the likelihood of medical improvement. for the WBDOC is provided at the top of the front side of Form SSA-455-OCR-SM. 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 SSA wants to know the current status of your medical conditions and any recent treatments you received. program for updating the Disability Control File (DCF). This website is produced and published at U.S. taxpayer expense. actions as reviews for purposes of annual reporting to Congress on the stewardship The notice you receive will identify how SSA would like to conduct the review. Check the profile sheet to determine This process is called a continuing disability review (CDR) and is meant to identify recipients who might no longer qualify as disabled. profile cases, or a deferral action results in the case of the MEDIUM and HIGH (not-LOW) activity may also be reported. The mailing address monitor the accuracy of the statistical analyses (profiling) that identify which cases Field 6 Scanning Form Identification Code (SFIC) (describes if it is a first or The SSI program pays benefits to adults and children who meet our requirements for a qualifying disability and have limited income and resources. In addition to being sorted by Title and PC jurisdiction, mailers are sorted based The agency hopes to complete 700,000 CDRs by the end of 2023 and eliminate this backlog. on-line information regarding the diary type that was set at the CPD. decided and input by the PC reviewer, the case is referred to the FO for a full medical as HIGHs or MEDIUMs, to differentiate between the scores of those who profile SIGNIFICANT RESPONSES AND/OR RELEVANT REMARKS/ATTACHMENTS to? or facsimile for an H (High), M (Medium), or L (Low), or check the profile sheet for the word High, Medium, or Low. on whether they are actionable or nonactionable. The NCC receives and prepares the data files for DCDRS to retrieve and process through If no code is provided in the scanline or on the profile sheet, query the DCF and For instance, if you're young and you've worked recently, you could have a higher profile. Actually, the SSA is required to review every individual receiving Social Security Disability (SSD,) or Supplemental Security Income (SSI.) received. The integrity sample is not intended, and BET/DT REVIEW NEEDED. in DI 26525.000. Instead, a computer scans it after you mail it back to the SSA. We call this review a Continuing Disability Review (CDR). A Social Security doctor who works for your states DDS office will perform this consultative exam. Box 4550 Wilkes-Barre, PA 18767-4550 Need a replacement form? We periodically review your case to determine in the third field of the second scanline on the front of the mailer or the facsimile. 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. 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. to the PCs in specially labeled containers. The NCC downloads the images into each PCs Paperless Processing Control system; See DI 13005.030 FO Personal Contacts and DI 13005.035 Exceptions to the Personal Contact. discontinued under the screen out criteria provided in DI 13005.020. Here are some bonus tips for making sure your Disability Update Report doesnt trigger a human review and medical exam: If your Disability Update Report answers arent clear or you mail it back late, youll likely have to undergo a medical exam. See our article on collecting continuing disability benefits while you appeal for information on when your disability benefit checks will stop. the facsimile of the mailer generated by DCDRS to process the case (see DI 40502.001F.3. Do not use DIRCON if the responses or other information provided indicate that a full These scanlines contain substantial information: Field 1 Social Security Number under which the mailer is being controlled, Field 2 Beneficiary Identification Code (BIC) (Title II), or, Individual Recipient Identification code (ID) (Title XVI), Field 5 Primary and Secondary Diagnosis Codes, Field 2 Concurrent Entitlement information, Field 3 Profile Type (High, Medium, or Low), Field 4 Profiling SCORE (9999 is highest), Field 5 Report Period covered by the mailer. or attachments are present. The letter you received from Social Security informed you that, based on the information you provided, they decided not to do a continuing disability review (CDR) and that is good news. and any attachments must be used with the alert, facsimile, and profile sheet for to a DE/DEC/DC, who conducts a review of the responses to the six questions, any remarks, PC personnel receive systems notification (a nonresponder alert) when the beneficiary CDRs can take as little as one to three months or upwards of six months to complete. Enter the following remark on the SSA-559: EARNINGS UNDER TOLERANCE LEVEL. What Are Workers Compensation Benefits & Do You Qualify? Enter Y next to REMARKS and enter a message that the mailer is being sent to the not an initial determination subject to administrative review, nor is a new comparison 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. what the details are of all your visits with doctors and treatment facilities. REVIEW is posted to the DCF QCDR screen. Note Does the SSA Offer Disability Assistance? Local procedures may have the DE/DEC/DC refer cases involving work and earnings for TO BET/DT AFTER DE/DEC/DC REVIEW.. if you continue to meet the eligibility rules to receive disability benefits. When any of these events happen, the mailer is referred the PCs for review. in this section). Contact the Representative Payee to initiate the CDR. The mailer, a generic cover notice and instruction insert, and a reply envelope are If the second mailer is not returned and receipted Document the results The PC considers or in response to question 1.b., earnings of $701 or more are reported for at least one month since the beginning of the Report Period. This is referred to as a Continuing Disability Review, or CDR for short. ACTION. profile cases. Number (SSN) determine PC 1 through 6 jurisdiction. DE/DEC/DC CONCURS WITH THE RECOMMENDED DECISION, REFER THE CASE TO THE FO USING A recent education or training, and recent attempts to (return to) work. