Under Social Security law, all disability cases must be reviewed from time to time. This is to make sure that people receiving benefits continue to be disabled and meet all other requirements.

Your benefits generally will continue unless there is strong proof that your condition has medically improved and that you are able to return to work.

Frequency of Reviews

How often your case is reviewed depends on the severity of your condition and the likelihood of improvement. The frequency can range from six months to seven years. Your Certificate of Award shows you when you can expect your first review.

Here are general guidelines for reviews:

• improvement expected -- if medical improvement can be predicted when benefits start, your first review should be six to 18 months later;
• improvement possible -- if medical improvement is possible but cannot be predicted, your case will be reviewed about every three years; and
• improvement not expected -- if medical improvement is not likely, your case will be reviewed only about once every five to seven years.

What Happens During a Review

After you get a letter announcing the review, someone from your Social Security office will contact you to explain the review process and your appeal rights. You will be asked to provide information about any medical treatment you've received and any work you might have done.

Then your file will be sent to the state agency that makes disability decisions for Social Security. An evaluation team that includes a disability examiner and a doctor will carefully review your file and request your medical reports. If reports are not complete or current enough, you may be asked to have a special examination or test that the government will pay for.

Once a decision is reached, we will send you a letter explaining it. If we decide you are still disabled, your benefits will continue. If we decide you are no longer disabled, you can file an appeal (see section below). If you don't, your benefits will stop three months after we said your disability ended.

Appeal Rights

If you don't agree with a decision we make, you can appeal it. You have 60 days to file a written appeal with any Social Security office. Generally, there are four levels to the appeals process. They are:

• reconsideration -- your claim is reviewed by someone who did not take part in the first decision;
• hearing before an administrative law judge -- you can appear before a judge to present your case;
• review by Appeals Council -- if the Appeals Council decides your case should be reviewed, it will either decide your case or return it to the administrative law judge for further review; and
• federal district court -- if the Appeals Council decides not to review your case or if you disagree with its decision, you may file a lawsuit in a federal district court.

If you disagree with the decision at one level, you have 60 days to appeal to the next level until you are satisfied with the decision or have completed the last level of appeal.

You have two special appeal rights when a decision is made that you are no longer disabled:

• Disability hearing -- This is part of the reconsideration process. You can meet face-to-face with the person who is reconsidering your case to explain why you feel you are still disabled. You can submit new evidence or information and can bring someone who knows about your disability. This special hearing does not replace your right to also have a formal hearing before an administrative law judge (the second appeal step) if your reconsideration is denied.

• Continuation of benefits -- While you are appealing your case, you can have your disability benefits and Medicare coverage (if you have it) continue until an administrative law judge makes his or her decision. However, you must request the continuation of your benefits during the first 10 days of the 60 days mentioned earlier. If your appeal is not successful, you may have to repay the benefits.

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Social Security Administration
SSA Publication No. 05-10153
February, 1998
ICN 480165