Disability Reviews

By Tom Margenau

March 19, 2014 6 min read

Q: After a long process, I started getting disability benefits about a year ago. And now, out of the blue, I just got a letter from Social Security telling me they want to review my claim. I think this is harassment! It took me almost 12 months, and several appeals, to prove to them that I am disabled in the first place. And now they are turning around and threatening to take my money away from me! How can they do this? And can you please refer to me a good lawyer so I can fight this?

A: They (the Social Security Administration) can do this because the law requires them to do it. That law says that every Social Security disability claim must be reviewed from time to time to make sure that the person getting monthly checks from the government still meets the legal definition of disability.

How often a claim gets reviewed depends on the severity of the impairment. In cases where the person's medical condition is expected to improve, the rules say the claim must be re-examined every 6 to 18 months. Obviously, your impairment must be in that category.

In situations where medical improvement is possible, but not probable, the claim should be reviewed every three years or so.

And even in cases where medical improvement is not expected, the law still requires that the case be reviewed once every five to seven years.

So the good news is that you must have a condition that shows every sign of improving, and you could be on your feet and off the government dole and back in the work force in the foreseeable future. But the tone of your email tells me you don't see it this way. You obviously think you are still disabled and deserve to continue receiving the benefits you are currently getting. So let me tell you what's going to happen.

You're going to have to fill out a form in which you will explain what your impairment is and how you believe it continues to keep you from returning to work. At the same time, you will be asked to provide updated medical reports. You very likely may be sent to a Social Security doctor for a medical examination. (See the next question and answer about this.) You certainly don't need a lawyer to deal with this first round of paperwork and possible medical exams.

Then a couple months later, you will either learn that your disability is still considered severe enough to merit continued monthly benefits. Or you will get a letter telling you that your condition has improved to the point where you no longer qualify for disability. That letter usually says your checks will stop in three months. If the latter happens, then you will immediately want to file an appeal. And it's at that point that you might want to start looking in the Yellow Pages or searching online for lawyers who specialize in Social Security disability cases in your area. There are dozens of them in any large city.

Q: I filed for Social Security disability benefits about a month ago. I have severe back pain, fibromyalgia, high blood pressure, poor eyesight and other problems. As part of the application process, I provided them with enough doctors' reports, lab test results and other medical records to fill a small suitcase! Yet I just received a letter telling me they want me to go to one of their Social Security doctors. I don't want to do this because these guys are obviously employed by Social Security so they are in cahoots with the government. I've heard they are even paid more money for each disability claim they reject. Also, I don't have the money or insurance to pay for a visit to another doctor. Is there any way I can get out of this?

A: Well, you could get out of it by simply not showing up for your scheduled appointment. But then I could almost guarantee you your claim will be instantly denied.

Maybe I can alleviate your fears and obvious mistrust of this process. The reason these consultative examinations are often needed is because Social Security law can be very specific about the kind of documentation needed to prove that a person is disabled. Your suitcase full of medical records may have lots of helpful information, but it may not have the precise evidence needed to make your case.

So that's why you are sent to a doctor. And you should understand that the medical professional you will be seeing isn't really a "Social Security doctor." The government doesn't employ doctors to do these medical exams. Instead, they simply ask that you go to a doctor in your area. This doctor is paid a small fee to examine you. The doctor fills out some forms and sends them to SSA. He or she is not involved in the final decision about your disability. And the doctor gets the same fee whether your claim is allowed or denied.

To answer your final concern, you will not have to pay for this medical exam. The government picks up all the costs. And they will even reimburse you for any transportation charges you might incur to get to the doctor's office.

If you have a Social Security question, Tom Margenau has the answer. Contact him at thomas.margenau@comcast.net. To find out more about Tom Margenau and to read past columns and see features from other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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