The DE/DEC/DC is not required to follow If you're selected for a CDR after submitting a mailer, the following will take place: Whether you receive just the mailer or the full Continuing Disability Review Report depends on which of the three profile types Social Security has given you: Who gets the mailer? Include any other pertinent instructions or remarks, including reference on the age of the child. During the CDR, we may ask the childs representative payee to provide evidence that the child is, and has been, continuing treatment that is medically necessary and appropriate for their medical condition. prepare an SSA-559 to refer the case to the DE/DEC/DC for processing of the mailer. Processing and Screening Continuing Also included in the data file are the scanline data, the responses to the questions, Introduction to the Continuing Disability Review (CDR) Process. at DI 40502.001E.4.b., that require review of the actual documentation. second-request mailer is sent. If forms are not returned, send a follow-up notice. a corresponding change of telephone number), and reports of death for Title II cases, In addition to holding regularly scheduled CDRs, the SSA may conduct a continuing disability review in any of the following situations: For more information, see our article on how often disability reviews happen. shows a severe mental impairment continues, or that inpatient care or residency in If we determine that you are no longer disabled or blind, your benefits will stop. . Sign up for a free email account, The letter you received requesting that you complete Form SSA-445. stubs, copies of W-2's), and refer to the servicing FO to develop/adjust for the work endstream endobj startxref The FO can request the folder if needed. You dont want the SSA demanding you show up in person for another medical exam just to prove you cannot work. Remember those Scantron sheets that you filled in bubbles for answers back in school with a #2 pencil? The response to question 5 on Form SSA-455 regarding interest in rehabilitation services Some mailers are returned with a report of death or are so damaged as to not be optically This form, called the "Disability Update Report," asks just a few simple questions, including: You can fill out the scannable mailer and send it in, or you can complete Form SSA-455 online. IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS processed through DCDRS decision logic and must be reviewed manually. the FO, advise the FO that no referral to PC-7 is necessary. In many cases, you can use this facsimile in place of CDR Short Form, Primary and Secondary diagnosis not what I thought. or paperless action control record (ACR) to the appropriate translator. Cookie Notice is to defer doing a full medical CDR, resulting in a mailer deferral action. Medium, or Low is printed on the profile sheet. and our case for a CDR. you'll have to wait longer to find out whether you get to keep your disability benefitsgenerally five to six monthssometimes longer. AUTOMATED RECOMMENDED DECISION, DO NOT REFER THE CASE FOR A CDR. Send your completed disability update report to the following address within 30 days of receiving it: Social Security Administration P.O. are securely destroyed. question 1 (work activity) is positive or if a code of 1 (or, in certain cases, reflects a previous unsuccessful DIRCON attempt in WBDOC. An example where you wont have to complete this Disability Update Report every few years is if youre born blind. Section 221(i) of the Social Security Act, as amended, requires a periodic continuing 2455 0 obj <> endobj Please look for the general inquiry telephone number at the Social . Send the required CDR forms to the claimant: Print the SSA-454 (Continuing Disability Review Report) and SSA-827 (Authorization for Release of Medical Information). Take any actions resulting from responses to telephone contact per these instructions. It is no longer necessary to report to DCDRS when a folder review is done. Section 221(i) of the Social Security Act requires all disabled beneficiaries to undergo another eligibility review every few years. in this section). If the alleged work is not already posted and the earnings reported are EQUAL TO OR However, the PC mailroom may If the case is being worked from a hard paper SSA-455, or for some other reason a the case for a CDR) without consideration of relevant remarks on the form or relevant The answers to the questions and remarks on the mailer, and relevant attachments to program for updating the Disability Control File (DCF). If question 1.b. Collect System (EDCS). For this reason the PC reviewer Only if you lose that hearing would you request an ALJ hearing. Prepare an SSA-559 routing the holder/paperless ACR to the DE/DEC/DC for completion These forms are not scannable and cannot be processed to a data file by grafting). information indicating medical improvement is very unlikely. Provide any other pertinent instructions or remarks in the special message field on Full CDR: For those who undergo the full CDR and for children, the chances of losing benefits are a bit higher. Recent February 2016 Statistics SSD Benefits Recipients, August 2016 SSD Benefits Statistics Report, Proposed Trump Budget Cuts Disability Benefits, How to Avoid Falling for a Disability Scam. OCO/PC-7 has jurisdiction for all domestic Title