Benefits Stopped? | The Disability Benefits Podcast #37

In this episode, we discuss what a Continuing Disability Review (CDR) is and how our firm handles those situations for our clients.

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Disability Consulting, LLC
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Disclaimer: We are a non-attorney firm. Our company specializes in representation for Social Security disability claims and is not a law office. The information provided in this video is for general informational purposes only and does not constitute legal advice. For legal guidance specific to your situation, please consult a licensed attorney.

Transcript

SPEAKER_00 0:00

We'll talk about cessation cases and we'll talk about what cessation even means because before I started working for you, I didn't know what the word cessation meant because I never hear I've never heard it used for anything other than what we're about to talk about with disability cases.

SPEAKER_01 0:15

Right.

SPEAKER_00 0:16

But yeah, so you get approved for Social Security disability benefits. You have health insurance now and you have a monthly benefit that you get. The idea is that it doesn't expire, but sometimes they will do uh reviews to basically make sure that you're still eligible for the program. Right. Um if those reviews result in a certain way or results in a certain decision that they make, then they will stop your benefits. Correct. They will cease your benefits. That's what the where the cessation comes from. Um and then what do you do about that? So a lot of people, before they even get approved for benefits, are worried about you know, what what if I get cut off? Are they gonna keep their eye on me? Are they gonna be reviewing me every month or two? Um so talk to us a little bit about how that works.

SPEAKER_01 1:00

Yeah, that's whoever approves you in the letter that you get, if it's it's at a hearing, it'll be the judge. But if if it's at the lower levels, and that has does happen, we've been really hard on the lower levels in our podcasts, but you people do get approved at the lower levels. It's just it doesn't always go to the hearing. It's just yeah, it's just a really small percentage. But yeah, you'll get a letter and it'll say something like, you know, your condition is expected to improve, and uh therefore we will we've we've set a diary date on your case, and um and we'll let we'll notify you if we do review your case. If you're a younger individual, and keeping in mind Social Security believes that any adult 49 down to 18 is a younger individual, you're probably gonna have at least one um continuing disability review, and that's what it's called a CDR, continuing disability review. If you're 52 and a half, they usually don't bother with it. Um, but there are exceptions. For example, um they run these uh earnings queries from time to time because Social Security and IRS and unemployment, uh your Department of Employment Security in your state will you know report to Social Security, new hires if you've just gotten a job, um, and then earnings. And that can trigger a CDR, continuing disability review. Um so I do like to tell people, especially if they're younger, you can probably expect going through one of these. There are a lot of things that I like about a CDR case, so, and we'll we'll we'll talk about that. But what it is is you'll get a letter and they'll just tell you that you know, your case has come up for review. It could be, you know, if they gave you a three-year diary, those three years have passed. Most likely, if they gave you a three-year diary, those five years have passed, because it takes them a while to kind of catch up on that. But they'll send you a letter telling you what they're gonna do. And what you need to remember is they're not trying to cut you off, but they are trying to review your case to see that if you see if you improved. And you got to think about it from Social Security standpoint. If, and you already said it, if you have been approved for benefits, now you've got some health insurance, it stands to reason that Social Security would say, okay, well, this person, if it was a mental health case, they got into therapy and they're you know, they're they're going into regular continuing therapy, um, and it's very likely that they could get better. This person with the all these orthopedic problems that we allowed, um, now they're able to go in there and they're able to get physical therapy, or they've been able to get a corrective surgery, you know, back surgery, knee surgery, shoulder surgery, they've been able to do that. It stands to reason that, okay, well, you had some kind of procedure or some treatment that should result in you being a little bit better.

SPEAKER_00 4:12

Yeah.

