When do Social Security Disability Benefits End?
by Pittman Dickey

Once Social Security has approved a person’s Disability Insurance Benefits that does not mean the benefits will continue forever. This column will deal with how the Social Security Administration decides when to terminate disability benefits it has previously granted.

The Social Security Administration periodically reviews disability awards through a process called a Continuing Disability Review. These reviews can be triggered by a specific provision in the decision of an Administrative Law Judge which directs the SSA to review the claim in a year or some other fixed time. The SSA on its own also reviews previously approved Disability Insurance claims to determine if the claimant’s condition has improved to the extent that he can return to work.

As an example we will use the case of Will Jones. Will worked in a textile factory and as part of his job had to lift extremely heavy bundles of cloth. He had to quit work on 1 June 1993 as a result of severe back pain. He underwent a laminectomy in September 1994 on his lumbar spine to relieve his chronic pain. He was out of work for months prior to the surgery and was unable to work after the surgery. In the Fall of 1994 an Administrative Law Judge awarded Will Social Security Disability Insurance Benefits effective 1 June 1993. As part of the decision the Judge directed that his case be reviewed in 3 years by the SSA. Will has been at home suffering from chronic pain and feels that the surgery really did not improve his condition.

In our example, Will would be notified by mail that the SSA is going to review his health situation to determine if he still qualifies for disability benefits. These letters naturally cause concern on the part of the disabled worker. The SSA will send Will a request for updated medical information regarding his medical treatment since his disability award and will request him to provide additional information regarding his daily activities and the effect of his health problems on his health.

The test for whether Will gets to keep his disability benefits is whether “medical improvement has occurred since the comparison point of decision and that the claimant has regained the capacity to return to substantial gainful activity.” In English that means that the SSA has to find that Will’s condition has actually improved medically and that he is now able to return to work. The SSA defines “substantial gainful activity” as the ability to earn at least $500 per month which is a very low threshold for employment.

The initial part of the review is done by government employees who obtain updated medical records from Will’s doctors and review his statements as to how his back problems effects his ability to perform daily life activities. If the medical reports are such that he clearly continues to be disabled the review ends at the level and the benefits continue. If the agency determines that Will’s condition has improved to the extent that he can return to work then they will notify Will of that decision and advise him that he has the right to have a hearing before a Hearing Officer appointed by the SSA. Will must give written notice to appeal this decision to trigger the next level of review with a Hearing Officer.

The hearing before the Hearing Officer is reasonably informal. Will can offer live testimony and bring in other witnesses such as relatives or neighbors to testify concerning his condition. Will can also submit additional medical records from his treating physicians regarding his present condition. The Hearing Officer will review all the documentary evidence in the file, consider the testimony offered at the hearing and then will prepare a written decision as to whether Will continues to be eligible to draw disability benefits.

The Hearing Officer looks to the last time that Will was found to have met the requirements for disability as the Comparison Point for the new decision. In Will’s case his Comparison Point was the decision by the Administrative Law Judge that he was disabled effective 1 June 1993. The Hearing Officer reviews all that has occurred since the Comparison Point in reaching his decision.

The Hearing Officer’s written decision will discuss Will’s medical treatment and evaluations and his daily life activities since the Comparison Point. The decision will also review his vocational history prior to his disability to determine if he has work experience that he could now use to return to work.

The Hearing Officer goes through a 12 step series of evaluation steps to determine if Will still meets the disability requirements. If he determines that Will is still disabled then the benefits will continue. If the Officer determines that he is no longer disabled then Will is notified in writing of the cessation of his disability benefits. Will then must give written notice of appeal to an Administrative Law Judge within 60 days of the Hearing Officer’s determination that his benefits should be terminated.

Once the Hearing Officer issues his written decision, Will must make a decision within 10 days as to whether he wants to continue to have his disability benefits continue during his appeal of the Hearing Officer’s decision to an Administrative Law Judge.