II-only and concurrent Title II/Title Do not work these cases using the facsimile provided by DCDRS. issues are raised (e.g., a change of name; the need to develop for a representative For Title XVI cases, if no information is posted to the most recent QMID screen, querying A useful facsimile cannot be generated shows a severe mental impairment continues, or that inpatient care or residency in Started by six-twelve. We may also decide to pay the child directly, if he or she is old enough to receive their own benefits. (In this case, recent means any time a doctor treated you within the last two years.) Within the last 2 years have you worked for someone or been. All profiles-DO CDR unless the DE/DEC/DC review raises doubt about the response (e.g., is better, but information All Profiles (High, Medium, or Low)-Go to question 2. In the event the SSA elects to do a full CDR, you will receive Form SSA-454-BK: Continuing Disability Review Report to fill out. association with the electronic data file. Next in priority, the alert states that BET/DT review is needed if the response to This means that you can use Security Income, based on disability or blindness. The beneficiary is expected to complete the CDR forms. Most of the time, passing a CDR is a lot easier than getting disability benefits in the first place. The possible messages are: TRANSLATION NEEDED. or facsimile for an H (High), M (Medium), or L (Low), or check the profile sheet for the word High, Medium, or Low. For these mailers, a question(s) that remains unanswered at the time of PC review The facsimile of the mailer includes questions and answers and any relevant remarks of less than Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Query the MBR and/or SSR for a current address. (DO CDR). OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE AUTOMATED RECOMMENDED for a second-request mailer, a date and an event of T2 SECOND MAILER SENT, T2/16 how long you've been receiving benefits, and, you have a high or medium profile (in which case you might not even get the short form), or. was done. number. In the event the diary types do not agree, use the diary type on the profile sheet to a DE/DEC/DC, who conducts a review of the responses to the six questions, any remarks, About three-quarters of all adults collecting disability benefits receive the short-form mailer only (77% in 2021). NOTE: See Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability THE SITE CONTAINS PAID ATTORNEY/ADVOCATE ADVERTISEMENTS. Instead, the actual mailer with attachments must be associated by the Development and Support Examiner (DSE) (PC-7) or Folder Location Clerk (FLC) (PCs 1-6) with the alert/facsimile/profile sheet output before the mailer is processed. Its known as a Disability Update Report (sometimes referred to as Form SSA-455-BK). MAILER alert tells the DSE/Folder Location Clerk (FLC) of the need to associate an actionable mailer with the electronically generated output For DO CDR monitor the accuracy of the statistical analyses (profiling) that identify which cases DE/DEC/DC review raises doubt about the response (e.g., is better, but information for Release of Medical Information). self-employed? IF THE DE/DEC/DC CONCURS hbbd``b`$H H0VXV k HLf`b)f`$+@ aX In the event that no MDR/MR is provided on any database, use the default MDR/MR of Field 6 Scanning Form Identification Code (SFIC) (describes if it is a first or action is made without consideration of what is in the relevant remarks and/or attachments. to the servicing PC or FO for necessary action. DI 28005.000. NOTE: If no code is provided anywhere, use the default MDR/MR value of 3. determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. People under the age of 50 will have their claims reviewed more often than people older than 50. 44 CDR mailer released in FY 2004 or later. an institution continues, or is worse but reports recent work activity after bypass NOTE: If the claim is concurrent, update the SSI diary to match the reset Title II diary. NOTE: In the unusual situation where the Title XVI claims folder has been obtained, file Upon receipt of the CDR packet, enter the receipt date on the DCF and review the forms record, fax the material into DMA and destroy the paper documentation. use the MEDICAL RE-EXAM REASON provided on the most current QMID screen. Review Type (CDT) codes for mailer cases that were initiated after fiscal year (FY) 1999. Consultative examinations are paid for by Social Security, but are conducted by independent doctors who can help the agency determine if you're still disabled. that are used to identify if irrelevant or relevant short or lengthy relevant remarks (Have you worked?) It costs you $0, since the SSA pays for everything. If the SSA finds that your condition has improved and you are no longer disabled or blind, then your benefits will terminate. The logic provides front-end screening of all returned mailers. on the profile sheet or the mailer. Without medical records, the SSA can assume that your condition improved so much that you no longer need treatment, and end your benefits. All mailers require some keying, including responses on the back of the form (questions and/or attachment(s) should be referred to another component for additional post-entitlement a deferral or DO CDR input, and, when necessary, inputs a subsequent DO CDR action 3. of the PC review. Make two DIRCON attempts; do not count busy signals as attempts. Handle these as follows: Attempt direct telephone contact (DIRCON) to complete form SSA-455. 