Once a claimant is awarded Social Security benefits, the Social Security Administration (SSA) can and will periodically review a claimant’s medical impairments to determine if the claimant is still disabled. More precisely, SSA will likely have a state’s Disability Determination Services (DDS) conduct the period evaluation. A periodic evaluation is called a continuing disability review (CDR). If DDS determines that a claimant is not disabled anymore, SSA will stop paying benefits. SSA has the burden of showing that a claimant has had medical improvement and is able to return to work.
DDS is supposed to conduct a review every three years, unless (1) SSA determines the claimant has a medical condition that will improve sooner or (2) a claimant’s medical condition is not expected to improve. If SSA believes a claimant’s condition will improve more quickly than three years, DDS will reevaluate the case more quickly. If the disability is not expected to improve, DDS is supposed to evaluate the case every five to seven years. Despite the mandate, because of a backlog of work, DDS may take longer than three years to conduct a CDR. Of note, during the CDR, DDS will ask about a claimant’s assets to see if the claimant is still financially eligible for Supplemental Security Income (SSI), also known as Title II benefits. If DDS determines you are no longer financially eligible for disability benefits, DDS will ask you to pay back any overpayments made.
As for children that are receiving benefits, SSA is supposed to conduct a CDR unless SSA expects the condition to improve more quickly. If the impairment is related to a low birth weight, DDS will likely conduct a CDR by age 1, unless SSA determines the child will still be underweight at age 1. During a CDR, DDS may reach out to the child’s representative payee to determine the child’s condition. If the representative payee is impeding the process, SSA may look for another payee.
If a child is on disability at age 17 and 10 months, DDS will review conduct a CDR and apply the criteria to determine if a child would be disabled under the criteria used to determine if an adult is disabled. If the child is not disabled under the criteria used to determine if an adult is disabled, the child will stop receiving benefits.
If DDS determines a claimant is not disabled, the claimant should ask for a reconsideration. During this process, the claimant can submit additional evidence proving that they are disabled. Prior to stopping the benefits, DDS should conduct a hearing. If the outcome of the DDS hearing is unfavorable, the claimant should appeal the case to an Administrative Law Judge. The Due Process Clause of the Fifth Amendment of the Constitution guarantees a claimant’s right to an evidentiary hearing if SSA is going to stop benefits.
If a claimant timely appeals an unfavorable decision the claimant can elect to continue receiving benefits until their case is resolved. However, if a claimant is found to be able to work, SSA will ask the claimant to repay any benefits paid after the date which the claimant was able to return to work. As the Law Office of Phillip E. Chalker can explain, a claimant can request a waiver so that they do not have to repay these overpayments.