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How Do They Decide if I Still Have a Qualifying Disability?  

Crysti D. Farra Attorney at Law June 10, 2024

Young injured woman and male lawyerIf you or a loved one are receiving Social Security Disability benefits, you might wonder how the Social Security Administration (SSA) decides if you still have a qualifying disability. Facing an SSA review can be a source of anxiety, and it's important to understand the process and your rights.  

I'm Crysti D. Farra, Attorney at Law, located in Long Beach, New York, and I happily serve clients in Social Security Disability matters throughout Lido Beach, Long Beach, and the surrounding communities with empathy and open communication.  

I'm here to break down the fundamentals of an SSA review, what happens during the review, common reasons for denial, and your options if you disagree with the decision. 

Understanding the Social Security Disability Review

A Social Security Disability Review is a periodic assessment conducted by the Social Security Administration (SSA) to determine if individuals receiving disability benefits still qualify under the program’s criteria.  

This review ensures that recipients remain eligible based on their current medical condition and ability to work. The frequency of these reviews depends on the severity of your condition and the likelihood of improvement. Typically, the review cycle is every 3 to 7 years, but it can vary. 

During a review, the SSA will evaluate your medical condition to see if there has been any improvement that would allow you to return to work. They will review your medical records, treatments, and any other relevant information. 

The SSA Review Process

When it's time for your review, the SSA will send you a notice by mail. This notice will explain that your case is being reviewed and outline the steps you need to take. Here's what you can expect: 

  1. Completing forms: You’ll be required to fill out forms detailing your medical condition, treatments, and how your disability affects your daily life. This could include Form SSA-454-BK, "Continuing Disability Review Report." 

  1. Medical evidence: The SSA will request updated medical records from your healthcare providers. It's crucial to have thorough documentation of your condition and treatments. 

  1. Consultative examination: In some cases, the SSA might schedule a consultative examination (CE) with a doctor. This CE could be necessary if there is insufficient medical evidence in your records. 

  1. Decision making: Based on the information gathered, the SSA will determine whether you still meet the criteria for disability benefits. They will send you a notice with their decision. 

Reasons Your SSDI Application Can Be Denied

Several factors can lead to the denial of Social Security Disability Insurance (SSDI) benefits. Understanding these can help you prepare better for your review: 

  • Insufficient medical evidence: If your medical records do not provide enough evidence to support your claim, your application might be denied. Ensure that all your treatments and medical visits are well-documented. 

  • Failure to follow prescribed treatment: If the SSA believes you are not following the treatment prescribed by your doctor, they may deny your benefits. It's important to follow your doctor's instructions and keep records of your treatments. 

  • Engaging in substantial gainful activity (SGA): If you're working and earning above a certain amount, the SSA might consider you capable of substantial gainful activity, which could lead to denial. 

Appealing the SSA Decision If Benefits Are Terminated

If you disagree with the SSA's decision to terminate your benefits, you have the right to appeal. The appeals process includes several stages: 

  1. Reconsideration: This is the first step in the appeals process. You can request a reconsideration of your case, and a new SSA representative will review your claim. 

  1. Hearing: If your reconsideration is denied, you can request a hearing before an Administrative Law Judge (ALJ). You’ll have the opportunity to present your case and provide additional evidence. 

  1. Appeals council: If the ALJ denies your claim, you can request a review by the SSA Appeals Council. 

  1. Federal court: If the Appeals Council denies your claim, you can file a lawsuit in federal court. 

The appeals process can be intimidating, but with trusted legal support, it becomes much more manageable. With ten years of experience in the trenches fighting for my clients to receive their rightful benefits, I am ready to help you with your appeals case to fight for the best outcome possible in your Social Security disability case.  

Frequently Asked Questions About Social Security Disability Reviews

How often does the SSA conduct disability reviews?

The frequency of disability reviews depends on the nature and expected progression of your medical condition: 

  • Medical Improvement Expected (MIE): Reviewed every 6-18 months 

  • Medical Improvement Possible (MIP): Reviewed every 3 years 

  • Medical Improvement Not Expected (MINE): Reviewed every 7 years 

These timelines are flexible and individualized; however, the SSA notifies beneficiaries when a review is due. 

What documentation is required for a disability review? 

For a disability review, you may need to provide: 

  • Medical records from healthcare providers. 

  • Recent medical test results. 

  • Treatment plans and medication lists. 

  • Statements from doctors regarding your condition. 

  • Employment records if applicable. 

It's critical to keep all medical documentation up-to-date and readily available to facilitate a smooth review process. 

What happens if my condition has improved? 

If the SSA determines that your condition has medically improved and you are capable of engaging in substantial gainful activity (SGA), your benefits may be discontinued.  

However, there are exceptions and protections such as the "Trial Work Period" which allows you to test your ability to work without losing benefits immediately. You also have the right to appeal the decision within 60 days. 

What should I do if my benefits are terminated after a review?

If your benefits are terminated following a review: 

  • Request reconsideration: You have 60 days to file an appeal. 

  • Continue benefits during appeal: Request continued benefits within 10 days of receiving the termination notice. 

  • Prepare for a hearing: Gather additional medical evidence and potentially seek legal assistance. 

Having thorough and updated medical documentation can significantly enhance your chances during the appeal process.  

The Importance of Legal Counsel in Your Social Security Disability Review Process

Facing Social Security Disability reviews can be challenging, but having a knowledgeable attorney by your side can make a significant difference. I can help you gather the necessary documentation, represent you in appeals, and protect your rights throughout the process. 

If you're concerned about your Social Security Disability status or facing an SSA review, don't hesitate to reach out. Contact me, Crysti D. Farra, Attorney at Law, in Long Beach, New York. I'm here to help you navigate the review process and fight for the benefits you deserve.