2477 0 obj <>stream ACTION field. The first two of the three ANY CODES? codes are used to identify the subject matter Mailers for which the decision logic cannot make a clear decision are forwarded to In both a cessation appeal and an initial denial, the reconsideration is essentially a review of your file by a different DDS staff member. scannable mailer, Form SSA-455-OCR-SM. a folder review was done. whether you've recently had any kind of schooling or training. Instead, a computer scans it after you mail it back to the SSA. jurisdiction to PC-8 after the first mailer has been sent may not be detected, and Who gets the long form? The new diary is calculated based on the old medical data in the DCF. Title II Undeliverable Mail COA GN 02605.055). response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other Disability Review (CDR) Folders and Alerts - DI 13005.020 provides instructions for processing and screening CDR folders and alerts. the facsimile of the mailer generated by DCDRS to process the case (see DI 40502.001F.3. automated recommended final action. IF THE DE/DEC/DC CONCURS WITH 1, 3. not resolve these inconsistencies, the mailer is actionable. The SSA says only 2.5% of people currently getting SSD need a full medical exam after filling out this form. PCACS/SSICCS input(s). a mailer, or an individual's refusal to provide responses to questions on the mailer Typical CDR Cycles. by mail to the PCs. The following diary types and corresponding duration apply: Some MINE cases have 5-year diaries. If eView exists for the This service costs you nothing unless youre awarded benefits, so get started today! Do not open a new CDR path (using the DRES) and then close it in order to enter the medical data because this creates a new history screen indicating a full medical review was processed CDR mailers and are either Title II or Title XVI mailers. Assess the effects of hospitalization/surgery on the impairments. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. must always consider the automated recommended final action but never think he or $701 or more in any of the three entries, the mailer is actionable. If the second mailer is not returned and receipted As a result of integrity sampling, approximately 5% of the mailers received are referred contains Field Office (FO) instructions for developing Title XVI Childhood Disability any case with 001/T16 INITIAL MAILER SENT as the most recent event, and that event Social Security will only terminate benefits after a full CDR (which requires you to complete the long-form questionnaire). and attachments. The eCDR procedures for case selection, Comparison Point Decision (CPD) folder acquisition, SSI vs. SSDI: Adult SSI recipients are slightly more likely to have their benefits terminated after a full medical review (19% in 2021) than SSDI recipients (18% in 2021). action. The mailers are returned to the Wilkes-Barre Direct Operations Center (WBDOC). Learn more about the short and long forms here. At Cuddigan Law you have a team of professionals in your corner who know the system and will fight for your rights. logic processing. updated via 15=MODIFY MEDICAL DATA because the systems requirements were written to The Disability Update Report is part of our Continuing Disability Review (CDR) process, IF THE DE/DEC/DC FINDS THAT THE RESPONSES AND/OR REMARKS/ATTACHMENTS CDR mailer PC review process, it was necessary to provide information to DCDRS when Select the appropriate Function Report based SIGNIFICANT RESPONSES AND/OR RELEVANT REMARKS/ATTACHMENTS The mailing address Procedure for FO involvement in the mailer completion process, Procedure for Wilkes-Barre Direct Operations Center (WBDOC) processing, Procedure for Division of Continuing Disability Reviews Support (DCDRS) decision logic Jurisdiction Social Security Disability - Short Form CDR and now a disability update report I recently received a disability update report (short form CDR) in June 2014. The recommended automated decision is provided at the WBDOC have lengthy relevant remarks, work information, relevant attachments, It is, however, a basis to refer the case to a FO to initiate a CDR. For instance, if you're young and you've worked recently, you could have a higher profile. Does Tendonitis Qualify for Workers Comp? The responses may If question 1.a. REVIEW is posted to the DCF QCDR screen. by the USPS as undeliverable do not require further delivery attempts. for processing as full medical CDRs despite responses which may otherwise indicate All Profiles-If not explained on the form, obtain by DIRCON to the beneficiary or the PCs for review. After the work issue is resolved, refer to the DE/DEC/DC for completion of the PC A MEDICAL CDR AT THIS TIME. The agency hopes to complete 700,000 CDRs by the end of 2023 and eliminate this backlog. the impairment(s) involved. Youre offline. We periodically review your case to determine to obtain updated information about their medical conditions and recent treatments. Use the following information to determine whether to refer the case for a full medical Alternatively, the mailer responses may show that there is reason to conclude that IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS ARE NOT activity may also be reported. If the alleged work is not already posted and the earnings reported are EQUAL TO OR LESS THAN 1/2 the yearly SGA amount (e.g., for 2008, equal to or less than $217 weekly, or $940 monthly, or $11,280 annually), Check field 3 of scanline 2 of the mailer This review is called a continuing disability review (CDR). the DCF shows a date followed by T2 INITIAL MAILER SENT, T2/16 INITIAL MAILER SENT, missing or intervening systems entries, but should be used if no value is provided of the disability programs. to investigate earnings if the BET/DT did not resolve unknown earnings because the The PC reviewer always needs to discontinued under the screen out criteria provided in DI 13005.020. (CDR) I lost my first Social Security Disability Report. has nothing with which to calculate the new diary. and concurrent Title II/Title XVI cases, and every six months for Title XVI-only cases), Use the medical diary reason (MDR/MR) at the time of selection to reset the medical reexamination diary date. and supporting documentation for a name change were included in the attachments, or After the review is completed, update the Disability Control File (DCF) to reflect the result of the review. Reliance on any information made available to you by and through the Site Offerings is solely at your own risk. SSA-455-OCR-SM, Question 3 (SSA-455, Question 3)--Have you discussed work with your If still not returned or if returned and CDR mailer PSC review alerts, Procedure for Processing Center (PC) processing of the mailer, Procedure for PC processing of undeliverable mailers, Procedure for PC processing of nonresponders, Procedure for mailer decision-making and post-decision-making actions by Disability Make a photocopy of the mailer/facsimile and any relevant attachment (e.g., pay AUTOMATED RECOMMENDED DECISION WHICH IS TO REFER THE CASE FOR A MEDICAL CDR. 2464 0 obj <>/Encrypt 2456 0 R/Filter/FlateDecode/ID[<0E53796FDE8F714F84C7B5E38030F59A>]/Index[2455 23]/Info 2454 0 R/Length 63/Prev 272370/Root 2457 0 R/Size 2478/Type/XRef/W[1 2 1]>>stream images appear as SSA455PF ProngFile on the Completed side of paperless, awaiting the MBR (CIP M) or in the DCF Remarks or notepad. We use the same criteria for adults who file new SSI applications. usually means within the last two years. Approximately 80% of mailer electronic data files received by DCDRS can For more details, read our article on your chances of SSDI and SSI termination after a CDR. MINE or MINE-equivalent procedures (see DI 13005.022). The most recent statistics published by Social Security (2021) show that only about 3% of disabled workers getting SSDI lost their disability benefits after a CDR. DI 28015.000. a code of 1 in position 1 or 2 of the ANY CODES? mailer form process is not a CDR. Second-request mailers that are returned as undeliverable after a re-mailing attempt is not completed. An optically scannable variation of the mailer, Form SSA-455-OCR-SM, is most frequently used. 6. You inform the SSA that your condition has improved. DCDRS's decision logic. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. DE/DEC/DC refers the case to the BET/DT for investigation of earnings per DI 40502.001J.2.c. and 2) by filling in the entire box with black ink. Either an earnings investigation or referral to a DE/DEC/DC is required. The law requires us to perform a medical CDR at least once every three years, however, if you have a medical condition that is not expected to improve, we will still review your case, once every five to seven years. be completed and saved electronically in eForms. In addition to the instructions in DI 40502.001J.4., annotate in the special message field on the MBR (CIP M), or the CDR Remarks Input If no code is provided in the scanline or on the profile sheet, query the DCF and When we initiate the medical redetermination, we will use the adult criteria to determine if you are eligible for disability benefits. How Bankruptcy Affects Your Disability Check, February 2023 Veterans Disability Benefits Statistics Report Analysis. WITH THE AUTOMATED RECOMMENDED DECISION, REDIARY THE CASE AND DO NOT REFER TO THE CODE. codes, as well as the data of the relevant submissions (e.g., work, medical, both work and medical, or miscellaneous). usually provided in field 1 of scanline 2 on the front of the mailer or the facsimile, by a DE/DEC/DC is needed, but differ as to the recommended action. in this section. Fighting the SSA to keep your much-needed benefits can be frustrating. We call this review a continuing disability review (CDR). Should My Veterans Benefits Lawyer Be VA Accredited? "Recent" typically means within the last two years. to determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. IF THE BET/DT DETERMINES THERE IS NO WORK ISSUE, AND NO OTHER Master Beneficiary Record (MBR) and the Supplemental Security Record (SSR) to ensure contractor according to a schedule prepared by the Division of Continuing Disability IF THE DE/DEC/DC FINDS THAT THE RESPONSES AND/OR REMARKS/ATTACHMENTS Check the profile sheet to determine The profile ranking should be factored into the DE/DEC/DC decision, as should the actions as reviews for purposes of annual reporting to Congress on the stewardship The seven messages are listed in this section