[0:01] If you're applying for disability benefits or help people that are, the path to success
[0:05] has never been more complicated.
[0:07] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview
[0:11] the country's top experts to help you better navigate the disability process.
[0:16] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated.
[0:26] I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, it's Chad Brown.
[0:32] Welcome to the episode of the Disability Expert Podcast, where we talk about all things
[0:36] such as disability, back with my trusted associate Aaron Dalton.
[0:42] Got to be back.
[0:43] Yeah, we are, we're almost going political today.
[0:47] So, one of the things that we've been getting a lot of questions about lately are continuing
[0:55] disability reviews.
[0:56] And we realize we've never done an episode on continuing disability reviews or CDRs.
[1:01] That's what we'll call them in the episode, CDRs, but it's somewhat of a political topic
[1:07] right now.
[1:08] It can be.
[1:09] It's on the news.
[1:10] So, historically, CDR, basically what a CDR is, is once you own so secure disability, the
[1:18] government has the ability to come in and review your medical condition to see if it's improved.
[1:23] And if it has improved, then you're going to be eligible for disability.
[1:28] And if it hasn't improved, you get to keep your disability.
[1:31] And as you can imagine, it is not friendly when you get a, I was thinking about this last
[1:37] night.
[1:38] I've been trying to think of what to work this story in all day.
[1:40] So, I've started taking karate with my son and he's like almost a black belt and I'm like
[1:46] I'm a white belt.
[1:47] So, that literally means I don't know anything.
[1:51] And we're sparring last night and literally I got punched in the mouth.
[1:56] So, we're just sparring.
[1:58] It's like 30% effort but still, it's like man, that's stings and I was thinking that's
[2:02] what it's like to get a CDR.
[2:04] Yeah.
[2:05] You're cruising along.
[2:06] Everything's going all right.
[2:07] And then boom, you open the mail, you get a notice, your case is being reviewed.
[2:12] Here we go again.
[2:13] Here we go again.
[2:14] That's right.
[2:15] So, what makes this topic somewhat political at this point is historically disability termination
[2:20] services which is the local or the state level agency that does initial and reconsideration
[2:25] reviews handled the CDR process.
[2:30] But back in March, for reasons I believe other people to speculate about politically, that
[2:38] was moved away from DDS and moved to a federal agency.
[2:42] So, now there will be a federal group that reviews these.
[2:48] I think the only safe assumption that you could make from that decision is that someone
[2:54] up the chain politically doesn't think enough of these cases are being reviewed.
[3:02] There are stats that come out from the government that whether they're accurate or not, I don't
[3:09] know, there's certainly some truth in them.
[3:12] Tens of billions, that's billions with a B. Tens of billions of dollars every year are presumably
[3:19] lost, paying disability benefits to people who are no longer disabled, who have medical
[3:24] improvement.
[3:27] And presumably this is being moved because of the chain somewhere politically.
[3:33] There's a belief that this needs to be given more scrutiny.
[3:37] These cases need to be handled more aggressively.
[3:41] They need to be done more frequently.
[3:43] With the idea being, they will claw back money that's being paid to people in their mind
[3:51] inappropriately.
[3:52] The agency doesn't set up a new department because they're happy with the way that states
[3:56] are doing things.
[3:57] Yeah, I thought, yeah, yeah, for sure.
[4:00] So, therefore, here we are.
[4:03] That was earlier this year, and I said, hey, let's talk about CDRs because the reality is,
[4:10] are there people own disability benefits whose medical condition has improved?
[4:15] Yeah, for sure.
[4:17] Are there people who received benefits who shouldn't?
[4:20] Yeah, for sure.
[4:21] There's people who get approved that shouldn't get approved, right?
[4:23] I mean, it's a massive system full of inefficiencies.
[4:31] But that doesn't change the fact that you're going to feel like I did last night inspiring
[4:36] at Karate when that letter comes in the mail.
[4:38] You're going to feel like you got punched in the mouth.
[4:41] And so, we want to go through today and walk through and help you understand what is a CDR?
[4:46] What's the process sort of look like?
[4:48] Give you a few tips to take away that you can say, this is what you should be doing
[4:53] after you win your case before this CDR potentially happens, even though it may never even happen.
[5:00] And these are the things you should do when you actually get that letter in the mail, all
[5:03] right?
[5:04] So, I'm done talking.
[5:05] It is your turn, tag your it, tell our folks what, tell what is a CDR, just sort of walk
[5:13] through the basics of it.
[5:15] We'll start with the timing.
[5:16] In theory, everyone is supposed to be reviewed five to seven years to determine if those
[5:23] conditions have improved.
[5:25] What we see in practice, though, is that certain groups tend to get a CDR'd more frequently.
[5:31] Young people tend to get reviewed more often than every five to seven years.
[5:36] Folks who are 55 and older very rarely undergo a continuing disability review absent some
[5:43] unusual circumstances we may get to later if we have time.
[5:46] The question with CDRs is, has there been medical improvement since the most recent comparison
[5:54] point decision?
[5:55] So, if the most recent decision on your case was at the administrative law judge level, that's
[6:00] what they'll use.
[6:01] If there's been a CDR in the past that found your disability continued, that's what they'll
[6:07] go off of.
[6:08] And what they're looking for is, has there been medical improvement related to the ability
[6:14] to work?