SPEAKER_01 4:13

And if you have gotten better, um you could now no longer meet the definition of disability. What I like about a CDR case, a cessation case, is if they go through this, the burdens on them to prove that you've one, gotten better, and then the biggie, two, you've gotten so much better that you can work. Yeah. Um got to think about uh how unlikely that is, sadly. Um, you know, the the human condition, you know, the older we get, we don't recover as quickly from injuries, um, you know, we don't respond as well to certain kinds of treatment. And so if you were put on in your 30s and now you're in your 40s, time can take its toll, and um the the chances of your medical record showing that one, you've improved, and two, you've improved to such an extent that you could make it through an eight-hour workday, a 40-hour work week, 50 weeks out of the year. Yeah, that's that's that's a tall task for Social Security to prove, and that's why I say that I like them because when we're dealing with regular claims, we have to prove that you're disabled. The burden is on us. But it flip-flops in a CDR case, in a cessation case, Social Security has to prove that you got better and that you got better to the extent that you can work now. Um, they do that the same way that they do uh initial or reconsideration case. The lower levels process these claims, they request medical records. Sometimes they'll send you to an exam, and then the same doctors who uh work there for other things will say, okay, well, this person, they do a s what they call a side-by-side analysis, and here's when we put them on, this is what we found. Are the medical records so different right now in an improved way that we're gonna cease them? And if so, you're gonna get a letter, you know, and you got two two-month notice that we're gonna cease your benefits, and you can appeal it. Um, and while you're appealing, there's two things that we don't obviously run into in regular initial or reconsideration cases. There are two appeals that you have to be very mindful of. If you've gotten that cessation letter, you have ten days to tell them, okay, I am gonna appeal this, and while I'm appealing it, I want you to send me my check. Yeah. And while it's under review, it's called benefit continuation. You want to do that. And you have to do that in ten days. And that kind of trips some people up. People come to us all the time and they say, you know, I'm going through a cessation case, and you know, I got my letter, and what am I gonna do? Are you receiving benefits still? No, no, they cut me off. Did you appeal that? Well, I have sixty days. No, you have sixty days to appeal the decision that they're going to cease you, but you only have 10 days to tell them while I'm in the appeal process, I want my benefits continuing. So that's something you have to be very mindful of. Yeah. Um but that's what you'll get. You'll get a letter and then you'll get the notice. You know, if you want to appeal and receive benefits while you're in your appeal, um you have to let us know. And then the 60-day deadline. You have to appeal that just like any other 60-day deadline you you get in any kind of decision from Social Security. So that's um, you know, that's the mechanics of a cessation case. Um, it's a little bit different at the lower levels, you know, at the a regular, you know, new disability claim, the first level is the initial level. In a CDR, the first level is the initial level. And then the second level uh in a initial claim or a regular claim is the reconsideration, but it's not called that in a cessation. You're actually before a hearing officer. Um and the hearing officer still works at the lower level place, um, they're not a judge, but it is kind of a hearing. Um, and they basically you know ask you why you believe that you're still disabled, the medical records, you know, show this, blah, blah, blah, blah, blah. If you're represented, your representative will be there at that too. And then if if the hearing officer denies your case at that second level, which is kind of the same as reconsideration, then it's the same after that. Goes to uh an administrative law judge at a hearing level, and um and that's that's how that proceeds. Everything else is the same.

SPEAKER_00 8:52

Yeah, that makes sense. We've done a few episodes talking about different conditions and how not all conditions are expected to last the same amount of time. Right. And so a good example of something that would recover is if you're otherwise healthy, but you have really bad arthritis in your knee, you get a knee replacement, and it actually works out pretty well. Yeah. Now you're able to go back to work. You have to be expected to remain out of work for 12 months or longer for disability, but there's no it's just 12 months. So if you recover in 14 months, I mean you would technically qualify. And then if they stop your benefits and you go back to work after those 14 months, then that's completely fine. There are other conditions like if you have a double amputation, that's not, you know, 14 months later you still have a double amputation. That's not gonna make any kind of difference. So for the actual um for the reviews itself, um, it's just the claimant can expect to get a letter from Social Security, and then what is the not not when their benefits are stopped, but when they're under review, what does the claimant actually have to do? Do they do anything?

