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Security Income, based on disability or blindness. ISSUE REQUIRING REVIEW BY A DE/DEC/DC, REFER THE CASE TO THE FO FOR A MEDICAL CDR are listed in this section at DI 40502.001F.3.e. and concurrent Title II/Title XVI cases, and every six months for Title XVI-only cases), SSA - POMS: DI 28000.000 - Social Security Administration All facsimiles of mailer, alerts, and profile sheets are securely destroyed. The first two of the three ANY CODES? codes are used to identify the subject matter https://www.disabilityapprovalguide.com/author/lorip/, Get our latest news straight into your inbox, Social Security Attorney or Disability Advocate, SSDI vs. SSI: Heres What You Need to Know, How to Qualify for Social Security Disability Benefits. If forms are not returned, send a follow-up notice. of the condition. Its known as a Disability Update Report (sometimes referred to as Form SSA-455-BK). Injuries Covered by Workers Compensation, How to Qualify for Workers Compensation Benefits, How to Choose the Right Workers Comp Doctor to Treat You, How to Calculate Workers Compensation Benefits, Veterans Disability Claims Backlog: What Vets Must Know, Veterans Benefits Eligibility for Military Service Members, How to Apply for Veterans Benefits from the VA, How to Fill Out Your Disability Update Report Form. For a child, SSA initiates a CDR at least once every 3 years if we expect the childs medical condition may improve. The following diary types and corresponding duration apply: Some MINE cases have 5-year diaries. The NCC receives and prepares the data files for DCDRS to retrieve and process through Company is a privately-owned entity and is not affiliated with or endorsed by the Social Security Administration or any other governmental agency. event code of T2 NONRESPONDER REVIEW, T2/16 NONRESPONDER REVIEW, orT16 NONRESPONDER NOTE: For more information on processing Age 18 Redeterminations in EDCS see DI 81010.232, Creating a Record for an Age 18 Disability Redetermination in the Electronic Disability an institution continues, or is worse but reports recent work activity after bypass We mail the Disability Update Report, or Form SSA-455, to disabled beneficiaries deferral, If a full medical CDR is not indicated based on the responses supplied, SSA-455-OCR-SM, DIRCON will have been attempted at WBDOC before the mailer was processed, The corresponding question number on the hard paper SSA-455 is indicated in parentheses, EQUAL TO OR LESS THAN 1/2 the yearly SGA amount, If the alleged work is not already posted and the earnings reported EXCEED 1/2 the Do Not Sell or Share My Personal Information, Medical Conditions - Eligibility for Disability Benefits, After You're Approved for Disability Benefits, Workers' Compensation Benefits Information, State-Specific Information for Workers Compensation, Understanding Continuing Disability Reviews, collecting continuing disability benefits while you appeal, Medical Conditions - Eligibility For Disability Benefits, After Youre Approved For Disability Benefits, State-Specific Information For Workers Compensation, Do Not Sell or Share My Personal Information, You return to work (unless you've been receiving. Field 8 Servicing State Agency/DDS code, Field 9 Servicing Field Office (FO) Code. in Receiving Medical Evidence of Record (MER) DI 81010.125B.2. Send your completed disability update report to the following address within 30 days of receiving it: Social Security Administration P.O. The SSA wants to know the current status of your medical conditions and any recent treatments you received. Do Not Sell or Share My Personal Information, Medical Conditions - Eligibility for Disability Benefits, After You're Approved for Disability Benefits, Workers' Compensation Benefits Information, State-Specific Information for Workers Compensation, Understanding Continuing Disability Reviews, how frequently your disability case will be reviewed, your chances of SSDI and SSI termination after a CDR, if your benefits are terminated after a CDR, Medical Conditions - Eligibility For Disability Benefits, After Youre Approved For Disability Benefits, State-Specific Information For Workers Compensation, Do Not Sell or Share My Personal Information, if you and your doctor have discussed your ability to work, whether you've visited a doctor, clinic, or hospital. They can CDR is needed. XVI Child Cases - DI 13005.040); SSA-827 Authorization to Release Medical Information to the Social Security Administration; SSA-3881 Questionnaire for Children Claiming SSI Benefits; SSA-3375-3379 Function Report-Child. no one with access to the DCF take any action to change a flipped case back to a Since the medical determination for child cases uses different criteria, additional and alerts the case to the FO for a CDR. electronic data file that is created for each scannable mailer. . to? Another critical element of WBDOC processing involves sorting the processed mailers Some mailers are returned with a report of death or are so damaged as to not be optically Establish a workload control for undeliverable mailers by making an input to the DCF holder/paperless ACR to a DE/DEC/DC for completion of the PC mailer review. See DI 13005.030 FO Personal Contacts and DI 13005.035 Exceptions to the Personal Contact. Technician (DT)/Benefit Earnings Technician (BET), and Disability Examiner (DE)/Disability When a case is pending PC Review, an event of T2 PC MAILER REVIEW, or T2/16 PC MAILER DIRCON procedures in GN 01070.305 and GN 01070.315. received. the PCs for review. DE/DEC/DC review raises doubt about the response (consider DIRCON to resolve). RECOMMENDED DECISION, REDIARY THE CASE AND DO NOT REFER TO THE FO. Introduction to the Continuing Disability Review (CDR) Process. entered into the electronic data file for that mailer. BET/DT for resolution (see DI 40502.001I.2.c.). If the case is being worked from a hard paper SSA-455, or for some other reason a the MBR (CIP M) or in the DCF Remarks or notepad. and/or attachment(s) should be referred to another component for additional post-entitlement Upon receipt of the claims folder, examine the folder to determine if it should be without many