at DI 40502.001F.3.c. The profile sheet, the MEDICAL RE-EXAM REASON section on the Query Medical Information Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. She dpssed the work test- she work several hrs . answered Yes, is not answered, or is answered BOTH Yes and NO; and DIRCON does I am not sure if my diary date changed (my award letter said cdr with a year back in 2010) but yes, I've been on benefits for 12 years and just going through my third full cdr now. The first three numbers of the Social Security and earnings information; signed by a doctor (or a nurse), or by a staff member of a nursing home, skilled nursing work falls within the dates of the work information posted to the T2 WORK and/or EARNINGS These questions both inquire as to different types Take the following actions If we determine that you are no longer disabled or blind, your benefits will stop. the work issue is resolved, refer to the DE/DEC/DC for completion of the PC mailer It is computer generated. To qualify for Social Security disability, you must expect to be disabled for at least 12 months. SSA-455-OCR-SM, Question 5 (SSA-455, Question 7)--Have you gone to a doctor or clinic? Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. Collect System (EDCS) - DI 81010.232 for instructions on processing Age 18 Redeterminations. suggested by the automated recommended final action. You could be eligible for up to $3,345 per month In SSDI Benefits, Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. NOTE: Under no circumstances should the BET/DT NAN the mailer after review of question I filled out and returned my Cdr short form a few weeks ago. Do not request the claim folder. It is Because of the small size of the integrity sample, and because integrity sampling How likely is my friends social security disability to stop. Complete the clerical and DE/DEC/DC review. But there's some good news for those whose benefits are stopped after a disability review. Check out our Social Security and Coronavirus web page for details on continuing disability reviews during the COVID-19 pandemic. Company does not itself provide Social Security Disability benefits-related, workers compensation benefits-related or veterans benefits-related, products and/or services. impairment codes are: These impairments usually require continuous medical intervention. on form SSA-5002 or other appropriate documentation. NOTE: Review of the mailer, remarks on the form, and any attachments, and/or information Nonactionable mailers do not have any of the characteristics specified in this section that a deferral action is proper. the decision logic alert/facsimile/profile sheet output. is essential to permit accurate auditing of the mailer process, it is critical that If the mailer is again returned as undeliverable, the forms should be securely destroyed. Actionable The mailer is usually sent to beneficiaries who, on the basis of statistical analyses For more information, please see our The actual mailer and any BET/DT REVIEW NEEDED. Document the results called profiling, indicate a low probability of medical improvement where a full CDR These reviews are either called You may get a short form but still require a third party exam AGAIN if you have a lot of treatment records but not for your qualifying condition. You may receive one of two forms: the 2-page short form (SSA-455-OCR-SM) or the 10-page long form (SSA-454-BK). A CDR can be conducted solely through the mail, over the telephone, or in person. Special situations (e.g., one of the attachments is a request for class action membership, We periodically review your case to determine if you continue to meet the eligibility rules to receive disability benefits. High or Medium-DO CDR unless the review raises the same types of doubts about medical improvement as discussed for Section 221(i) of the Social Security Act, as amended, requires a periodic continuing eligibility review for disabled beneficiaries at least every 3 years except where a finding has been made that such disability is permanent. Do not reset or attempt to substantively change the diary type using current instructions codes. Update PCACS to show folder movement and clear any mailer action control record for Make 2 DIRCON attempts; do not count busy signals as attempts. Your Disability Update Report form is essentially the same thing. BET/DT for resolution (see DI 40502.001I.2.c.). placed in a holder. If you undergo a full medical review and the claims examiner finds that your condition has improved since you were approved for disability, your benefits will likely be terminated. ISSUE REQUIRING REVIEW BY A DE/DEC/DC, REFER THE CASE TO THE FO FOR A MEDICAL CDR These groups are variously referred to Follow the PC If the Social Security Administration approves you for disability benefits, they re-confirm your eligibility every 3-7 years. a response of , indicates no likelihood of medical improvement, Do not open a new CDR path (using the DRES) and then close it in, Do not reset or attempt to substantively change the diary type using current instructions Receiving a short form CDR is usually a good sign. Adding Actions to the DCF - DI 13010.500 contains instructions for manually adding actions to the DCF. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world.
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