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Reviewing your medical condition

All people receiving disability benefits must have their medical conditions reviewed from time to time. Your benefits will continue unless there is strong proof that your condition has improved medically and that you are able to return to work.

Frequency of reviews

How often your medical condition is reviewed depends on how severe its and the likelihood it will improve. Your award notice tells you when you can expect your first review.

  • Medical improvement expected - if your condition is expected to improve within a specific time, your first review will be six to18 months after you started getting disability benefits.
  • Improvement possible - if improvement in your medical condition is possible, your case will be reviewed about every three years.
  • Improvement not expected - if your medical condition is unlikely to improve, your case will be reviewed only about once every five to seven years.

What happens during a review?

Social Security will send you a letter telling you that they will conduct a review. Soon after that, someone from your local Social Security office will contact you to explain the review process and your appeal rights. The Social Security representative will ask you to provide information about your medical treatment and any work that you may have done.

A team consisting of a disability examiner and a doctor will review your file and request your medical reports. You may be asked to have special examination. Social Security will pay for the examination and some of your transportation costs.

When a decision is made, they will send you a letter. If Social Security decides that you still are disabled, your benefits will continue.

If Social Security decides you no longer are disabled and you disagree, you can file an appeal. If you decide not to appeal the decision, your benefits will stop three months after they decide that your disability ended.

For more information, ask for Your Right To Question The Decision To Stop Your Disability Benefits (Publication No.05-10090).



There are 13 Comments

Why is it that some people have never been reviewed? My cousin for example has been on the system for 10 years and she never is reviewed. Is it because when the history of her progress shows deterioration that she is automatically not reviewed? Does social security keep tabs on the medical history of disabled persons, for example if they are going to appointments with doctors, medicine refills, etc.

Here is an excerpt from a 2011 report to Congress regarding the Continuing Disability Review (CDR) process conducted by Social Security :

We conduct periodic CDRs to ensure that only those who remain disabled continue to receive benefits. For CDR cases selected in our headquarters (centrally initiated cases), we conduct CDRs using one of two methods. We send some cases to the disability determination services (DDS) for a full medical review; others we complete using the mailer process. The mailer process consists of two tools: a profiling system that uses data from our records to determine the likelihood of medical improvement for disabled beneficiaries and the individuals' responses to a mailer questionnaire.

We first profile all cases to identify those with a higher likelihood of medical improvement. We send those cases to a DDS for a full medical review. For most cases, we send a mailer to obtain more information, which we evaluate to determine if there is any indication of medical improvement. If there is, we send the case to the DDS for a full medical review. Otherwise, we decide not to initiate a full medical review, and we schedule the case for a. future CDR.

Additionally, we conduct some CDRs based on events such as voluntary or third-party reports of medical improvement. These CDRs are always sent for a full medical review. There is also a subset of cases that we initiate as periodic CDRs, in which we curtail further development for technical reasons, such as the suspension or termination of benefits for non-medical reasons. We refer to these cases as "administrative closures."

After reviewing the relevant regulations and program guidance, I could not find a way to appeal the FREQUENCY of CDRs.

From the Code of Federal Regulations sections 416.99 : When and how often we will conduct a continuing disability review.

Frequency of review. If your impairment is expected to improve, generally we will review your continuing eligibility for payments based on disability or blindness at intervals from 6 months to 18 months following our most recent decision. Our notice to you about the review of your case will tell you more precisely when the review will be conducted. If your disability is not considered permanent but is such that any medical improvement in your impairment(s) cannot be accurately predicted, we will review your continuing eligibility for payments at least once every 3 years. If your disability is considered permanent, we will review your continuing eligibility for payments no less frequently than once every 7 years but no more frequently than once every 5 years. Regardless of your classification we will conduct an immediate continuing disability review if a question of continuing disability is raised pursuant to paragraph (b) of this section.

I'm currently, and have been for over 10 years, on SSD with a Representative Payee. My health has now significantly improved and I would be able to go back to work. My husband also would be able to provide financial security such that I will not be financially at great risk when these benefits stop. I also do not know when a review is coming, and don't remember a review any time in the last number of years.

Stopping SSD seems to be almost as hard as getting it in the first place. You can get off SSD if, during a review your doctor indicates that you are improved enough to go back to work, but I have yet to learn how to stop my SSD benefits and be removed from the program. I also don't know if having a Representative Payee will greatly increase this difficulty.

I am more than willing to write a letter myself and to get letters from both my Representative and my doctor, but I don't know if that's the right procedure. I also certainly don't think I should pay back any benefits since I received them WHILE I WAS disabled.

Any information?

If you receive Social Security or Supplemental Security Income disability benefits, you now have more opportunities to test your ability to work. Under the "Ticket to Work" program you will have:

  • Choices when seeking employment services;
  • Increased options for health care
  • Local benefit planning services;
  • A simpler process to get benefits started again if your medical problem keeps you from continuing to work.

hello if you have been honest from the start of your claim you will not have anything to worry about they are just looking for fraudster that are lieing about there disability

My father born in 59 has worked all of his life and recently was in a horrible accident that broke 3 of his ribs and needs to see a specialist anyhow his dr. wont release him from work and bill are stacking up fast is he eligible for a temporary disability benefit of any kind please help so stressed out.

Social Security does not provide "short-term" disability insurance. Social Security disability benefits can be paid only after you have been disabled continuously throughout a period of five full calendar months. Therefore, Social Security disability benefits will be paid beginning with the sixth full month after the date your disability began. You are not entitled to benefits for any month in the waiting period.

Some states, like California, provide short-term disability insurance, but qualifications vary so check with your state agency. Also, many employers provide short-term disability as an option which workers can purchase, often at a discount. Check with your employer benefits.

My husband had a hemorrahage in his right eye and blurred vision in his left eye due to diabetes and has limited vision. what information does he need to provide to be able to receive benefits?

I assume your husband is looking to qualify for Social Security disability.

To qualify for disability, you must have a sufficient work history and be unable to perform "substantial" work in any occupation.

If you don't have sufficient work history but are indigent and disabled (or elderly), you may qualify for SSI.

See here for details on qualifying and applying :

I am on SSD and my case is reviewed every 7 yrs...I have a payee and wonder if I have her removed if I will be reviewed and lose my benefits.

I have not heard of a case where request for dropping a representative payee has lead to loss of disability payments. However, dropping of a representative payee is fairly rare. In general, the two should be independent, but if your disability case is marginal, you may not want to bring attention to your case.

The SSA will send you a letter telling you that they have decided to pay your benefits to a payee. If you don't agree that you need a payee, or if you want a different payee, you have 60 days to appeal that decision by sending the SSA a letter.


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