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The SSA May Review Your Medical Condition

November 30, 2018 Blog

If you have been awarded Social Security Disability Insurance (SSDI) benefits by the Social Security Administration (SSA), then it’s important that you pay close attention to the medical condition that qualifies you for such benefits — you are not guaranteed lifetime benefits simply because the SSA has awarded you SSDI benefits.  If your condition changes significantly, then you may be deemed ineligible to receive further benefits.

To qualify for SSDI benefits, you must be able to show that:

  1. You cannot work in your current position;
  2. You cannot adapt to an alternative position; and
  3. Your disabling condition will last for a minimum of one year (or is terminal).

As such, if any of the above elements are influenced by changing circumstances, the SSA may be entitled to review your benefits and re-evaluate whether you are entitled to receive further benefits.

Duty to Report Changes

You must report a change in circumstances that could affect your eligibility to receive SSDI benefits.  Failure to report changes — such as an improvement in your medical condition that has removed you from qualification for SSDI benefits — could expose you to liability and require you to make payments for months where you were actually ineligible to receive such benefits.

Mandatory Reviews

Depending on the severity of your disabling condition (i.e., improvement expected, improvement possible, and improvement not expected), the SSA will impose different “review period” frequencies for evaluating your medical condition and determining whether you are still entitled to receive benefits.  For example, if your condition is expected to improve, the SSA will impose mandatory review within six months to a year-and-a-half after you begin to receive SSDI benefits.

When conducting a review of your medical condition (and the changed circumstances thereof), the SSA disability examiner will be attempting to discern whether your condition has improved enough to enable you to secure employment.  If you can secure adequate employment, then you will no longer be eligible to receive SSDI benefits.

How do mandatory reviews work?

The SSA will first send you a notice letter that will let you know that you’ll be going through the medical condition review process, and that will request certain documentation.  You’ll have to provide information (i.e., medical records and other documents) relating to your medical condition.  The SSA disability examiner — and a physician — will evaluate your submitted documents and may even request an in-person examination so that they can personally evaluate your condition for themselves.

In the event that the SSA makes an adverse decision and chooses to disqualify you from receiving further benefits, you may be entitled to challenge their decision through the appeals process.

If you have received a letter that you will have your medical condition reviewed by a disability examiner (and others), or if you have already been subjected to a review and have had your disability status changed, then it’s critical that you contact an attorney who has experience navigating the SSA appeals process and securing disability benefits.