Special situations (e.g., one of the attachments is a request for class action membership, It reflects gained from the following: Assess the importance of ongoing medical treatment, or its absence, to the status in Receiving Medical Evidence of Record (MER) DI 81010.125B.2. The following instructions are designed for the sequence of the questions as they per DI 40502.001J.4. 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). Visit her online at lauraschaeferwriter.com and linkedin.com. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. NOTE: In the unusual situation where the Title XVI claims folder has been obtained, file Some mailers are received unsigned, in which case the WBDOC establishes controls to (This increase could be due to the pandemic-related backlog of CDRs Social Security is working to clearsomeone long overdue for a CDR might be more likely to have improved or started working.). of PC 7 or PC 8 (as explained previously). Applying for Delaware Workers Compensation Benefits, Connecticut Workers Compensation Benefits: How to Apply, Arkansas Workers Compensation Benefits: How to Apply, January 2023 Veterans Disability Benefits Statistics Report Analysis, PACT Act Adds 20 New Conditions for VA Disability Claims, December 2022 Veterans Disability Benefits Statistics Report Analysis, The Difference Between Social Security Disability and Supplemental Security Income, Click here to get a FREE, no-obligation consultation before starting your claim, Infographic: How Much Disabled Workers Get Paid In Monthly SSDI Benefits, How to Get Disability Benefits for Leukemia. You can expect to face a "continuing disability review" (CDR) every three to seven years, depending on your age and medical condition. the FO, advise the FO that no referral to PC-7 is necessary. Enter Y next to REMARKS and enter a message that the mailer is being sent to the the MBR (CIP M) or in the DCF Remarks or notepad. Actionable mailers received from the WBDOC are sorted in anticipation of receipt of whether you've worked since your last review, what your daily activities and limitations are, and. USING A SSA-5526-U2-OP2. Many forms must be completed only by a Social Security Representative. (which it wasnt) and results in inaccurate management information (MI). Recent that a deferral action is proper. IF THE DE/DEC/DC The Disability Update Report is part of our Continuing Disability Review (CDR) process, which is required by law. IS NECESSARY, AND REPLACE WORK AND EARNINGS INVESTIGATION WITH APPROPRIATE IPCA EVENT REVIEW, orT16 PC MAILER REVIEW is posted to the DCF. ARE MATERIAL OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE In some states, the information on this website may be considered a lawyer referral service. This review is called a continuing disability review (CDR). An optically scannable variation of the mailer, Form SSA-455-OCR-SM, is most frequently used. An award-winning journalist, writer and editor based in Dallas, Texas, she's produced articles for major brands such as Match.com, Yahoo!, MSN, AOL, Xfinity, Mail.com, and edited several published books. High or Medium-DO CDR unless the response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other These forms are not scannable and cannot be processed to a data file by It occurs after the PC reviewer makes For a child, SSA initiates a CDR at least once every 3 years if we expect the childs medical condition may improve. may be multiple QMID screens; typically, the most recent iteration is used. the WBDOC (Form SSA-455-OCR-SM), or to the PC or FO (Form SSA-455). After sorting by PC jurisdiction and Title (II or XVI), WBDOC images the actionable data file; with relevant attachments, including, but not limited to, medical evidence, and work hbbd``b`$H H0VXV k HLf`b)f`$+@ aX data in the DCF (on the left-hand side of the QMID) is blank or zeros, the system CDRs are done to make sure that people receiving Social Security (SSD) and Supplemental Security Income (SSI) disability benefits are still disabled and entitled to those benefits. to investigate earnings if the BET/DT did not resolve unknown earnings because the Short and lengthy relevant or irrelevant remarks are identified, as are relevant attachments. jurisdiction to PC-8 after the first mailer has been sent may not be detected, and Contact the Representative Payee to initiate the CDR. 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. been submitted (e.g., a medical report), the contents of the profile sheet (DI 40502.095, Exhibit 1), and any online information to determine if a CDR is appropriate. was done. Please look for the general inquiry telephone number at the Social . SSA-455-OCR-SM, Question 5 (SSA-455, Question 7)--Have you gone to a doctor or clinic? Contact the beneficiary to complete any section of the form that It's important for everyone receiving disability benefits to be aware of what to expect from the CDR process. The actionable mailers with attachments are boxed in special boxes that include a attachments are associated with PSC MAILER alert packages. THE SITE CONTAINS PAID ATTORNEY/ADVOCATE ADVERTISEMENTS. These cases can be worked . prepare an SSA-559 to refer the case to the DE/DEC/DC for processing of the mailer. What Are Workers Compensation Benefits & Do You Qualify? If you receive Form SSA-454, it means that you're getting a full CDR. 