Re: SSD 3 year medical review of existing claim
I'm not exactly sure how SS does their medical review, but I can tell you how regular insurance policies do theirs (for a company disability policy). They are actually more rigorous (than SS) in that they send out forms once a year to be signed. You have to sign a HIPPA form to give them access to your medical records....They want to see that you've been seeing Docs and what for. And, there is a one page statement the Doc fills out...An "update form" where the Doc lists your condition, treatment, meds, and they point blank ask "can this patient work" and "How long is the patient disabled."
As long as your Doc checks the right box and doesn't throw you under the bus, everything is ok. To be honest, these forms are more a pain the in the you know what than anything else. But, insurance companies try to avoid paying, so they are going to check up on people. It costs them little to nothing to send out this paperwork. I have to imagine that SS works in a very similar fashion...SS does it every 3 years (instead of each year) because they don't have the resources to keep up with everyone more often than that.
I also know that SS performs regular computer audits....If your SS # shows up on a tax form somewhere (W2 or 1099), they will send you a letter and automatically put your case in review. They want to know why and how you're making money. SS does allow work based on monthly limits, but they still check.
I sold some stock options about a year or so ago, and then received some info from SS because the stock option sale generated a W2. Once I explained everything to them, they sent me another letter "approving" everything. The money I made was not "earned" but the realization of a stock sale.
Anytime something with your case comes up, they will write you a letter and give you a time frame to respond (usually 30-60) days. Nothing happens to your case (negatively) until they make a formal decision. I guess if one didn't respond, they would suspend payments.
Hope this helps.
Last edited by Executor; 06-21-2008 at 07:06 AM.