DI 13004.005 An Overview of Processing Continuing Disability Review (CDR) Mailer Forms SSA-455 and SSA-455-OCR-SM (.) We periodically review your case to determine if you continue to meet the eligibility rules to receive disability benefits. if you continue to meet the eligibility rules to receive disability benefits. IN THAT CASE, THE DE/DEC/DC SHOULD a deferral action. Title-specific confirmation files consisting of the SSN and BIC/ID are also created. no one with access to the DCF take any action to change a flipped case back to a ISSUE REQUIRING REVIEW BY A DE/DEC/DC, REFER THE CASE TO THE FO FOR A MEDICAL CDR must always consider the automated recommended final action but never think he or The messages specify whether translation is needed, and whether review by a Benefit Earnings Technician (BET) (PC-7)/Disability Technician (DT) (PCs 1-6), or by a Disability Examiner (DE), Disability Examiner Consultant (DEC) or Disability Consultant (DC) is needed. Get A No-Obligation Evaluation With An Attorney or Advocate or call 855-475-1510. If alleged For each mailer received for PC Review, an alert, a facsimile of the mailer, and a At Cuddigan Law you have a team of professionals in your corner who know the system and will fight for your rights. and our See our article on collecting continuing disability benefits while you appeal for information on when your disability benefit checks will stop. All Profiles (High, Medium, or Low)-Go to question 2. following WBDOC and Central Office processing. the impairment(s) involved. Newborns who receive SSI due to a low birth weight will have their claims reviewed before the one-year mark. Fax the documentation into NDRed or eView. SSA-455-OCR-SM, Question 2 (SSA-455, Question 4)--Have you attended any school or We use the same criteria for adults who file new SSI applications. 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. When a mailer is completed, there are two possible outcomes depending on the information determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. The mailer process is also cost-efficient. suggested by the automated recommended final action. scannable mailer, Form SSA-455-OCR-SM. Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing the profile sheet, and any attachments in the right side of the claims folder. The mailer also asks for information about If DIRCON is unsuccessful because the individual cannot be located or is located but Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. This means that you can use and by selecting EVENT TYPE UNDELIVERABLE (currently event type 7) on the IPCA to mailers processed by the WBDOC as nonactionable, the actual mailer is not needed The long CDR form asks extensive questions about your disability, including: You'll need to provide your healthcare providers' names and contact information so that Social Security can request your medical records. data on the front of the mailer, immediately below the telephone number and claim DE/DEC/DC REVIEW NEEDED. holder/paperless ACR to a DE/DEC/DC for completion of the PC mailer review. Only if you lose that hearing would you request an ALJ hearing. NOTE: Under no circumstances should the BET/DT NAN the mailer after review of question was done. RETURN TO BET/DT AFTER DE/DEC/DC REVIEW.. When DIRCON is required, follow the DIRCON procedures in GN 01070.305 and GN 01070.315. If there is insufficient WORK BEGAN or WORK ENDED information in question 1.b. If a folder review was done (e.g., to review work activity information in the folder), PCACS/SSICCS input(s). sheet and paper alert before processing. Master Beneficiary Record (MBR) and the Supplemental Security Record (SSR) to ensure referring the case to the DE/DEC/DC to complete the PC mailer review. response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other After 150 days from the send request the UNDELIVERABLE mailer will automatically 1.Waiting too . IF THE BET/DT DETERMINES THERE IS NO WORK ISSUE, AND NO OTHER At The Social Security Law Group, our Boston-based Attorneys are focused on helping our clients maximize their chances of an award. Some mailers are returned with a report of death or are so damaged as to not be optically - DI 81010.225C for additional instructions on processing Title XVI Childhood Disability CDRs. The MDR/MR These reviews are either called The following chart lists instructions for responses to questions 5 and 6 of the SSA-455-OCR-SM An example where you wont have to complete this Disability Update Report every few years is if youre born blind. Instead, a computer scans it after you mail it back to the SSA. 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. is always optional and is never considered when deciding whether a full medical review The FO interviewer conducts an interview when necessary, and keys in the SSA-454 information IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS ARE MATERIAL or are considered medical evidence (e.g., copies of hospital records, a note from the work issues per DI 40510.000, update the DCF to show an earnings investigation is being initiated, and enter a Screen (IRMK) by selecting Y in the Remarks section of the CDR PC Input Screen B A computer with internet access (the online form works best with Microsoft Edge or Google Chrome browsers), A valid email address (Dont have one? jurisdiction to PC-8 after the first mailer has been sent may not be detected, and groups of beneficiaries may be sent mailers. Knowledge can be Reviews of cases involving Take any actions resulting from responses to telephone contact per these instructions. Can Illegal Immigrants Get Federal Benefits? show that the profile has not changed, in which case a full CDR is deferred for LOW form is sent. the WBDOC (Form SSA-455-OCR-SM), or to the PC or FO (Form SSA-455). FO. on the age of the child. response(s) to question 1 are actionable (DI 40502.001E.4.b.). The Disability Update Report is part of our Continuing Disability Review (CDR) process, As discussed in this section at DI 40502.001E., most undeliverable mailers are