Question: I have been receiving disability for seven years and have received a letter saying Social Security does routine audits every three to seven years. Should I be concerned? Also, hearing in the news about the recent “billions of dollars paid to public who should have not qualified,” will this make it more difficult to be re-approved or have my case looked at more closely than normal? I figured you would prefer the long story short, so didn’t provide the particulars.
Answer: Social Security periodically reviews the condition of all Social Security disability recipients to confirm they still fit the definition of disabled – that is, that they are still unable to work. These reviews are called continuing disability reviews. So the letter you received is just routine.
Social Security should have sent you a disability award letter when you were approved for benefits, and that letter should have stated when you could expect your first review. If Social Security found that it was possible, though not necessarily likely, that your medical condition could improve, then your file would have been set for a three-year review. If Social Security didn’t expect your condition to improve, your file would have been set for a seven-year review. Generally, the files of disability recipients over 55 receive reviews less frequently than the above timeline. And in recent years, Social Security’s lack of funding has allowed the agency to do far fewer reviews than technically required.
But unless your condition has improved enough for you to work, a continuing disability review is not much to worry about. You won’t have to prove your disability over again. Instead, to terminate your benefits, Social Security would have to prove that there has been medical improvement in your condition – that is, that the severity of your impairment has become less severe. Also, the medical improvement in your condition must relate to your ability to work. In practical terms, this requirement means that you must have more residual functional capacity (RFC) than you had when your disability benefits were approved. If your RFC hasn’t changed (say you still can’t sit or stand for more than six hours), your benefits can’t be terminated. Social Security must also find that there is some kind of substantial gainful activity (full-time work) that you could do.
There are exceptions to these rules – such as Social Security finding there was a clear error or fraud in the original decision – but in actuality, only about 5% of disability recipients lose benefits after a review. And no, while there may be more scrutiny on initial disability decision in the near future, unless policy and regulations are changed regarding disability reviews, it won’t be more difficult to pass a review because of the political climate.
To read further, see our article on how likely it is your benefits will be terminated after a review and the frequency of disability reviews.