SPEAKER_01 9:56

Yeah, good question. The the exact same thing as they did on the initial and reconsideration letters. You're gonna get forms. It's gonna be the same forms too. They don't have special forms about, you know, tell us about how your condition improved. It's basically what do you do during the day? Are you able to feed your animals? Are you able to cook, clean, shop, be around others, drive? Um, the exact same form, you know, pain questionnaire. What's your pain like? Is it sharp? Is it stabbing? Is he achy? Is it dull? What kind of medications are you taking? Do you have any side effects from the medication, mental health? Um, do you have difficulties concentrating, staying on task, you know, being around other people? Same exact things. And um, and if there's a little work, they'll probably send you a work history form because Social Security's interested in you the last five years. That's rarely gonna be an issue in a CDR because you've been disabled. Um, but you could have some earnings, you know, if you you worked, you tried someplace and it didn't work out, but you were there for a couple months, you know, that you could have a couple three thousand earnings and they're gonna want to know about that. You know, what did you do? Why'd you leave? Stuff like that. That's not as common, but as the other forms, but yeah, the ADL form, the pain question questionnaire that we've talked about, the uh um yeah, activities that they live in ADL form.

SPEAKER_00 11:16

Yeah, all those all those same forms that you get when you file the cases.

SPEAKER_01 11:19

And they're not special, they're not different, uh just because as a CDR. Because keep in mind, they're going to do a side-by-side analysis. So they're really just the new side is going to be the new forms, the old side is gonna be the old forms that they have in your record. And they do, you know, they do keep these records for a long, long time. Yeah. Um usually I tell my clients, usually if you are 45 or younger, you know, if they're 49 when they're approved, by the time Social Security looks at their case, they're that that magic 52 and a half age, and they'll probably just nah, we're not we're not gonna not gonna mess with that. But I'll tell my clients who are like 45 or younger, you know, you can expect it. You can expect at least one. If you're in your 20s and you get approved, even if you are a double amputee, um, they'll they'll put what they call a permanent diary on your case. They'll definitely do that. And it'll still come up for review in seven years. Because there's there's a a regular diary, which is three years, then there's the special diary that, okay, this this, you know, yeah, he didn't respond in this 12 months to the stroke, but we still think that he's going to, and so they'll give an 18-month diary, stuff like that. And then there's okay, this guy's a double amputee, or they've got this chronic condition that there really is no treatment that makes them improve in any kind of marked way, um, we'll give them a permanent diary. But permanent again is a seven-year diary, so you know, seven or eight years. Um, somebody might look at that and say, they should look at that and say, yeah, that there's no reason to review this case. There's no way that it could change. There's nothing that they could do to improve this situation. But if you're in your 20s and you don't get that, you don't have a a condition, you know, um that's you know, horribly chronic, obviously horribly chronic, you can expect not just a CDR, probably several in the course of drawing disability. Um and it's it's a it's it's like anything else on Social Security, it's pretty much a political football that gets kicked around quite a bit. Um Social Security is always trying to balance getting claims out quickly to saving the taxpayer money. And it's it it it's for some reason it's a seesaw. You can do one, but you can't do the other. You know, if you want to get a get a case out efficiently and uh and correctly, it's gonna cost the taxpayer money. Sometimes they're like, we we've got to be efficient and we've got to be accurate. And then there are times we've got to save the taxpayer money. And then when that happens, usually you'll see a dramatic influx of CDRs. Um it's happened in my home state many times, to where we just start getting calls from people that we won their case two or three years ago. I just got a letter that they're gonna review me. You know, should I be alarmed? No. But you should, you know, do the things that they ask you to do. And if they deny you, give us a call, and um usually 99% of the time, I'll take their case on a CDR, especially if I'm the one who helped get them approved, um, and we'll fight it again. Yeah, you know.

SPEAKER_00 14:44

Yeah, and that's telling a client that they can expect to get reviewed any amount of times. But I mean, if the 20 year you're telling a 20-year-old, hey, you're gonna be reviewed multiple times, yeah. That can be scary for some people, and I they get kind of worried about it. But as long as you fill out the forms on time um in the correct way, and as long as you're still disabled and you're not trying to hide anything, you haven't secretly gone back to work, there's nothing to be worried about. It I mean, it's annoying to have to fill out the forms every few years, but you know, your case should speak for itself. You already got approved, and then it should just speak for itself.