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental AUTOMATED RECOMMENDED DECISION WHICH IS TO REFER THE CASE FOR A MEDICAL CDR. IF THE DE/DEC/DC FINDS THAT THE RESPONSES AND/OR REMARKS/ATTACHMENTS Beneficiaries under the jurisdiction of a deferral action. How Long Does It Take to Get Disability Benefits? Make two DIRCON attempts; do not count busy signals as attempts. 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. grafting). to mailers processed by the WBDOC as nonactionable, the actual mailer is not needed The SSA created it to gather information from disabled claimants currently receiving benefits. 5 through 7). to as non-LOWs or not-LOWs. response to question 5 or 6 (7 or 6 on SSA-455) is YES, or the reviewer has other MINE or MINE-equivalent procedures (see DI 13005.022). a doctor, a mailer signed by an official of a treatment facility) to the claims folder Then, they need you to complete this form and mail it back for re-approval before sending any more disability checks. medical diary type as calculated by DCDRS (the OD-CALC MDR: field). Periodically, if the PC MAILER REVIEW is not cleared, the system generates and posts IF THE BET/DT DETERMINES THERE IS NO WORK ISSUE, AND NO OTHER The WBDOC reviews and processes most scannable mailers, including mailers returned and by selecting EVENT TYPE UNDELIVERABLE (currently event type 7) on the IPCA This process is called a continuing disability review (CDR) and is meant to identify recipients who might no longer qualify as disabled. In those PSCs that do not scan actionable mailers into paperless, receipt of a PSC provide further details. Section 1614(a)(3) of the Act provides for periodic review of eligibility for Supplemental Security Income, based on disability or blindness. Consequently, an inability to locate an individual to complete 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. MATERIAL, OR THAT FOLDER REVIEW IS REQUIRED, THE DE/DEC/DC SHOULD CONSIDER THE AUTOMATED The messages specify who should review 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. If question 1.a. Since of the pandemic started, the SSA reports that its fallen behind on CDRs like these. is needed (examples 1 and 2). a mailer, or an individual's refusal to provide responses to questions on the mailer 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. work training program(s)? If it is not returned and receipted within a specific time frame, a 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 The following chart lists instructions for responses to questions 5 and 6 of the SSA-455-OCR-SM She dpssed the work test- she work several hrs . Instead, the actual mailer with attachments must be associated by the Development and Support Examiner (DSE) (PC-7) or Folder Location Clerk (FLC) (PCs 1-6) with the alert/facsimile/profile sheet output before the mailer is processed. Cookie Notice IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS ARE NOT Within the last 2 years has your doctor told you that you can return to work. If a full medical CDR is not indicated based on the responses supplied by the beneficiary, make direct telephone contact (DIRCON) to complete unanswered questions or to clarify unresolved issues. If the claimant or representative provides medical records to the FO, use the procedures the profile sheet, and any attachments in the right side of the claims folder. may be multiple QMID screens; typically, the most recent iteration is used. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. yearly SGA amount, If earnings are not known/previously reported, do not apply the Title II earnings The Social Security Administration (SSA) is required by law to periodically review the case of every person who receives disability benefits. Your Disability Update Report is a self-help mailer form that helps the SSA conduct your Continuing Disability Review (CDR). After 150 days from the send request the UNDELIVERABLE mailer will automatically the representative payee, if any, that a CDR is being initiated. When Social Security decides it's time for you to have a CDR, you'll receive a form in the mail. Your Disability Update Report is a self-help mailer form that helps the SSA conduct your Continuing Disability Review (CDR). Send your completed disability update report to the following address within 30 days of receiving it: Social Security Administration P.O. The actionable mailers with attachments are boxed in special boxes that include a and attachments. Otherwise, DEFER. review. awaiting association with the electronic data file. IF THE DE/DEC/DC FINDS THAT THE REMARKS/ATTACHMENTS But there's some good news for those whose benefits are stopped after a disability review. All keyed 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. For MISCELLANEOUS alerts, only one of two messages is generated. These groups are variously referred to If earnings are not known/previously reported, do not apply the Title II earnings groups of beneficiaries may be sent mailers. (questions 7 and 6 on the SSA-455). 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. If it is not screened out/discontinued, determine if it can be processed under the MAILER alert tells the DSE/Folder Location Clerk (FLC) of the need to associate an actionable mailer with the electronically generated output The decision logic uses the mark sense responses (Yes/No, Same/Better/Worse, etc.) medical improvement. . EVENT TYPE REVIEW NONRESPONDER (currently event type 6) on the IPCA screen, and then securely destroyed. For this reason the PC reviewer question 5, and nothing in remarks or on an attachment indicates there has been recent DCDRS makes the appropriate input to update the DCF to reflect the results of decision Title II Actions Without Folder Develop the work issue without the folder, if possible. The eCDR procedures for case selection, Comparison Point Decision (CPD) folder acquisition, Establish a workload control for undeliverable mailers by making an input to the DCF
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