Why Medical Reviews Happen

The Social Security Administration (SSA) is legally required to periodically review disability cases to determine whether beneficiaries are still eligible. This process helps ensure the SSDI program remains accurate and fair.

In Pennsylvania, your case may be reviewed:

• Every 3 years if your condition is expected to improve
• Every 5–7 years if improvement is not expected
• More frequently if new information is received that suggests your health may have improved

What Triggers a Review

You may receive a medical review notice if:

• Your last review is due based on your original SSDI approval timeline
• You’ve reported a change in your medical condition
• SSA receives information suggesting you're working or engaging in substantial gainful activity (SGA)
• A red flag is raised through earnings reported to the IRS

Steps in the Medical Review Process

1. Receiving the Review Notice

You’ll first get a CDR packet in the mail. This includes a form (SSA-454) asking about your medical condition, treatments, recent doctor visits, hospitalizations, and work activity (if any).

2. Filling Out the Forms

Provide accurate and detailed responses, especially about:

• Your current health status
• All doctors, clinics, and hospitals you've visited
• Any medications and side effects
• Any work attempts or part-time activity

Attach supporting documentation if possible—such as medical records, letters from providers, and updated test results.

3. SSA Requests Updated Medical Evidence

SSA will collect recent medical records and may contact your healthcare providers directly. In Pennsylvania, the Bureau of Disability Determination (BDD)—a state agency working with SSA—typically handles this step.

4. Possible Consultative Exam (CE)

If your medical records are outdated or incomplete, you may be scheduled for a consultative examination with a doctor SSA chooses. Attendance is mandatory.

5. Review Decision

SSA will decide whether your condition still meets its disability criteria. They’ll evaluate:

• Whether your medical condition has improved
• Whether that improvement enables you to work
• Whether you're performing SGA

Possible Outcomes of the Review

There are three possible results from a Pennsylvania SSDI medical review:

1. Benefits Continue – If your condition hasn’t improved or still limits your ability to work, your SSDI benefits will continue as normal.
2. Benefits Cease – If SSA finds that your health has improved to the point you can work, your benefits may stop. You’ll receive a written notice with the reason and your appeal rights.
3. Benefits Continue With a Set Review Period – Sometimes, SSA determines continued eligibility but sets a shorter timeframe for the next review (e.g., in one year).

What to Do if Benefits Are Denied After Review

You have 60 days to appeal the decision. This begins with a Request for Reconsideration and can eventually lead to a hearing before an administrative law judge. It’s important to act quickly, as delays could result in lost benefits or a gap in coverage.