SPEAKER_01 15:19

That's a fantastic point. And that is normally what happens. Um there, you know, obviously, because of what we do, you know, we see a lot of people getting denied um disability benefits because of what we do. We hear from people who are going through a CDR. We've gotten a letter that they're ceasing our benefits. Because of what we do, we see that, but that's not really the way it is in real life. I mean, especially with the CDR folks. Um, I I don't know the percentage, I haven't done the research, but I would say at least half, if not two-thirds of the cases that are up for CDR, somebody looks at it before they start it at Social Security and they're like, nah, there's no way that this person hadn't, there's no way this person's gotten any better, and it just it just doesn't go down. Or even if it does, um, the medical records will come in and they'll look at why they approved the case in that what they call the comparison point decision. Um, they'll look at the comparison point decision, why we approved it, and then what's going on now. And like I said, it's not just has it gotten a little bit better, it's has it gotten so much better that now they can work. Um, and when they when they see that, sometimes they'll just say, okay, we're yeah, we're we're we're gonna continue your benefits. Yeah. But sometimes, like I said, if you're that 20 or 30 year old or even 40-year-old, if you're if you're in those age, those younger age brackets, you'll you'll get the letter and it's gonna say sometime in that letter, we may review your case again in three to five years. We may review your case again in two years. You know, it'll it'll say that somewhere in there, and and they're not blowing smoke. I mean, they're they're really meaning that you know there's a good chance that at your age you're gonna get reviewed again. So it's nothing to be terribly alarmed about um that you're going through it. Because, like you said, if you cooperate with them, send in the forms and stuff like that, and you've had regular ongoing treatment for your condition or conditions, you should be okay. Unless you have improved to the point, then you know you're able to work. And we've said this many, many times in our podcast. If you are able to work, work. Yeah, that's that that that's a great thing, you know. So that that that could be that could very well be the case. Um but if they yeah, if they're denying your case and it's like a bogus denial, there's no way they they they should cease my case. I haven't gotten any better, and I certainly haven't gotten you know better enough to where I can work now, um, then you need to appeal that and possibly um appoint a rep to help you out with that appeal.

SPEAKER_00 18:11

Yeah, the thing that claimants should be worried about, or at least mindful of, I see or I talk to a substantial amount of clients that they say I was receiving benefits, they cut me off, and it's not because they filled out all the forms and then social security denied them, it's that they didn't fill out the forms. And a lot of times they change an address or something and they don't keep Social Security up to date. Right. And so those kind of technical denials, or in this case, a technical cessation, they cut you off simply because they tried to get you to fill out the ADLs and you didn't. That's important. That's a good way to win to lose your case, just like at the initial in recon. Well, at every stage, you know, if you fail to fill out a form, they're gonna deny you, and maybe they didn't even look at your medical condition. I would imagine it's the same thing with uh the CDRs.

SPEAKER_01 19:02

I have hearings every week, and I'm not joking, and I'm not, this is not hyperbole, I am absolutely telling the truth. I have hearings every week to where I'm going in front of the judge with my client and I look at the lower levels, and the reason that my client was denied is he or she didn't fill in the form fill out the forms twice. They didn't do it, they just ignored it at the initial level, they ignored it at the recon level. I don't know what they were thinking. Um and or they didn't go to an exam. Social Security's paying for the exam, they're gonna pay the travel if it's you know a long distance, they're gonna do everything for this exam, and you're just like, I'm not going. And you didn't go. Well, possibly somebody's told you down the line that you know they're not gonna deny you for not filling out forms, or they're not gonna deny you for not going to one of their exams. I mean, you're saving them money by not going to the exam. People might have told you that. Let me tell you emphatically, that is absolutely untrue. I see denials all the time and have hearings to where I'm going in front of a judge, and the judge is gonna ask first thing out, you know, what was what kept you from filling out, you know, a form about what you were doing, you know, during the day? And that's a great question. And I, you know, when that's asked, and of course I've already asked it to them in prep, but I want to hear what they say. Yeah, let me I'm interested to to hear how you tell how you defend not filling out a form.

SPEAKER_00 20:38

I bet you don't hear very, very many good answers. They're terrible answers. Usually just ah, I just forgot about it.

SPEAKER_01 20:43

Yeah, I mean, what what we normally hear is, you know, I didn't get it. That's that goes nowhere because that's not true. I mean, you got did you get everything else? Oh, we got everything else from Social Security. We just didn't get that form. Yeah, that's that's twice, you know, initial and reconsideration. That doesn't go go over. Um I lost it.

unknown 21:02

Okay.

