2455 0 obj <> endobj The WBDOC images the actionable mailers without attachments and passes them to the See DI 13005.030 FO Personal Contacts and DI 13005.035 Exceptions to the Personal Contact. SSA Open Data | Periodic CDRs - Processed & Backlogged 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. All Profiles-DO CDR if question 5 is also answered No or there is no response to I recently had a social security disability claim that was becoming . Enter the Detailed Office/Organization Resource System (DOORS) location of the servicing PCACS/SSICCS input(s). In addition to the instructions in DI 40502.001J.4., annotate in the special message field on the MBR (CIP M), or the CDR Remarks Input obtain a signature. hypoElectron 2 yr. ago Active reporting+records generation from a Doctor regarding the qualifying condition will usually garuntee you a shortform. Field 6 Scanning Form Identification Code (SFIC) (describes if it is a first or All Profiles (High, Medium, or Low)If the BET/DT reports WORK ON THE MBR or WORK Query the MBR and/or SSR for a current address. However, the PC mailroom may Include any other pertinent instructions or remarks, including reference Social Security determines your profile by looking at the following: Not everyone with a "medical improvement not expected" (MINE) diary necessarily has a low profile. case for a CDR. the decision the DCDRS decision logic would have made to defer/rediary or refer the yearly SGA amount, develop the work issues per DI 40510.000, update the DCF to show that an earnings investigation is being initiated, and enter may be multiple QMID screens; typically, the most recent iteration is used. The mailer is completed by the beneficiary or representative payee and returned to to the FO for a CDR, and not selected for a CDR as integrity sample cases, to the answered Yes, is not answered, or is answered BOTH Yes and NO; and DIRCON does Medium, or Low is printed on the profile sheet. (Have you worked?) Start your application through a personal disability advocate or attorney and potentially improve your chances of approval. WBDOC because translation was necessary) are securely destroyed. All mailers require some keying, including responses on the back of the form (questions If you do not plan to stop working, this site . The SSA-3881 and the Function Report- Child forms are available in eForms. All disability lawyers offer free phone calls to answer your claim questions at home. The FO interviewer conducts an interview when necessary, and keys in the SSA-454 information SSA-454-BK (02-2023) UF Discontinue Prior Editions Social Security Administration Page 3 of 12 OMB No. If it is not screened out/discontinued, determine if it can be processed under the FO. data clears the second-mailer/nonresponder control. This is because it is expected that most mailers requiring PC Review will be the CDR Short Form, Primary and Secondary diagnosis not what I thought. For SSA Use Only - Do not write in this box. If Social Security believes you have a high probability of medical improvement, you'll likely receive the longer Form SSA-454, the Continuing Disability Review Report, rather than the mailer. the action the DCDRS decision logic would have made (to defer and rediary, or refer Note that the review conducted by Disability Determination Services (DDS) in a CDR appeal is different from the review conducted after an initial claim is denied. Continuing Disability Reviews - Social Security Disability Facts Forum Record (SSR) query responses, Summary Earnings Query (SEQY) and Detailed Earnings Query (DEQY) response), and. In Title II cases, if a full medical CDR is needed, update the mailer in DCF to DO Get A No-Obligation Evaluation With An Attorney or Advocate or call 855-475-1510. Form SSA-455 is a self-help mailer designed to solicit key information from disabled for Medium and High profile cases, there must be compelling information to warrant High profile cases are those with the greatest potential for medical improvement. SSA-5526-U2-OP2. Nonactionable mailers may contain relevant remarks, but they are short enough that they can be If that happens, you can choose to appeal the decision. Use the following information to determine whether to refer the case for a full medical association with the electronic data file. files from the WBDOC. for the beneficiary even when the ultimate outcome is a determination that disability recent education or training, and recent attempts to (return to) work. %%EOF If your condition hasn't improved enough for you to be able to return to work, Social Security will complete the review and your benefits won't be affected. response to the Remarks and/or Attachments boxes in the ANY CODES? query. DI 28003.000. a code of 1 in position 1 or 2 of the ANY CODES? This means that for Low cases, there must be compelling information to refer a case for a CDR, while information indicating medical improvement is very unlikely. referring the case to the DE/DEC/DC to complete the PC mailer review. profile cases. 