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BLOG: When CDR causes end of benefits even with no medical improvement


The Social Security Administration has updated its POMs on 10/3/2017 with regard to CDR information, thereby reminding us that:

For adults under review for a cessation of SSDIB benefits, that termination of benefits will generally only apply under limited situations.

Two situations that terminate benefits under CDR

However, this is a reminder that this is not as simple as it may appear and those two situations can involve a lot more. The stated situations include:

  • If the SSA finds that the adult has had “medical improvement” (MI) related to his or her ability to work finds that there is an exception to this MI requirement.

  • If the adult’s impairments, both mental and/or physical, combined with consideration of his or her “vocational profile”, does not prevent him or her from engaging in “substantial gainful activity” (SGA)

Of course, these are loaded phrases, but here we will touch on what those “exceptions” may be to MI, that can make the first situation applicable and get a person terminated even though no medical improvement.

To trigger an exception, there may be a finding that the disability is no longer disabling in limited situations, despite lack of MI. This may constitute an exception that can warrant a termination of SSDIB benefits. Or, there may be MI but that MI is irrespective of the ability to work but one may still be found to fall under a terminating exception.

Interestingly, such an exception may result in a determining that the person never should have been considered disabled to begin with, not just that he or she should no longer be considered disabled.

Exceptions to take note of

Exceptions are divided into two sections. Group one requires a finding that the person is not currently disabled, i.e. that he or she can engage in SGA. Group one includes the following:

  • If you are engaging in SGA (1170/mo in 2017 for non-blind people)

  • If there are advances in medical or vocational therapy or technology (presumably now successfully allowing a person to engage in relevant activity he or she could not before perform

  • If one has had vocational therapy

  • If there is new or improved diagnostic or evaluative techniques (presumably may change the diagnosis or evaluation of impairments)

  • If there was prior error, such as on the face of the record itself, missing material evidence or new evidence that would affect the prior finding that the person was disabled

Much of Group one exceptions are outside the control of the disabled person.

Exceptions you can control

On the other hand, Group two is controllable by the person and includes:

  • Fraud or similar fault

  • Failure or refusal to cooperate (get those document requests in)

  • Whereabouts unknown

  • Failure to follow prescribed treatment (presumably this means without justification)

#CDR #MedicalImprovement

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