SPEAKER_01 21:02

Well you my dog ate it. Yeah, you you can call and get another one. Um I in my office can print you one and you know, and send it to you if that happens. And keep in mind also that the judges have a lot less patience with somebody who's represented because, you know, Mr. Groves, did you tell Miss Smith that it was very important for her to fill those forms? Yeah, yes, Your Honor. But she still didn't. I I guess she didn't, Your Honor. I mean, you know, but we're we're just stuck here, you know, answering questions in a hearing about why you should have done something that you didn't do like you're a child, when we should be talking about your conditions. We'll get there in a hearing, but I mean, if it starts out like, you know, I say they denied you because you didn't fill out the forms. I mean, why? Oh, great. You know, and it's it's you're kind of just sitting there wondering the same thing. So, yeah, if if if if it seems like we're harping on that in our podcast, it's only because we get those denials every week. And I have hearings. Every week to where I have to I'll I'll get where I need to get. We'll get we'll be arguing your case in a in a hearing in front of a judge, all your medical conditions. But to get there, I have to listen to the judge, probably slap your wrist and mine. If if I was representing you at the initial level and I called you and said you need to get these forms turned in. Well, you know, you gotta get the forms. And then I get a call two weeks later, you know, they denied me. I told you they were going to deny you. What are we gonna do? Well, appeal it, but please, on the appeal, fill out the form, and then they don't. And what are we gonna do now? Well, we're gonna request a hearing, but expect to get you know slapped around a little bit from the judge about not filling out forms. It's a it's a terrible, terrible way to lose a case just because you don't cooperate. I'm not gonna not gonna fill out the forms. It's yep, you gotta fill out the forms. Because you could have a great case. And but you know, and back to CDRs. I mean, they they have to do that side-by-side comparison. Um, how why did they allow you before? It could have been a judge's decision, and so they'll look at the judge's decision, what um limitations uh he or she found. And um here we are now, present day. Are those same limitations still there? Are they of the same severity? Are they posing the same kinds of limitations? If it's gotten better, has it gotten a lot better to where I think, yeah, I think that this person could work. Um you're gonna get denied, and um they're gonna send you the forms again. So it's you know, it it's certainly something cooperating with Social Security is it's not optional. You know, they are the entity that the US law has given authority to to administer this program, the disability program, which helps not thousands, not tens of thousands, not hundreds of thousands, but millions, millions of people are drawing Social Security disability benefits. And um the entity that has been given authority to you know administer the program, they say that these forms are necessary, and as such, these forms are necessary. If it doesn't matter if you disagree with them, you know, it's kind of like going up to somebody and you know they're looking up at this wonderfully blue sky, and and you saying, Well, I don't believe that that sky is blue. I I think that it's chartreuse. Well, you might think that, but the you know, the fact of the matter is still the fact of the matter. You know, I don't want to fill out the forms. You still gotta do it. Well, I'm not gonna do it. Okay, well, you're gonna get denied. Why do they deny me? You know, it's yeah, I mean things things have consequences. Right.

unknown 25:11

Okay.

SPEAKER_00 25:12

Well, is there anything else you want to add for CDRs or if uh if Social Security stops a client's benefits? Or do you think that's given to the other?

SPEAKER_01 25:20

No, nothing to add, but just remember that if you are, if you do get that letter, that cessation letter, we're gonna cease your benefits, they're gonna stop. You got two appeals to worry about, the normal one that if you went through the initial and reconsideration level or even the hearing level, you know that you got 60 days, 60 days, 60 days. And at the CDR level, you still have 60 days to appeal the decision that we're gonna set cease you. But you only have 10 days to tell them while you're ceasing while while I'm appealing this cessation, I want my benefits to continue. I I still, you know, this is you know, this is a gut punch for me. You know, I I I depend on this monthly check. I need for those benefits to continue while I'm appealing the case. I don't believe that I've gotten better. And uh and so I need for my benefits to continue 10 days. And they're they're kind of hard and fast on that. If you if you don't do it within 10 days, you're gonna have to give them a tremendously m spectacular reason why. Um so just be mindful of that. But yeah, that's all I have on that. Okay. We'll end it there.

SPEAKER_00 26:30

Scrooby. If you have a question about your disability case, drop it in the comment section below, and we will do our best to answer it in the next episode.