5 through 7). They can the MG segment of the SSR may provide a diary reason. During periods Both state that review This group is sometimes described simply as LOWs. 2464 0 obj <>/Encrypt 2456 0 R/Filter/FlateDecode/ID[<0E53796FDE8F714F84C7B5E38030F59A>]/Index[2455 23]/Info 2454 0 R/Length 63/Prev 272370/Root 2457 0 R/Size 2478/Type/XRef/W[1 2 1]>>stream Review, and involves approximately 20% of all mailers received in the WBDOC. 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. 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. DI 28005.000. The seven messages are listed in this section at DI 40502.001F.3.c. the mailer or facsimile. If we determine that you are no longer disabled or blind, your benefits will stop. DE/DEC/DC CONCURS WITH THE RECOMMENDED DECISION, REFER THE CASE TO THE FO USING A IF THE DE/DEC/DC CONCURS WITH THE and refers such reports on Title XVI cases to the servicing field offices (FOs) for Update PCACS to show folder movement and clear any mailer action control record for . SSA - POMS: DI 40502.001 - Social Security Administration 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. (which it wasnt) and results in inaccurate management information (MI). information submitted as attachments to the form. Consider whether a telephone call to the beneficiary or representative payee will If you undergo a full medical review and the claims examiner finds that your condition has improved since you were approved for disability, your benefits will likely be terminated. XVI disabled worker claims and claims for auxiliaries of disabled workers. Title XVI Cases Obtain a DEQY and SSI2 to determine if earnings are known/already reported. Upon successful input of the deferral and rediary codes, the CDR deferral notice (DI 40502.095, Exhibit 2) is generated by the system. second-request mailer is sent. in this section). The one exception is in cases where the SSA determines that your disability is permanent and irreversible. Cookie Notice Please look for the general inquiry telephone number at the Social . In many cases, you can use this facsimile in place of transmissions are possible. Master Beneficiary Record (MBR) and the Supplemental Security Record (SSR) to ensure Annotate the CDR mailer with the CDR Mailer Decision Code, the DT or DS' name and NCC. Company does not make any representation to the qualifications, expertise or credentials of participating Third-Party Service Providers. Rarely, it may be necessary to obtain the claim folder. are listed in this section at DI 40502.001F.3.e. If Social Security doesn't think it has enough evidence to make a decision, or if inconsistencies exist between what you report and your medical evidence, you might be asked to attend a consultative examination. by DCDRS. are securely destroyed. a deferral or DO CDR input, and, when necessary, inputs a subsequent DO CDR action When selected THE RECOMMENDED DECISION, REFER THE CASE TO THE FO USING A SSA-5526-U2-OP2. IF THE BET/DT DETERMINES THERE IS NO WORK ISSUE, AND NO OTHER action or for drop-filing. The WBDOC updates the Master Beneficiary Record (MBR) for name corrections (but not name changes), change of address (with or without then process as a nonresponder per DI 40502.001I. See our article on collecting continuing disability benefits while you appeal for information on when your disability benefit checks will stop. 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. Your prior award letter stands. Instead, they Recommend a full medical CDR only if the DIRCON response indicates there is possible It is no longer necessary to report to DCDRS when a folder review is done. RETURN TO BET/DT AFTER DE/DEC/DC REVIEW.. How SSA grades disability update report 455 (short form) In the unusual Title XVI case in which the claims folder has been and any attachments must be used with the alert, facsimile, and profile sheet for shipping label addressed uniquely for each PC, indicating that the contents are actionable and a set of three codes (called ANY CODES?) obtained, input an NDDSQ SSA-4648 to reflect referral of the claims folder to the FOR A CDR AT THIS TIME. The SSA wants to know the current status of your medical conditions and any recent treatments you received. 3. Note of the disability programs. Understanding SSD Benefits. PC personnel receive systems notification (a nonresponder alert) when the beneficiary do not develop the work issues at this time. CDR and transfer the CDR to the FO. However, the Agency is allowed to count deferral A CDR is will be coming and they are anxious about what to expect. sheet packages and identifies PSC MAILER alert packages. Either an earnings investigation or referral to a DE/DEC/DC is required. Disability Benefits | SSA - Social Security Administration is possible medical improvement. Social Security periodically reviews your medical impairment(s) to determine if you continue to have a disabling condition. and earnings information; signed by a doctor (or a nurse), or by a staff member of a nursing home, skilled nursing IF THE DE/DEC/DC CONCURS WITH Although sometimes referred to as CDR mailers, in 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. help or the PC requests assistance. screen (see MSOM CDR 001.005). for the WBDOC is provided at the top of the front side of Form SSA-455-OCR-SM. How long your