The continuing disability process works in a manner similar to the original disability adjudication process, but with several key differences.
First, SSA computers will flag certain cases for review. Some of the factors used in this initial review flag include:
- the claimant’s age
- the nature of the claimant’s impairment – is it one likely to show improvement with treatment
- whether the judge included a request for review in the favorable decision
In some jurisdictions, favorable decisions by specific judges may be flagged. This is true if a judge has a higher than average approval rate or if internal SSA audits reveal questions about the judge’s integrity.
Second, SSA personnel trained in claim review will request updated medical records and review the file for medical improvement. These adjudicators will work with SSA medical consultants who will help review the medical records. If the record clearly shows no improvement, the review of your case will be dismissed and you will never know that your case was even looked at.
If the medical record does show apparent improvement, the CDR adjudicator will send you a letter notifying you that your benefits will be terminated due to medical improvement and that you have 60 days to appeal.
You have two choices regarding your ongoing benefits if you decide to appeal. You can choose to have your benefits continue while your appeal is processed, or you can choose to have your benefits stop while your appeal is being processed. If you choose to have your benefits continue and you eventually lose your CDR appeal, you would be liable to pay back SSA all funds received after you receive notice of proposed termination of benefits.
Most people choose to have their benefits continue for obvious reasons. SSD overpayments are dischargeable in bankruptcy if you eventually have to go that route.
Your appeal will be treated like a initial application reconsideration. If you lose at this stage, your next option would be to request a hearing before an administrative law judge.
At your hearing the judge would look at your case and render a decision about whether you remain disabled.
One issue you will face if you end up before a judge has to do with representation. Unlike applications for benefits where you stand to recover a lump sum representing past due benefits, there are no past due benefits in a CDR. This means that you will have to pay a lawyer to represent you at your hearing. Legal fees for this service are likely to cost several thousand dollars.
Benefits Terminated for Non-Medical Reasons.
SSA can also move to terminate your benefits for non-medical reasons. Remember that once you are approved you can try to work for up to 9 months in any 5 year period without impacting your benefits. If you work at higher than substantial gainful activity income ($1,180 per month in 2018) for more than 9 months, SSA may decide that you are no longer disabled because you have returned to work.
Note that your earnings record will reflect the month you were paid rather than the month you earned money. So if you have worked at SGA level for 7 or 8 months, you need to pay close attention to the date earnings are received thereafter.