Navigating Continuing Disability Reviews

North Carolina law follows federal guidelines for disability law, meaning that beneficiaries must periodically prove they are still eligible. Understanding what to expect and how to respond can make all the difference in keeping benefits intact.

At Lloyd King Law Firm PLLC, based in Raleigh, North Carolina, I understand how stressful it can be to go through a Continuing Disability Review (CDR). When someone relies on disability benefits to support themselves and their family, receiving notice of a review can be unsettling. Here's some information that can help you stay calm and collected through the reviews.

Continuing Disability Reviews

The Social Security Administration (SSA) conducts CDRs to determine whether a beneficiary remains eligible for benefits. 

This process is a standard part of disability law and applies to individuals receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). The frequency of these reviews depends on the medical condition, the likelihood of improvement, and other factors specific to each case.

When a person is approved for disability benefits, the SSA categorizes their case based on the probability of medical improvement. If medical improvement is expected, a review typically occurs within 6 to 18 months. 

If improvement is possible but uncertain, the review generally happens every three years. If no improvement is expected, reviews usually occur every seven years. These evaluations allow the SSA to determine whether a person’s condition still meets the criteria set by disability law.

How the Review Process Works

When the SSA initiates a review, the beneficiary receives a notice in the mail requesting updated medical and employment information. This step is crucial because the SSA examines medical records, treatment history, and any work activity to assess whether the disability still prevents substantial gainful employment. 

The individual must complete forms detailing their current medical condition, treatments received, and any changes in daily activities.

In some cases, the SSA may only require a short-form review, which involves answering basic questions about one’s health and ability to work. Other cases require a more detailed assessment, including medical records, doctor evaluations, and possibly new examinations by an SSA-appointed physician. 

A decision is then made based on the information provided, determining whether benefits will continue or be discontinued.

Medical Evidence and Its Importance

Providing strong medical evidence is essential in maintaining benefits. Disability law requires that medical records clearly demonstrate ongoing limitations that prevent gainful employment. 

Doctor’s notes, test results, treatment plans, and statements from healthcare providers play a crucial role in this process. If records are outdated or incomplete, it can jeopardize the outcome of the review.

Regular doctor visits and consistent treatment are critical. If someone fails to follow prescribed treatment plans without valid justification, the SSA may assume their condition has improved, leading to a denial of benefits. 

Keeping a detailed medical history and obtaining statements from treating physicians about the severity and impact of the condition can help strengthen a case.

Work Activity and Its Impact on Benefits

Employment status is a significant factor in CDRs. If a beneficiary has returned to work or earns income above a certain threshold, the SSA may determine that they are no longer disabled under disability law. 

However, participation in trial work periods or vocational rehabilitation programs does not automatically disqualify someone from receiving benefits.

The SSA allows individuals to test their ability to work through a Trial Work Period (TWP), where they can earn income for up to nine months without losing benefits. After the TWP, the SSA evaluates whether the individual can sustain employment. 

If work activity shows an ability to maintain substantial gainful activity, benefits may be discontinued. Understanding how earnings and work attempts affect eligibility is critical to avoiding unexpected benefit termination.

Appealing a Denial After a CDR

If the SSA determines that a person is no longer eligible for benefits, they will receive a notice explaining the decision. However, disability law allows for appeals. The first step is filing a request for reconsideration within 60 days of receiving the denial. 

During this phase, additional medical evidence and supporting documentation can be submitted to challenge the decision.

If reconsideration does not result in reinstatement of benefits, a hearing before an administrative law judge (ALJ) is the next step. This hearing allows the claimant to present their case, provide testimony, and submit further medical evidence. 

Witnesses, including doctors or vocational experts, may testify to support the claim. If the ALJ denies the appeal, further options include requesting review by the Appeals Council or filing a lawsuit in federal court.

The Importance of Legal Representation

Going through a CDR without legal representation can be overwhelming. Understanding the requirements of disability law, gathering proper documentation, and presenting a strong case requires experience with the SSA’s procedures. 

A legal representative can assist in gathering medical evidence, communicating with healthcare providers, and preparing a case for reconsideration or appeal.

For those facing a review, consulting with an attorney early in the process can make a significant difference. Legal guidance can help avoid common mistakes, such as incomplete forms, missing deadlines, or failing to submit necessary medical documentation. 

It can also provide clarity on rights and options available to maintain benefits.

Common Reasons Benefits Are Terminated

Several factors contribute to the discontinuation of disability benefits after a CDR. Medical improvement is a primary reason, as the SSA may determine that the beneficiary no longer meets the eligibility criteria. 

However, benefits may also be revoked due to failure to comply with treatment, lack of medical evidence, or returning to work at a level considered substantial gainful activity.

Inaccurate or missing information on review forms can also result in termination. Beneficiaries should always provide honest and complete responses and seek legal assistance if they are unsure about how to present their medical condition effectively. 

Keeping thorough medical records and attending all scheduled doctor’s appointments helps maintain accurate documentation that supports continued eligibility.

Planning for a Successful CDR Outcome

Proactive steps can help make the CDR process smoother. Regular medical appointments, detailed symptom tracking, and consistent treatment are all valuable in demonstrating ongoing disability. 

Keeping organized records of doctor visits, prescribed medications, and any changes in health conditions strengthens the case for continued benefits.

Beneficiaries should also keep copies of all communication from the SSA and promptly respond to any requests for information. Missing deadlines or failing to submit required documents can lead to unnecessary complications. 

By staying informed about disability law and being prepared for a review, individuals can reduce the risk of benefit termination.

The Impact of Age on CDRs

Age plays a significant role in disability evaluations. Generally, as a person grows older, the SSA is less likely to determine that they can return to work. 

Those over 50 may have a higher chance of retaining benefits due to vocational rules that consider work history, education, and skill transferability. Knowing how age affects disability law can help beneficiaries prepare for their review.

Maintaining Financial Stability During a CDR

Going through a CDR can create financial uncertainty. Beneficiaries should plan ahead by budgeting carefully and exploring other resources such as state assistance programs. 

Having a financial plan in place can help reduce stress during the review process, making it easier to focus on gathering necessary medical evidence and responding to SSA inquiries.

Call My Firm Today

At Lloyd King Law Firm PLLC, I help individuals facing CDRs protect their rights under disability law. I’m proud to serve Raleigh, North Carolina, and the surrounding areas of Roanoke Rapids, Fayetteville, and Greensboro. Call today.