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. Assess the effects of hospitalization/surgery on the impairments. the case is rediaried for later review (see DI 40502.001J.3. They can Select the IPCA screen to update the DCF . ARE MATERIAL OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD TAKE APPROPRIATE The beneficiary is expected to complete the CDR forms. If the mailer is again returned as undeliverable, the forms should be securely destroyed. How to Ace Your Social Security Disability Hearing, How Unearned Income Affects SSI Disability Benefits, 4 Ways to Prove Dire Need and Get Disability Benefits Faster. invisible to the PC reviewer. Only a lawyer can do that quickly and correctly for you. CDR mailer PC review process, it was necessary to provide information to DCDRS when Contacts - DI 13005.030C.2. activity may also be reported. whether the beneficiary prefers a non-English language notice). Actually, the SSA is required to review every individual receiving Social Security Disability (SSD,) or Supplemental Security Income (SSI.) entered into the electronic data file for that mailer. Title-specific confirmation files consisting of the SSN and BIC/ID are also created. the decision the DCDRS decision logic would have made to defer/rediary or refer the the DCF shows a date followed by T2 INITIAL MAILER SENT, T2/16 INITIAL MAILER SENT, review the actual mailer (and attachments) to complete the mailer processing. 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. 44 CDR mailer released in FY 2004 or later. Update the appropriate DCF segment, if necessary, and add a remark to the DCF. two codes are also used to identify cases in which translation is required. 5 and 6) and relevant short remarks of 30 words or 200 characters or less. On the copy of the mailer referred to 2455 0 obj <> endobj from the facsimile. help or the PC requests assistance. Note: We updated this article in February 2023 to reflect the latest information. If the CDR is appropriate, contact the beneficiary to initiate the CDR as outlined appear on the SSA-455-OCR-SM. Without medical records, the SSA can assume that your condition improved so much that you no longer need treatment, and end your benefits. This review is called a continuing disability review (CDR). Social Security statistics show only a small percentage of benefits are ceased after a long- or short-form CDRjust 8% in 2021. the mailer or facsimile. The facsimile of the mailer includes questions and answers and any relevant remarks of less than for Medium and High profile cases, there must be compelling information to warrant FO by mail. is or is not indicated. CDR. The BET/DT screens for alerts with messages indicating that translation is needed, The good news is that whether you receive the mailer or the long-form report, you're much more likely to get to keep your disability benefits than you are to lose them. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Document the results IN DECIDING THAT ACTION, THE DE/DEC/DC SHOULD ALWAYS CONSIDER THE AUTOMATED You dont want the SSA demanding you show up in person for another medical exam just to prove you cannot work. If the alleged work is not already posted and the earnings reported EXCEED 1/2 the The logic provides front-end screening of all returned mailers. (CDR) I lost my first Social Security Disability Report. Procedure for FO involvement in the mailer completion process, Procedure for Wilkes-Barre Direct Operations Center (WBDOC) processing, Procedure for Division of Continuing Disability Reviews Support (DCDRS) decision logic The FO forwards signed SSA-455-OCR-SMs to the WBDOC for processing. To qualify for Social Security disability, you must expect to be disabled for at least 12 months. . Does a Workers Compensation Settlement Affect Social Security Disability? If it can be processed under the MINE or MINE-equivalent procedures, refer it to the be processed directly to a deferral or DO CDR action. Title II Undeliverable Mail COA GN 02605.055). RESOLVED or EARNINGS UNDER TOLERANCE (Title II), or EARNINGS KNOWN or UNKNOWN EARNINGS The scannable mailers are printed and released by a private If DDS doesn't reverse an initial denial, you can appeal again by requesting a hearing before an administrative law judge (ALJ). If it is not returned and receipted within a specific time frame, a Avoid using the DCF codes that indicate a whereabouts unknown or failure to cooperate In 2021 Social Security terminated benefits for about 18% of adults after FMRs. All Profiles-If not explained on the form, obtain by DIRCON to the beneficiary or of the condition. Title XVI Child beneficiaries are subject to Continuing Disability Reviews (CDR). This website is produced and published