• 10
  • October
    2011

When a person receives Social Security disability benefits, the Social Security Administration (SSA) periodically reviews his or her medical condition to make sure that the recipient still meets the SSA's definition of disabled and should continue to receive benefits. Many people are confused about what happens during a review and what the outcome of the review could mean for their benefits.

How Often the SSA Reviews Conditions

When the SSA awards an applicant disability benefits, they place the person in one of three categories for review timelines, based on the applicant's condition:

  • Medical improvement expected: if the SSA determines that a person's condition is likely to improve within a given time, the SSA will review the applicant's condition between six and 18 months after the benefit award
  • Medical improvement possible: if the SSA decides that it is possible that a person's condition could improve but does not expect it to do so, then the SSA will review the applicant's condition every three years
  • Medical improvement not expected: if the SSA does not anticipate that an applicant's condition will improve, then the SSA reviews the person's condition every five to seven years

What Happens During a Review

The SSA will inform the recipient by letter when it is time for his or her review. An SSA representative will then contact the recipient and request records from any healthcare providers that the recipient has seen and information about any employment that the recipient has done during the time since the award of benefits. The SSA representative then forwards that information to a disability review team consisting of a doctor and a disability examiner.

The team reviews the applicant's file to determine whether the applicant still meets the SSA's definition as a disabled: "the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."

After the Review

After the team makes a decision, the SSA sends a letter to the recipient informing him or her of the outcome. If the disability review team decides the recipient is still disabled by the SSA's definition, the recipient continues to receive benefits as before.

If the team decides the recipient is no longer disabled, the recipient may appeal the team's decision in the same manner a person appeals an initial denial of benefits. If a person chooses not to appeal the decision, then he or she will stop receiving benefits three months after the decision.

The rules governing Social Security disability benefits are complex and can be confusing. If you have been denied benefits or the SSA has stopped your benefits, contact an experienced attorney who is familiar with the rules governing disability benefits and can help you navigate the maze of SSA regulations.