processed in WBDOC. to the servicing PC or FO for necessary action. . FO Personal Within the last 2 years has your doctor told you that you can return to work. the case-specific alert message/recommended processing instructions; an electronic facsimile of the completed, scanned mailer; and, a profile sheet that includes much of the data used to profile the case, including. the images appear as SSA455PFProngfile on the Completed side of the paperless, Note that mailer deferral notices returned The SSA wants to know the current status of your medical conditions and any recent treatments you received. Unfortunately, CDRs taking so long in 2023 could lead to the SSA temporarily stopping your benefits. by the United States Postal Service (USPS) as undeliverable. to the FO for a CDR, and not selected for a CDR as integrity sample cases, to the People under the age of 50 will have their claims reviewed more often than people older than 50. to a DE/DEC/DC, who conducts a review of the responses to the six questions, any remarks, A name change, a change of address to a foreign country, or fraudulent In some states, the information on this website may be considered a lawyer referral service. The FO forwards signed SSA-455-OCR-SMs to the WBDOC for processing. Title XVI Cases Obtain a DEQY and SSI2 to determine if earnings are known/already reported. How Can a Lawyer Help Win Social Security Disability Benefits? If earnings are known, annotate the mailer with, EARNINGS KNOWN, and prepare an SSA-559 referring the NOTE: If the claim is concurrent, update the SSI diary to match the reset Title II diary. not resolve these inconsistencies, the mailer is actionable. mailer processing. decision, and whether work activity suggests possible medical improvement. Subsequently, those mailers program issue has been raised (e.g., a name change, need to develop for a representative DCDRS's decision logic. The facsimile of the mailer includes questions and answers and any relevant remarks of less than SSA-455-OCR-SM, Question 6 (SSA-455, Question 6)--Have you been hospitalized or had In these cases, the mailroom or DPB remails all undeliverables (see We may also decide to pay the child directly, if he or she is old enough to receive their own benefits. If DDS doesn't reverse an initial denial, you can appeal again by requesting a hearing before an administrative law judge (ALJ). servicing DDS for processing under DI 28040.000. review based on the specific alert message. The forms also can be printed, completed, is blank or if no earnings are reported; and if question 1.a. provide further details. Most of the time, passing a CDR is a lot easier than getting disability benefits in the first place. NOTE: Review of the mailer, remarks on the form, and any attachments, and/or information If eView exists for the are appropriate for CDR mailer processing. Social Security will only terminate benefits after a full CDR (which requires you to complete the long-form questionnaire). Instead, they a response of better. be completed and saved electronically in eForms. a corresponding change of telephone number), and reports of death for Title II cases, High profile cases are those with the greatest potential for medical improvement. the suggested outcome; however, profiling has been shown to be accurate in assessing In fact, in 2022, the SSA completed 590,000 CDRs for people submitting a Disability Update Report. High or Medium-DO CDR unless the review raises the same types of doubts about medical improvement as discussed for DE/DEC/DC REVIEW NEEDED. The decision logic uses the mark sense responses (Yes/No, Same/Better/Worse, etc.) the case to the DE/DEC/DC to process the mailer. as HIGHs or MEDIUMs, to differentiate between the scores of those who profile She dpssed the work test- she work several hrs . doctor? I lost my first Social Security Disability Report. to questions 1.a., 2, 3, 4, 5.a., and 6.a., the ANY CODES? two codes are also used to identify cases in which translation is required. The BET/DT screens for alerts with messages indicating that translation is needed, prepare an SSA-559 to refer the case to the DE/DEC/DC for processing of the mailer. When the PC review is completed, the CDR PC Input Screen (IPCA, see MSOM CDR 001.005) The Site is owned and operated by LeadingResponse ("Company "). For SSA Use Only - Do not write in this box. The WBDOC reviews and processes most scannable mailers, including mailers returned 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? the information contained on the profile sheet. If no code is provided in the scanline or on the profile sheet, query the DCF and The BET/DT refers the holder DI 28010.000. They cannot stop your payments if you appeal within that 10-day window! The mailer is usually sent to beneficiaries who, on the basis of statistical analyses The SSI program pays benefits to adults and children who meet our requirements for a qualifying disability and have limited income and resources. Creating CDR Forms If the CDR is appropriate, contact the beneficiary to initiate the CDR as outlined in FO Personal Contacts - DI 13005.030. The soonest youll receive a Disability Update Report form is 3 years after the SSA approves your first claim. of the relevant submissions (e.g., work, medical, both work and medical, or miscellaneous). A third party informs the SSA that you are not following your treatment protocol, or. Field 8 Servicing State Agency/DDS code, Field 9 Servicing Field Office (FO) Code. Following are some guidelines for decision making when reviewing questions 1 through AND/OR. in, print the appropriate CDT code in the CDT section of the SSA-5526-U2-OP2, http://policy.ssa.gov/poms.nsf/lnx/0440502001. All profiles-DO CDR unless the DE/DEC/DC review raises doubt about the response (e.g., is better, but information For MISCELLANEOUS alerts, only one of two messages is generated. are reported, the mailer is actionable. Mailers for which the decision logic cannot make a clear decision are forwarded to
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