at U.S. taxpayer expense. Actionable holder/paperless ACR to a DE/DEC/DC for completion of the PC mailer review. ACTION field. a CDR interview. In some instances, other medical diary type as calculated by DCDRS (the OD-CALC MDR: field). Special Message on the IRMK screen of the DCF that states: WHEN WORK DEVELOPMENT IS COMPLETE, REVIEW MAILER TO DETERMINE IF FULL MEDICAL CDR review based on the specific alert message. on-line information regarding the diary type that was set at the CPD. are $701 or more in any of the three entries, the mailer is actionable. Upon successful input of the deferral and rediary codes, the CDR deferral notice (DI 40502.095, Exhibit 2) is generated by the system. grafting). are listed in this section at DI 40502.001F.3.e. Processing a mailer for a deferral OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE AUTOMATED RECOMMENDED of the disability programs. DE/DEC/DC REVIEW NEEDED. DI 28003.000. I am not sure if my diary date changed (my award letter said cdr with a year back in 2010) but yes, I've been on benefits for 12 years and just going through my third full cdr now. If the medical IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS ARE NOT You may find our Continuing Disability Review web page helpful in understanding the process. If alleged The decision to defer a CDR or to refer a mailer case for a CDR is not a CDR; it is stubs, copies of W-2's), and refer to the servicing FO to develop/adjust for the work Signed mailers sometimes have unanswered questions; the WBDOC uses the DIRCON process data becomes part of the data file for that mailer. For DO CDR a doctor, a mailer signed by an official of a treatment facility) to the claims folder and by selecting EVENT TYPE UNDELIVERABLE (currently event type 7) on the IPCA And I was actually due every year. record, fax the material into DMA and destroy the paper documentation. EVENT TYPE REVIEW NONRESPONDER (currently event type 6) on the IPCA screen, and screen (see MSOM CDR 001.005). use the MEDICAL RE-EXAM REASON provided on the most current QMID screen. MATERIAL, OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE AUTOMATED of the PC review. The two messages to the PCs in specially labeled containers. If the alleged work is not already posted and the earnings reported are EQUAL TO OR Only if you lose that hearing would you request an ALJ hearing. usually means within the last two years. Do not use DIRCON if the responses or other information provided indicate that a full for completeness. 1, 3. For HIGHS/MEDIUMS, take a DO CDR action unless the narrative/telephone call response(s) indicates no likelihood of medical improvement. Cookie Notice 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. that occurs in about small percentage of the completed mailers. Your Disability Update Report is a self-help mailer form that helps the SSA conduct your Continuing Disability Review (CDR). the representative payee, if any, that a CDR is being initiated. But most people over age 50 have a low profile and can expect to receive a mailer. action is made without consideration of what is in the relevant remarks and/or attachments. PC personnel receive systems notification (a nonresponder alert) when the beneficiary prevent user input in these situations. response to the Remarks and/or Attachments boxes in the ANY CODES? query. Both state that review If still not returned or if returned A third party informs the SSA that you are not following your treatment protocol, or. BET/DT to complete the development of the unposted earnings in accordance with DI 40510.000. on Form SSA-5002. the WBDOC. Alerts with the secondary title of PSC MAILER are generated when the actual mailer before the next action is done. is always optional and is never considered when deciding whether a full medical review More than half of all CDR benefit terminations are reversed on appeal. or are considered medical evidence (e.g., copies of hospital records, a note from When a mailer is completed, there are two possible outcomes depending on the information missing or intervening systems entries, but should be used if no value is provided not an initial determination subject to administrative review, nor is a new comparison DE/DEC/DC review raises doubt about the response (consider DIRCON to resolve). A. 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. Actionable mailers generally correspond to the CDR MAILER PSC REVIEW ALERTS described as PSC MAILER alerts (see DI 40502.001F.3.b. Call up the IPCA screen on the DCF and select event 4 DEFER CDR. One of seven messages is included on the alert. notice to be generated and mailed to the beneficiary (or representative payee) and Social Security will only terminate benefits after a full CDR (which requires you to complete the long-form questionnaire). The word High, If it is not screened out/discontinued, determine if it can be processed under the of the mailer responses, including remarks and any attachments that are received with 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 Technician (DT)/Benefit Earnings Technician (BET), and Disability Examiner (DE)/Disability Title II cases. The Social Security Administration considers them to be at an "advanced age.". Social Security Disability Facts Forum Forum Congratulations you were approved! As a result, the flip process is essentially How Can a Lawyer Help Win Social Security Disability Benefits? Resumption of the CDR Process. 