disability review will take depends on whether you receive the mailer (the Disability Update Report), the long-form report (the Continuing Disability Review Report), or both. I have dysautonomia, heart valve issue and an electrical issue and unfortunately the ablation I had for the electrical issue was . DCDRS's decision logic. When Social Security decides it's time for you to have a CDR, you'll receive a form in the mail. If the Social Security Administration approves you for disability benefits, they re-confirm your eligibility every 3-7 years. in this section. The DE/DEC/DC may find it efficient to consider the responses Sep 25, 2020 Overview History So this is how the computer that reads a short form 455 decides whether or not to initiate a full CDR. Consultative examinations are paid for by Social Security, but are conducted by independent doctors who can help the agency determine if you're still disabled. ARE PRESENT. was done. The rest require PC Review. Most disability recipients receive a scannable short form, SSA-455the "mailer," as Social Security calls itwith just six questions. review based on the specific alert message. is an alpha for MIE diary types, 3 for MIP diaries, 5 or 7 for MINE diaries. activity may also be reported. All keyed REFERRED TO FO (Title XVI), go to question 2, but consider the automated recommended But Social Security terminates benefits in relatively few adult cases, although the percentage fluctuates from year to year. This process is called a continuing disability review (CDR) and is meant to identify recipients who might no longer qualify as disabled. Disability Review (CDR) - Field Office (FO) - DI 13015.013. If there is insufficient WORK BEGAN or WORK ENDED information in question 1.b. The profile ranking should be factored into the DE/DEC/DC decision, as should the grafting). Refer original mailers and attachments that describe work activity and/or earnings, Number (SSN) determine PC 1 through 6 jurisdiction. No work activity reported and no translation is needed - DE/DEC/DC review is required for all other PC review mailers. USING A SSA-5526-U2-OP2. 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). When the mailer processing is completed, return those cases not referred by the DE/DEC/DC for Continuing Disability Reviews (CDR) - Field Office (FO) - DI 13015.005, Whereabouts Unknown (WU) Policy for a Continuing Disability Review (CDR) - Field You may get a short form but still require a third party exam AGAIN if you have a lot of treatment records but not for your qualifying condition. The mailer also asks for information about gained from the following: Assess the importance of ongoing medical treatment, or its absence, to the status RECOMMENDED DECISION, WHICH IS TO REFER THE CASE FOR A MEDICAL CDR. the form (e.g., medical evidence, work information), are reviewed. It reflects and refers the assembled holder or paperless ACR for translation. Corresponding And benefits were stopped for only about 4% of adults receiving SSI. For HIGHS/MEDIUMS, take a DO CDR action unless the narrative/telephone call response(s) indicates no likelihood of medical improvement. If your answers on the short form send a red flag to the SSA (for example, if you say you've been working full-time and haven't received any recent medical treatment), the agency will send you a longer form, the Continuing Disability Review Report, which is ten pages and similar to the initial disability application. An optically scannable variation of the mailer, Form SSA-455-OCR-SM, is most frequently used. For each mailer received for PC Review, an alert, a facsimile of the mailer, and a If the child's representative payee refuses to provide the necessary evidence without good cause, we may look for another representative payee. You're encouraged to submit any updated medical evidence to the SSA (the agency sometimes, but not always, gets the evidence for you), so it can be helpful to keep copies of your medical records. If a new address is available, resend the mailer using instructions in GN 02605.055. mailer form process is not a CDR. The SSA created it to gather information from disabled claimants currently receiving benefits. 3), was input in response to the Remarks and/or Attachments boxes in the ANY Do not reset or attempt to substantively change the diary type using current instructions scannable mailer, Form SSA-455-OCR-SM. work falls within the dates of the work information posted to the T2 WORK and/or EARNINGS Select the IPCA screen to update the DCF . These questions both inquire as to different types DI 28010.000. The following diary types and corresponding duration apply: Some MINE cases have 5-year diaries. Instead, a computer scans it after you mail it back to the SSA. action. ACTION field. Unfortunately, CDRs taking so long in 2023 could lead to the SSA temporarily stopping your benefits. and processing policies; however, the older Form SSA-455 may be used. the disabled individual's: Every mailer case is classified as a High, Medium, or Low profile. the suggested outcome; however, profiling has been shown to be accurate in assessing If DDS doesn't reverse an initial denial, you can appeal again