How to Learn Whether You Still Qualify for a Disability Program

The law requires the Social Security Administration (SSA) to regularly review the current medical status of all people who receive disability benefits to ensure that those people continue to have a qualifying disability. Generally speaking, if a person’s health does not improve, or if their disability still prevents them from pursuing gainful employment, they will continue to receive the benefits to which they are entitled. 

These ongoing disability reviews help the SSA ensure that only eligible individuals receive disability benefits. This helps support the integrity of the Social Security system while providing fair services to children and adults with chronic diseases, injuries, and other disabling conditions.

 To make better decisions, the SSA first collects updated information about disability benefits recipients’ personal health. They may request medical records from their doctors, hospitals, and other medical sources. They may also ask how their health conditions restrict the patients’ activities, request the results of their recent medical examinations, and inquire about any medical treatments that they receive. If the SSA needs more information, you may be asked to take a particular exam or test at the SSA’s expense and at no cost to you.

Frequency of Review 

The actual frequency of review depends on the nature and severity of your symptoms if your conditions qualify for disability and are expected to improve. 

• If improvements to your condition are expected, your first review will generally be six to 18 months after the date you became disabled. 
• If improvements to your condition are possible but cannot be predicted, the SSA may review your case every three years. 
• If your condition is not expected to improve, the SSA may review your case every seven years. 

Your initial ruling notice should tell you when you should expect to have your first medical review. 

What happens during the medical review?

During the medical review, the SSA may ask how your health has affected you since your last review and whether you have noticed any improvements in your condition. You should be able to provide: 

• Your doctor’s name, address, and phone number
• Any patient record number from any hospital and another medical source since the SSA last contacted you. 
• The date you returned to work (if you have worked since the last review), the salary you received, and the type of work you performed

Gathering Information

The SSA will forward your case to the disability recognition service in your state that makes disability decisions on the  SSA’s behalf. This process generally does not apply to people receiving benefits under short term disability insurance. You can expect to be asked about your doctor, hospital, and other sources for your medical history. They also may ask whether your health restricts your activities, for a copy of the results from your physical examination, and what medical care you have received recently. 

If the officials need more information, they may ask you to participate in a special examination or test at no cost to you. You would receive written notice of the exam date, time, and location. 

An experienced New Jersey Disability Lawyer and a medical consultant carefully review all of the information you provided about your case and then make their decision.

How does this process affect your benefits?

If your health improves and the SSA determines that you are able to work, your benefits may stop. Your  benefits may also stop if the following conditions occur: 

• You can work because you have benefited from vocational training or advances in medical or vocational skills. 
• The SSA made a mistake in its previous decision to grant or continue your disability benefits. 
• Without a valid reason, you failed to follow the treatment plan that your doctor prescribed and that may have allowed you to be able to work.
• When the SSA made its previous decision, you provided false or misleading information. 
• You have not cooperated with the SSA, and you have no good reason not to cooperate. 
• You are working, and your average monthly income demonstrates that you are doing a substantial amount of paid work. The amount of income that the SSA deems to be substantial may change dramatically every year.

What to do if you disagree with the SSA’s decision 

If the SSA determines that your disability benefits should stop and you disagree with its decision, you can appeal. This means you can ask the SSA to review your file again to determine whether it may have made a mistake. There are four levels of appeal, and you usually have 60 days to go from one level to the next. The four levels are: 

• Reconsideration: In the reconsideration phase, your case is independently reviewed by someone who was not involved in the original decision. You may appear before the disability hearing officer, who will decide on this level of your appeal. 
• Hearing: If you disagree with the decision from the reconsideration phase, you can request a hearing with an administrative law judge. 
• Board of Appeals: If you disagree with the administrative law judge’s findings, you can ask the Board of Appeals to review the decision. 
• Federal Court: If you do not agree with the Board of Appeals’ decision, or if the Board of Appeals decides not to review your case, you can file a civil action in federal court.

Contact the SSA to request more information about what you can expect from the process. If the whole process seems a bit overwhelming, you can seek the help of an experienced Social Security disability lawyer. Your attorney can help you take the right steps to preserve your benefits.