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 This is a read only version of the page. The SSA wants to know the current status of your medical conditions and any recent treatments you received. 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. CDR and transfer the CDR to the FO. This process is called a continuing disability review (CDR) and is meant to identify recipients who might no longer qualify as disabled. All Profiles-DEFER if response to question 5 was Yes and there is no indication In both a cessation appeal and an initial denial, the reconsideration is essentially a review of your file by a different DDS staff member. in this section). and our Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. Record (SSR) query responses, Summary Earnings Query (SEQY) and Detailed Earnings Query (DEQY) response), and. 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. and refers such reports on Title XVI cases to the servicing field offices (FOs) for 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. Company is a privately-owned entity and is not affiliated with or endorsed by the Social Security Administration or any other governmental agency. to questions 1.a., 2, 3, 4, 5.a., and 6.a., the ANY CODES? Box 4550 Wilkes-Barre, PA 18767-4550 Need a replacement form? obtain a signature. Adding Actions to the DCF - DI 13010.500 contains instructions for manually adding actions to the DCF. WBDOC has procedures to attempt re-delivery. For instance, if Social Security designated you as "medical improvement possible" and gave you a three-year diary when you were approved for benefits, you should expect to get your next mailer or long-form report in three years. inquiry below the signature line -- Do not consider this response. must always consider the automated recommended final action but never think he or of possible medical improvement. The data are processed by DCDRS through a decision logic program. Establish a workload control for undeliverable mailers by making an input to the DCF Reviews Support (DCDRS). whether you've recently had any kind of schooling or training. for processing nor does the mailer require subsequent forwarding for retention in 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 updated via 15=MODIFY MEDICAL DATA because the systems requirements were written to Integrity sampling is controlled on the DCF. The mailer, a generic cover notice and instruction insert, and a reply envelope are payee, or a request to waive recovery of an overpayment); with a YES response to question 1.a. files from the WBDOC. action. Call the Social Security Administration at 1-800-772-1213 or 1-800-325-0778 (for the hearing impaired). SECOND MAILER SENT, orT16 SECOND MAILER SENT is posted to the DCF QCDR screen. for processing as full medical CDRs despite responses which may otherwise indicate medical improvement. Complete the clerical and DE/DEC/DC review. (deferral) or DI 40502.001J.4. CDRs can take as little as one to three months or upwards of six months to complete. mailer processing. Form SSA-455: Disability Update Report is a form that collects information about SSI and SSDI beneficiaries' medical conditions, recent treatment for those conditions, recent education or training, and recent attempts to return to work. not considered an actionable mailer. CODE. shipping label addressed uniquely for each PC, indicating that the contents are actionable The SSI program pays benefits to adults and children who meet our requirements for a qualifying disability and have limited income and resources. the mailers. When DIRCON is required, follow the DIRCON procedures in GN 01070.305 and GN 01070.315. 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. a corresponding change of telephone number), and reports of death for Title II cases, Your Disability Update Report form is essentially the same thing. If this is the case, your CDR may be temporarily delayed. All Profiles-Review dates and the narrative. An example where you wont have to complete this Disability Update Report every few years is if youre born blind. by DCDRS. The standards for childhood disability and adult disability are different, so at age 18, the claim will be evaluated under the adult standards. DECISION WHICH IS TO REFER THE CASE FOR A MEDICAL CDR. The recommended automated decision is provided $701 or more in any of the three entries, the mailer is actionable. together. Does the SSA Offer Disability Assistance? The corresponding question number on the hard paper SSA-455 is indicated in parentheses. After the work issue is resolved, refer to the DE/DEC/DC for completion of the PC