Wednesday, March 05, 2008

Review of my SSDI Case

An individual in a forum recently wrote that he had received social security disability benefits for five years and that social security was doing an extensive review of his social security disability claim. This was his first social security review after receiving benefits for five years and he, naturally, felt nervous about the prospect of his claim being re-evaluated.

What were his fears, and questions, regarding his social security disability review?

1. That his claim would be denied---Well, this sometimes happens on a CDR (continuing disability review), but, by and large, most claimants who have been approved for disability also have their benefits continued after a periodic review has been conducted.

2. How many disability appeals would he get if his disability case was denied on review. Actually, this works no different than when a person decides to file for disability. If the disability determination on a social security disability application is a denial, the claimant may file a request for reconsideration. And if that first appeal is denied (they usually are, of course), then the individual may file the second appeal which is a request for a hearing before an administrative law judge. The process works exactly the same way when it comes to a discontinuation of benefits following an SSDI or SSI review. If the individual's benefits are discontinued, they may ask for a request for reconsideration and then a hearing.

3. Is it a bad sign if social security decides to send you to an examination (either a mental exam or a physical exam). This is an interesting question because the answer is a little different depending on whether or not a person has been denied on a disability application, or has been discontinued following a review of their existing claim.

On a disability application, being sent to a social security medical exam (otherwise known, officially, as a CE, or consultative examination) may indicate that a claimant has not been treated for one of the conditions that has emerged in the course of processing their claim ("emerged" could mean that it popped up in the medical evidence or was listed on the disability application by the claimant). It may also mean that the claimant has not received medical treatment for a considerable amount of time ("considerable, however, is subjective---typically, an exam will be scheduled if a claimant has not been to a doctor in over two months). In either case, this may point to the relative weakness of the case.

However, with reviews of social security disability and SSI disability cases, things are different. How so? This is how. A claimant who has been approved for disability will not have their benefits discontinued (terminated) unless it can be shown that medical improvement has taken place. Let me repeat: The medical records must document medical improvement in the claimant's condition in order for the social security administration to justify stopping someone's benefits.

Well, how can medical improvement be shown when a claimant no longer goes to the doctor much, which is often the case for individuals who are on disability and have conditions that, really, do not respond to continued regular treatment. Many individuals, in fact, have disabling conditions but have been released from their doctor's care because they have reached MMI (maximum medical improvement) and their doctor can do nothing to improve their condition.

Such individuals will often find no reason to go to the doctor every single month. They may go only once every six months, or less. And such individuals will, on a review conducted by social security, be required to go to a medical exam or mental exam. But this fact alone does not mean they have a weak case. It may actually mean the opposite.

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