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How Do They Decide if I Still Have a Qualifying Disability?

Gordon, Wolf & Carney June 7, 2023

The average Social Security disability benefit in 2021 was only $1,358.30 a month, which may not seem like a lot to some. For others, though, it can be life changing if they’ve lost their ability to earn for themselves due to a medical condition. To secure this much-needed financial aid, recipients must have a qualifying disability that makes them unable to work. To maintain these Social Security benefits, the SSA performs a periodic review to determine if you still qualify. Because this process has the potential to stop your payments, it’s essential you understand what factors are used in an SSA determination of disability. 

For legal guidance during this time, reach out to our team at Gordon, Wolf & Carney. Our attorneys are proud to serve individuals in Maryland and nationwide. 

What Happens During an SSA Review?  

No matter what your disability is or the severity of your disability, everyone who receives SSA benefits must have periodic reviews to keep their benefits going. However, when these reviews happen will vary and you’ll typically fall into one of three categories: 

  1. Reviews every six to 18 months: If your condition is expected to improve, the SSA will review your case much more frequently than other beneficiaries. 

  1. Reviews every three years: If your condition has the possibility of improvement, but medical providers have not predicted a timeline, reviews will generally happen every three years. 

  1. Reviews every seven years: For those with little to no chance of improvement, you’ll have reviews every seven years. 

When your review comes up, an SSA representative will contact you for an interview and you’ll have to provide updated medical information such as doctor’s names and contact info, any new diagnosis, patient records, or treatment plans. You’ll also need to provide information about any employment you’ve had since your last review including the dates you worked, the type of work, and how much income you earned from it. The representative will then contact your medical providers to check on your status as a patient and verify the information you provided. Once all the new data is compiled, a medical consultant and a disability analyst will review your case and decide whether or not to continue your benefits. 

What Can Cause Benefits to Stop?  

This can be a stressful experience if you’re worried that you may lose your benefits. SSA uses several factors to determine whether your benefits should continue. If, during the course of the review, the SSA finds that you’ve received new education or training that allows you to work, that your condition has improved well enough that you can now work, or that you have worked recently and have earned enough to qualify as “substantial gainful work,” you may have become ineligible for benefits.  

Other ways people might lose their benefits during the review process include: 

  • Lying or misleading the SSA about your medical condition or your ability to perform work 

  • Not following treatment protocols or taking the medications your provider prescribes 

  • Failing to cooperate with the SSA during the review process 

  • The SSA finds it made an earlier mistake in your evaluation and needs to reverse its decision 

What If You Disagree with the Decision?  

You always have the option of appealing the SSA’s decision, though this process can be complicated. Because of this, many people choose to work with a Social Security disability benefits attorney. There are four levels of appeal and each must be completed before moving on to the next. 

  1. Reconsideration: The simplest level of appeal is asking the SSA to reconsider its decision. For this initial step, you won’t have to present any new evidence; rather, a different SSA agent will review your file to see if a mistake was made during the original review. If the SSA is going to reverse its decision, it’s most likely to happen during reconsideration. 

  1. Hearing: If your reconsideration request was denied, you can then request a hearing where you’ll present your case in front of an administrative law judge. It’s here you can present new evidence to support your appeal. If you do not yet have a lawyer, it’s highly recommended you hire one at this stage. 

  1. Appeals Council: If your hearing was unsuccessful, the next level is going to an appeals council that will review the details of your hearing to see if a new determination should be made. 

  1. Federal Court: Although uncommon, some appeals may go as high as a federal court and this must be done by filing a civil lawsuit against the SSA. 

Understand Your Rights and Expectations  

If you’re already living and coping with a disability, you know how difficult it can be just to get through your everyday life. What can make this even more difficult is knowing you have to go through the stressful process of a disability review. For help with this or any aspect of applying for or maintaining your SSA benefits, reach out to us at Gordon, Wolf & Carney. We can help individuals across the country from our main offices in Towson, Maryland.