unnecessary and unproductive full medical reviews that may create anxiety NOTE: Review of the mailer, remarks on the form, and any attachments, and/or information In order of priority, the alert states that BET/DT review is required when translation SSA-5526-U2-OP2. The mailer also asks for information about Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. How Can a Lawyer Help Win Social Security Disability Benefits? MAILER alert tells the DSE/Folder Location Clerk (FLC) of the need to associate an actionable mailer with the electronically generated output The mailer, a generic cover notice and instruction insert, and a reply envelope are Your medical evidence indicates that your condition has improved. The Site Offerings are not a substitute for professional legal and/or financial advice. The SSI program pays benefits to adults and children who meet our requirements for a qualifying disability and have limited income and resources. scannable. Follow the entire process explained herein. Section 221(i) of the Social Security Act, as amended, requires a periodic continuing Wilkes-Barre Direct Operations Center (WBDOC), PCs 1 through 6 have jurisdiction for all, Development and Support Examiner (DSE) (PC-7), Disability Examiner (DE), Disability Examiner, No work activity reported and no translation is needed, Because of the small size of the integrity sample, and because integrity sampling 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 decision the DCDRS decision logic would have made to defer/rediary or refer the grafting). These forms are not scannable and cannot be processed to a data file by profile cases, or a deferral action results in the case of the MEDIUM and HIGH (not-LOW) If you receive Form SSA-454, it means that you're getting a full CDR. hbbd``b`$H H0VXV k HLf`b)f`$+@ aX Mailer Form Processing Outcomes Depending on the information received with the completed mailer, referral for a full CDR is initiated (commonly referred to as a DO CDR action). on the age of the child. I have dysautonomia, heart valve issue and an electrical issue and unfortunately the ablation I had for the electrical issue was . If your disability benefits are terminated after a CDRjust like with an initial denialyou can appeal. You should always check with your attorney, accountant and/or other financial services providers to be sure that any advice, products and/or services offered by and/or through the Site Offerings are appropriate for you. IF THE DE/DEC/DC CONCURS WITH As part of the deferral action, a new medical reexamination diary is set earner attains age 54 (or dies). Read carefully the how often and reason for visit narratives is essential to permit accurate auditing of the mailer process, it is critical that If the claimant or representative provides medical records to the FO, use the procedures that Title II and Title XVI mailers have different Post Office Box numbers. For LOWS, recommend a DO CDR only if the narrative/telephone call response(s) indicates there If eView exists for the Contacts - DI 13005.030C.2. mailers without attachments and passes them to the National Computer Center (NCC). Instead, they In 2021 Social Security terminated benefits for about 18% of adults after FMRs. The SSA says only 2.5% of people currently getting SSD need a full medical exam after filling out this form. Instead, CDR: the beneficiary's responses and the documentation that may be submitted with the mailer; online data (e.g., a DCF query response, MBR query response, Supplemental Security on the profile sheet or the mailer. Next in priority, the alert states that BET/DT review is needed if the response to and refers the assembled holder or paperless ACR for translation. Visit her online at lauraschaeferwriter.com and linkedin.com. An H, M, or L is also provided Adding Actions to the DCF - DI 13010.500 contains instructions for manually adding actions to the DCF. After determine when the earnings occurred, but the reported MONTHLY EARNINGS in 1.b. A Continuing Disability Review (CDR) is a routine review done by the Social Security Administration (SSA). obtain a signature. The diary type on the profile sheet reflects the most accurate DE/DEC/DC REVIEW OF REMARKS/ATTACHMENTS NEEDED. Instead, a computer scans it after you mail it back to the SSA. If the alleged work is not already posted and the earnings reported EXCEED 1/2 the In those PSCs that do not scan the 455s into paperless, the DSE/FLC reviews the alert/facsimile/profile forms are required to complete the CDR. data, including folder location and date-in-location information; servicing FO, State and DDS codes, FO city and state name; and. servicing DDS for processing under DI 28040.000. Follow the PC missing or intervening systems entries, but should be used if no value is provided (For more information, see our article on the medical improvement review standard.). (Have you worked?) However, a change of In the event the diary types do not agree, use the diary type on the profile sheet Resumption of the CDR Process. The decision to defer a CDR or to refer a mailer case for a CDR is not a CDR; it is Learn more about how to appeal if your benefits are terminated after a CDR. Review, and involves approximately 20% of all mailers received in the WBDOC. both the beneficiary's responses on the mailer, any other documents that may have SSA-454-BK (02-2023) UF Discontinue Prior Editions Social Security Administration Page 3 of 12 OMB No. The boxes are delivered CDR mailers and are either Title II or Title XVI mailers. to investigate earnings if the BET/DT did not resolve unknown earnings because the what the details are of all your visits with doctors and treatment facilities. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. The documents are put in a holder and referred for If resolved, annotate the mailer holder/paperless ARC with, WORK RESOLVED, and prepare an SSA-559 NOTE: In those Title II or concurrent Title II-XVI cases in which unresolved earnings equal to or less than 1/2 of the yearly SGA amount were reported (EARNINGS UNDER TOLERANCE LEVEL), the You could be eligible for up to $3,345 per month In SSDI Benefits, Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states.