Will is faced with an important choice, if he decides that he wants to have his monthly benefits and Medicare to continue while he is waiting for a Judge to decide his case he can do so but if he loses at the Judge’s level he will be faced with the possibility of having to repay the monthly benefits. He will not have to repay the Medicare benefits. Frequently people in Will’s situation will decide to continue to receive the monthly benefits because they have no other source of income.

At the hearing before the Administrative Law Judge, the Judge will make a new decision to determine if Will is still disabled. The Judge is not bound by the earlier decision of the Hearing Officer but will make his decision based on the evidence that is produced at the hearing before the Judge.

In our example, Will would be notified by mail that the SSA is going to review his health situation to determine if he still qualifies for disability benefits. These letters naturally cause concern on the part of the disabled worker. The SSA will send Will a request for updated medical information regarding his medical treatment since his disability award and will request him to provide additional information regarding his daily activities and the effect of his health problems on his health.

The test for whether Will gets to keep his disability benefits is whether “medical improvement has occurred since the comparison point of decision and that the claimant has regained the capacity to return to substantial gainful activity.” In English that means that the SSA has to find that Will’s condition has actually improved medically and that he is now able to return to work. The SSA defines “substantial gainful activity” as the ability to earn at least $500 per month which is a very low threshold for employment.

The initial part of the review is done by government employees who obtain updated medical records from Will’s doctors and review his statements as to how his back problems effects his ability to perform daily life activities. If the medical reports are such that he clearly continues to be disabled the review ends at the level and the benefits continue. If the agency determines that Will’s condition has improved to the extent that he can return to work then they will notify Will of that decision and advise him that he has the right to have a hearing before a Hearing Officer appointed by the SSA. Will must give written notice to appeal this decision to trigger the next level of review with a Hearing Officer.

The hearing before the Hearing Officer is reasonably informal. Will can offer live testimony and bring in other witnesses such as relatives or neighbors to testify concerning his condition. Will can also submit additional medical records from his treating physicians regarding his present condition. The Hearing Officer will review all the documentary evidence in the file, consider the testimony offered at the hearing and then will prepare a written decision as to whether Will continues to be eligible to draw disability benefits.

The Hearing Officer looks to the last time that Will was found to have met the requirements for disability as the Comparison Point for the new decision. In Will’s case his Comparison Point was the decision by the Administrative Law Judge that he was disabled effective 1 June 1993. The Hearing Officer reviews all that has occurred since the Comparison Point in reaching his decision.

The Hearing Officer’s written decision will discuss Will’s medical treatment and evaluations and his daily life activities since the Comparison Point. The decision will also review his vocational history prior to his disability to determine if he has work experience that he could now use to return to work.

The Hearing Officer goes through a 12 step series of evaluation steps to determine if Will still meets the disability requirements. If he determines that Will is still disabled then the benefits will continue. If the Officer determines that he is no longer disabled then Will is notified in writing of the cessation of his disability benefits. Will then must give written notice of appeal to an Administrative Law Judge within 60 days of the Hearing Officer’s determination that his benefits should be terminated.

Once the Hearing Officer issues his written decision, Will must make a decision within 10 days as to whether he wants to continue to have his disability benefits continue during his appeal of the Hearing Officer’s decision to an Administrative Law Judge.

Will is faced with an important choice, if he decides that he wants to have his monthly benefits and Medicare to continue while he is waiting for a Judge to decide his case he can do so but if he loses at the Judge’s level he will be faced with the possibility of having to repay the monthly benefits. He will not have to repay the Medicare benefits. Frequently people in Will’s situation will decide to continue to receive the monthly benefits because they have no other source of income.

At the hearing before the Administrative Law Judge, the Judge will make a new decision to determine if Will is still disabled. The Judge is not bound by the earlier decision of the Hearing Officer but will make his decision based on the evidence that is produced at the hearing before the Judge.

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Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over sixteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 309 Person Street and can be reached at 484-8195.

Pitt Dickey has practiced law in Fayetteville since 1978. He has handled SSA disability claims for over sixteen years. He practices with the firm of Smith Dickey Dempster & Carpenter, P.A. at 309 Person Street and can be reached at 484-8195.