If you care for a family member who receives Social Security disability benefits, they may face a Continuing Disability Review (CDR). It's normal to worry about this review, but it's meant to make sure people with disabilities keep getting healthcare and medical services.
Whether it's your first CDR or a re-evaluation, you have a better chance of passing the review if you understand the process. What do you need to know?
A Continuing Disability Review (CDR) is a periodic evaluation conducted by the Social Security Administration (SSA) to determine if individuals receiving disability benefits still meet the medical criteria for their benefits. The review ensures that the condition causing the disability has not improved to a point where the individual can return to work. CDRs are scheduled based on the likelihood of medical improvement, typically occurring every 3 to 7 years. If the review finds medical improvement, benefits may be discontinued.
The Social Security Administration usually has three stages when deciding whether your loved one is eligible for Social Security Disability Insurance (SSDI) benefits:
The CDR process begins when the SSA sends a Disability Update Report (Form SSA-455) to gather information about the individual's current medical condition, prescribed treatment, medical improvement, and work activity.
If the SSA needs added details, they may send a more in-depth form called the Continuing Disability Review Report (Form SSA-454), which delves into the individual's medical history, limitations, and any trial work period undergone.
Sometimes, a medical exam with your healthcare professional may be scheduled. The exam will include a routine physical examination, discussion of any medical improvement, medical reviews, gainful activity, and whether they work.
These evaluations are not just routine checks. Their purpose is to assess whether individuals receiving SSI due to a disability continue to meet the medical and non-medical eligibility criteria.
These reviews help the Social Security Administration (SSA) ensure that recipients still qualify for benefits, particularly if their condition has improved. CDRs help maintain program integrity and ensure resources go to those still in need.
The appeals process and program requirements come into play during this review period, impacting monthly benefits for people with disabilities. Thankfully, ninety percent of people with disabilities pass their CDR.
As a family caregiver, you play a vital role in the CDR process:
After the review, Social Security will make a decision. What might happen? If Social Security decides your loved one's disability is still preventing them from working, their benefits continue.
If Social Security decides your loved one's condition has improved and they can return to work, their benefits might stop. But remember, they can appeal this decision.
A CDR review can be triggered by several factors, including:
Understanding these triggers can help you expect and get ready for a possible CDR.
If the Social Security Administration (SSA) terminates your loved one's disability benefits following a CDR, your care recipient can appeal this decision.
The appeal process offers multiple levels of review, each providing an opportunity to present additional evidence and advocate for continued benefits. This means family caregivers have options and a chance to fight for what their loved ones deserve.
During this phase, a different team within the SSA reviews the initial decision. Submit any new medical records, statements from treating physicians, or other relevant paperwork.
It's important to provide information about the period, likelihood of improvement, daily activities, and current condition. You want to demonstrate your care recipient has been following their physician's orders to improve their medical condition.
If the reconsideration is unsuccessful, you can request a hearing before an ALJ. This is a formal hearing where you can present your case in person or through a representative.
The ALJ will review the medical evidence, your testimony, and any other relevant information to determine if your loved one continues to meet the disability criteria.
If the ALJ's decision is unfavorable, appeal to the Appeals Council. They will examine your case to determine if there were any errors in the previous decisions. This is where keeping meticulous records will help your loved one's case.
You can take the case to federal court if the Appeals Council denies your appeal. This is the final level of appeal within the Social Security system. However, filing a lawsuit can be complex, expensive, and time-consuming.
It's best to consult with a disability attorney if the Social Security Administration denies eligibility. A qualified disability lawyer will assist in gathering the right medical records and communicating with the Social Security Administration on your loved one's behalf.
As you go through the CDR appeal process, take advantage of any legal assistance available. Help your loved one obtain the benefits they so desperately need.
How to Qualify for SSI: Eligibility and Application Guide >>
