my weekly livestream, and I am available for consultations for a nominal fee.
Final Thoughts: Plan Ahead and Stay Vigilant
A Continuing Disability Review is not something to take lightly. SSA may only review your case every few years, but when they do, the consequences of not being prepared can be severe. Choosing whether to continue benefits during appeal and ensuring ongoing medical care are two pivotal factors that can determine the outcome of your case.
If you are receiving disability benefits, the best time to prepare for a CDR is now. Stay engaged with your medical treatment, document your limitations, and keep your contact information current with SSA. If you do receive a CDR notice, act quickly and contact your lawyer for help navigating this complex process.