Once you begin receiving disability benefits, your case is re-examined periodically through a continuing disability review (CDR). (See Chapter 14 for more on this subject.) The SSA can end your benefits for a variety of reasons, including:
• a determination that your condition has improved and you can now work, or
• your failure to cooperate in the CDR.
This decision to terminate your benefits is made by a DDS medical consultant and examiner team.
You will receive a notice and explanation from the SSA explaining why your benefits are being terminated. The language of the notice should include something similar to the following words:
We are writing to tell you that we have looked at your case to see if your health problems are still disabling. After looking at all of the information in your case carefully, we found that you are not disabled under our rules as of (month/year).
The notice will come with a brief explanation of your medical condition and of how the SSA reached its decision. If you want to appeal, you must request a reconsideration of a CDR at a hearing before a disability hearing officer (DHO). If you appeal, before your claim goes to the hearing officer it will receive a second review by a different DDS medical consultant and examiner who could reverse the prior CDR decision to terminate your benefits (see Section b, below.)
Remember that although the DHO is not a doctor or a psychologist, they are allowed to form their own medical opinions about the severity of your physical or mental impairments. In fact, some DHOs reverse half the CDR denial (termination) cases they see, saving the claimant's benefits. They are often not hesitant to disregard the judgments of two different DDS medical consultant/examiner teams who thought your benefits should stop. So, there is a fairly good chance your benefits will be continued, and you have nothing to lose by trying.
As you prepare for the DHO hearing, keep in mind that the SSA must have good evidence that you have had significant work-related medical improvement— except for certain exceptions discussed in Chapter 14. At your DHO hearing, this is the critical issue. And it is a matter of medical judgment, for which your treating doctor's judgment should carry great weight. If your case is borderline, your benefits should continue.
a. Complete the Forms
To request a reconsideration determination by a disability hearing officer, you must file Form SSA-789-U4: Request for Reconsideration—Disability Cessation, with your local Social Security Field Office. If many months pass between when your CDR began and your hearing with a DHO, you can update the information you originally provided on the SSA Form 454-BK with Form SSA-782-BK, which you must request from your local Social Security Field Office. It is not available from the DDS.
sentative in the Field Office when you request reconsideration of disability cessation. The form is a multicopy form separated by carbon paper. We include instructions and a sample form below.
The top of the form asks for the claimant's name and Social Security number (SSN). If the wage earner is different than the claimant, then the name of that person is required, along with their SSN. If your claim is an SSI case, there is a blank requiring your spouse's name and SSN. The blank space in the upper right-hand corner is called "For Social Security Office Use Only," but has some important little boxes in it. One box allows you to request notices in Spanish. Another is to be checked if you want your benefits to continue during your appeal. Continuation of benefits only applies to appeals before the SSA; you cannot continue to receive benefits while appealing to a federal court.
If you want your benefits to continue during appeals before the Disability Hearing Officer (DHO), Administrative Law Judge or the Appeals Council, you have only ten days from the time you receive the CDR benefit cessation notice to file your appeal. The CDR benefit termination notice (see Chapter 14) will remind you of this fact. Since the SSA allows five days for mailing time, a more accurate way to count the days you actually have is to add 15 days to the date on the cessation notice.
If you continue benefits through your appeals and lose, you may have to repay the SSA. If you do decide to continue your benefits during appeals, you should also file Form SSA-632-BK: Request for Waiver of Overpayment, with your local Social Security Field Office. One of the exemptions for having to repay benefits is if you are unable to do so. Even if you eventually have to pay back some benefits, the amount can be as small as $10 per month.
i. Form SSA 789-U4: Request for Reconsideration— Disability Cessation:
Form SSA 789-U4 is easy to complete, and your local Field Office will be happy to help with any questions you have. The form is completed by the SSA repre
The next set of blanks concerns the type of benefit involved in your claim. There are boxes under "Disability" (SSDI claims) and SSI. Those that apply must be checked.
You are next asked for the name and address of any authorized representative you might have, as well as their telephone number.
Next, the form asks for the specific reasons you don't agree with the determination to stop your benefits. Remember, this is just a form to get your appeal started. You don't need to make long arguments here—just the basic facts. For example, you might say, "My arthritis has not improved, and the decision to stop my benefits ignored the opinion of my treating doctor that I have not gotten better. I have additional information from my doctor showing that I have not improved."
Then the next line lets you refer to any additional information, such as "New medical records and opinion from my treating doctor." Then give your doctor's name and address. If there is not enough room, the Social Security representative will enter it onto additional pages.
The form then has check boxes asking if you wish to appear at the disability hearing with a DHO, and whether you have or need an interpreter provided by the SSA. If you can only make an "X" for a signature, two witnesses who know you will also have to sign as well as provide their addresses. You will also be required to provide your address. Make sure it is an address where the SSA can reach you.
As discussed above, Form SSA-789 lets you waive your right to personally appear at the hearing. Another SSA form is also used to waive the right to personally appear at the hearing (Form SSA-773), and the DHO may ask you to sign Form SSA-773 to assure that you understand what it means to waive your rights. Form SSA-773 contains language explaining the nature and importance of the rights you waive when you sign Form SSA-773 or the waiver section of Form SSA-789:
I have been advised of my right to have a disability hearing. I understand that a hearing will give me an opportunity to present witnesses and explain in detail to the disability hearing officer, who will decide my case, the reasons why my disability benefits should not end. I understand that this opportunity to be seen and heard could be effective in explaining the facts in my case, since the disability hearing officer would give me an opportunity to present and question witnesses and explain how my impairments prevent me from working and restrict my activities. I have been given an explanation of my right to representation, including representation at a hearing by an attorney or other person of my choice.
Although the above has been explained to me, I do not want to appear at a disability hearing, or have someone represent me at a disability hearing. I prefer to have the disability hearing officer decide my case on the evidence of record plus any evidence that I may submit or which may be obtained by the Social Security Administration. I have been advised that if I change my mind, I can request a hearing prior to the writing of a decision in my case. In this event, I can make the request with any Social Security office.
You do not want to waive your right to attend a hearing unless it will be impossible for you to attend. The hearing gives you the chance to personally explain to the DHO why you believe you are still disabled. Also, the hearing officer may notice something about you that is not obvious from the medical file which supports your contention that you are still disabled.
ii. Form SSA-782-BK: Reconsideration Report for Disability Cessation:
This form is very much like the Form SSA-454-BK you completed at the beginning of the continuing disability review. (See Chapter 14 for information on filling out Form SSA 454-BK.) You need to complete it only to include new developments or corrections since completion of Form SSA-454-BK—for example, if you saw new doctors or received additional medical treatments. See the sample of this form below.
b. DDS Review
Before the Disability Hearing Officer considers your case, a new DDS team (consisting of a medical consultant and a DDS examiner) will review the decision to terminate your benefits. The purpose of the new review is to see if your benefits can continue without the inconvenience of a hearing. The second team might reverse the first team and grant you a continuation of your benefits, either because they think the first team is in error or if the DDS received important additional information that influences the determination. In that case, the hearing is no longer necessary.
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