The Disability Review Process

If you are receiving Social Security Disability (SSD) benefits, the Social Security Administration (SSA) will review your medical condition periodically to determine whether you still need those benefits. How frequently this occurs depends on the disability for which you receive benefits. If your disability is expected to become less severe, the first review will take place from six to 18 months after you became disabled. Otherwise, your case will be reviewed every three years if some improvement is expected, or every seven years if you are believed to be permanently disabled.

During the review, you will provide documentation about your medical treatment during the period since your last review or decision. This means doctors' names and contact information, and hospitalization information. If you worked at any time during the time you were receiving disability benefits, you will need to provide employment information, including documentation of your income from employment.

After reviewing the information you provided, the Disability Determination Services office in your state will issue a decision about whether you should continue to receive benefits. If you disagree with the decision, you have the right to appeal. There are four levels of appeal. Having an advocate from a firm such as Binder & Binder ® can help you get through the appeal process.

The stages of appeal are:

Reconsideration: The reconsideration process involves a review by a panel that had no involvement in the original decision.

Hearing: You can request a hearing before an administrative law judge (ALJ).

Appeals Council: If you wish to contest the ALJ's decision, you may ask the Appeals Council to review the previous determination.

Federal court: You have the right to bring a civil action in federal court if you disagree with the Appeals Council or if it declines to hear your case.

Source: Social Security Online, "What You Need To Know: Reviewing Your Disability," Jan. 2005.

In The News

On Thursday, 11 people were charged in a fraud scheme—a scheme that involved hundreds of Long Island Rail Road (LIRR) Workers. The LIRR Workers involved in the scheme are being accused of falsely having claimed a multitude of disabling injuries that have allowed them to collect tens of thousands of dollars from their pension funds, in addition to disability payments. Included in the group of individuals charged were two doctors. A sampling of hundreds of claims that were approved by the two doctors revealed that over $100 million dollars, if not much more, had been paid out to LIRR workers whose disabilities were either fabricated or exaggerated.

While there is a separate federal disability and retirement fund for railroad workers, the fund mirrors that of the Social Security Administration’s in many ways. It’s unfortunate that instances of fraud, even as enormous as the LIRR Workers scheme, are not uncommon. But what is also unfortunate is the impact that fraudulent claims, whether they occur through a single individual or as part of a larger scheme, have on disability funds.

When an individual fabricates or exaggerates a disability and has their claim awarded benefits, they are drawing monies from the disability fund. The benefits awarded to fraudulent claims are subsequently no longer available to help individuals with legitimate disabilities. In an attempt to control fraudulent claims, the Social Security Administration participates in Continuing Disability Reviews to weed out those who are not or are no longer disabled. In 2008, Continuing Disability Reviews were expected to eventually cut benefits to 33,000 people who were not disabled or were no longer in need, but continuing to collect benefits fraudulently. The reviews in that year alone were estimated to yield a savings of $3.3 billion dollars that would have been spent in future benefits.

But fraudulent claims have more than just a monetary effect on the system. They can make the process of obtaining Social Security Benefits more difficult, as they lead way to increased skepticism. Individuals with legitimate claims may run into amplified pressure to provide more information in support of their disability—a task that can often be difficult on its own.

At Binder &BinderÒ, we fight for our clients because we understand what they are going through — how it can be difficult to make ends meet when you cannot work and how many people worry about keeping food on the table and roofs over their heads. But, we also know how of negative an impact a fraudulent claim can of have on the Social Security Disability fund. We want our current clients and future clients to know that we diligently screen our potential cases to help cut down on fraudulent claims.