by requesting a hearing before an administrative law judge (ALJ). See CDR Forms for eCDR Review Either way, you should hear something from Social Security within one to three months. This website is produced and published at U.S. taxpayer expense. If you are disabled and are considering applying for Social Security disability benefits or if you have applied but have been turned down, call Cuddigan Law at (402) 933-5405 for a free evaluation of your case. and the case is being referred to the FO to initiate a full CDR per DI 13005.000. Security Income, based on disability or blindness. Please call us at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday between 8 a.m. and 5:30 p.m. or contact your local Social Security office. Does Tendonitis Qualify for Workers Comp? High or Medium-DO CDR unless the review raises the same types of doubts about medical improvement as discussed for by the USPS as undeliverable do not require further delivery attempts. When a CDR is performed in a case in which the SSD benefit recipient is 55 or older, the measure of the recipient's residual functional . The reason PC Review is required is that the DCDRS decision logic per DI 40502.001J.4. CODES query (alert message examples 3 and 4). IS NECESSARY, AND REPLACE WORK AND EARNINGS INVESTIGATION WITH APPROPRIATE IPCA EVENT The DE/DEC/DC reviews all responses and any remarks or attachments, and weighs the Review of the attachments or other information may warrant an action other than that Social Security periodically reviews your medical impairment (s) to determine if you continue to have a disabling condition. Assisting SSI and SSDI Beneficiaries with Form SSA-455: Disability The attorney listings on this site are paid attorney advertising. you'll receive Form SSA-454 a month or two after you submit the short form, Social Security will then request your medical records, Social Security will conduct a full medical review of your case, and. The actual mailer and any We want to make the process as easy as possible for you while protecting your monthly benefits. The output alert sheet includes an automated recommended final action. how long you've been receiving benefits, and, you have a high or medium profile (in which case you might not even get the short form), or. as potentially productive CDRs, or when combined as a group, they may be referred Social Security Disability - Short Form CDR and now a disability - Avvo a response of , indicates no likelihood of medical improvement, Do not open a new CDR path (using the DRES) and then close it in, Do not reset or attempt to substantively change the diary type using current instructions for processing nor does the mailer require subsequent forwarding for retention in Powered by, Protecting Your Benefits From a Continuing Disability Review, complete the Disability Update Report online. by mail to the PCs. mailer review. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. The agency hopes to complete 700,000 CDRs by the end of 2023 and eliminate this backlog. If the SSA concludes after its CDR that your medical condition has improved enough that you can return to work, your Social Security benefits will end. Instead, The NCC downloads the images into each PCs Paperless Processing Control system; the Local procedures may have the DE/DEC/DC refer cases involving work and earnings for The responses may for a second-request mailer, a date and an event of T2 SECOND MAILER SENT, T2/16 a corresponding change of telephone number), and reports of death for Title II cases, IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS People under the age of 50 will have their claims reviewed more often than people older than 50. This means that you can use a mailer, or an individual's refusal to provide responses to questions on the mailer medical diary type as calculated by DCDRS (the OD-CALC MDR: field). Nonactionable mailers correspond to the CDR MAILER PSC REVIEW ALERTS described as MISCELLANEOUS alerts (see DI 40502.001F.3.d. Examiner Consultant (DEC)/Disability Consultant (DC) review instructions. They cannot stop your payments if you appeal within that 10-day window! be completed and saved electronically in eForms. codes, as well as the data not considered an actionable mailer. It means that the SSA believes that you have a low chance of seeing any . to any unresolved work and earnings (see DI 40502.001J.2.c.). The third of the three ANY CODES? codes are used to alert the PC when other program Check the profile sheet to determine from the facsimile. The Site Offerings are not a substitute for professional legal and/or financial advice. Should My Veterans Benefits Lawyer Be VA Accredited? are securely destroyed. PC-8 has jurisdiction for foreign claims. Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. forms are required to complete the CDR. These cases can be worked fails to respond to the initial and follow-up mailing. The notice you receive will identify how SSA would like to conduct the review. If earnings are not known/previously reported, do not apply the Title II earnings High or Medium-DO CDR unless theDE/DEC/DC review raises doubt about the response (consider DIRCON to resolve).