[6:15] So, sometimes we see decisions where there's maybe been a little bit of medical improvement,
[6:20] but it was so slight they don't even really proceed further.
[6:23] They say that's not even related to the ability to work.
[6:26] You're almost as bad off as you were last time, we're going to leave you alone.
[6:30] They sort of start their review process.
[6:33] It's not quite the five-step sequential evaluation process, but it's somewhat similar.
[6:38] They sort of start off looking at the conditions that you had at the comparison point decision.
[6:44] And if those conditions remain disabling, that's all they look at.
[6:49] But if they're looking at your file and they say, well, you know, there's been some improvement
[6:53] in those same conditions from last time, we don't think those ones by themselves remain
[6:57] disabling.
[6:59] Then the next question is, well, what's new?
[7:02] And so, they'll look at any new conditions that have arisen since the last time they're
[7:05] a future file.
[7:06] So they'll look at it and basically say, I mean, there's a bunch of different possible
[7:11] outcomes.
[7:12] They could look at it initially and say, you haven't gotten any better or frequently you've
[7:16] gotten worse.
[7:17] Got worse.
[7:18] So that, you know, you'll be approved, you'll be continued, your benefits will be continued.
[7:23] They can look at it and say, well, we think your medical conditions have improved, but
[7:28] not necessarily improved to the point, I mean, you rarely see this, but this is what they're
[7:32] doing, not the point to the, you could return to stanchions like activity, your benefits
[7:37] will be continued.
[7:38] They could review it and say, well, we think your condition has improved such that you could
[7:42] return to substantial gain flight activity, but there's new conditions and they look at
[7:47] those, those new conditions in and of themselves could be disabling or in conjunction with whatever
[7:53] level of disability you residually have from the impairments that led you to be disabled
[7:59] to start with.
[8:00] Or they could look at all that and say, hey, you know, you're just not, you're not
[8:05] to say, yeah, new conditions, your new conditions aren't enough either.
[8:09] So I think one thing to remember, and this is sort of at the points at the end, but sometimes
[8:16] we run out of time, and I want to make sure people understand this, when you get that letter
[8:22] in the mail, you cannot ignore it.
[8:26] So for example, would you tell someone when they receive this letter in the mail, this is
[8:31] what's coming, this review process we just described, primarily what are the advice you're
[8:37] going to give someone, because our clients call our former clients and we have thousands
[8:40] of them, our former clients call in when this happens, and we do, and there are attorneys
[8:45] who help people with CDR cases, our firm does CDR cases, you know, for our former clients
[8:52] and for other clients, what generally are you making sure, hey, make sure you don't do
[8:57] this, and these are the things we need to do.
[9:00] The first thing, if they're one of our former clients and we, you know, maybe they're younger,
[9:04] we sort of expected that there might be a CDR in the near future.
[9:09] What I try to remind clients, when we get that favorable decision way back when, is go ahead
[9:15] and start keeping a notebook now, and anytime you see a new medical provider go to the hospital,
[9:22] anything like that, put that in your notebook, so when we have that CDR, you have a quick reference
[9:27] point.
[9:28] So one of the things to stop right there, one of the things people need to understand
[9:31] is preparing for a CDR starts the day you get your favorable decision initially.
[9:38] Yes.
[9:38] Yeah, and that seems, that's not the most, that's not the favorite advice we give people,
[9:45] because they just got up through the process, they're like, oh, by the way, you could have
[9:47] to do this again.
[9:48] We're not optimistic people.
[9:49] Yeah, but, but at the same time, that is really when it starts.
[9:53] Yes.
[9:53] Yeah, okay, so let's say you've done that and you've kept your evidence and you've gone to
[9:57] the doctor and you've complied and all the things you're supposed to do, and you actually
[10:00] get the letter, what are some tips you're going to get people at that point?
[10:03] Yes.
[10:04] Get that letter back as quick as you can.
[10:08] What it's going to be asking for is essentially updated treatment since the time of the favorable
[10:12] decision or the last time they reviewed your file, and sometimes like we said, that could
[10:17] be five to seven years of doctor's visits that you're trying to go back and remember who
[10:20] all you've seen, but it's very important to be thorough there because this is the basis
[10:25] for the continuing disability review is the medical improvement.
[10:29] So take your time filling that out, make sure it's very thorough, but also hurry up and get
[10:33] it back in the mail.
[10:34] Well, and I think, too, is say, you know, don't, don't that, Pam, please, don't do this.
[10:41] Don't assume that it's just about the conditions that got you on disability to start with, because
[10:46] a lot of times what people will come to us and they've been denied, they did their own CDR
[10:50] initial review and they've been denied, or even they did a hearing, they initial hearing
[10:54] and got denied.
[10:56] And we start talking to them and realize they only updated the medical evidence related
[11:00] to their cancer, but like two years after they had disability, they had, you know, bilateral
[11:06] knee replacements.
[11:07] And they're like, well, I didn't think that was relevant because that wasn't what my initial
[11:11] case was cited on.
[11:12] So understand, not only do you need to update that record initially, I mean, this, you
[11:16] just, you know, fire the shotgun, anything that's going on with you, just, you need to go
[11:20] ahead and get all that evidence in, okay?
[11:22] So I think two big takeaways are be prepared to give a full, the full medical history since
[11:28] the unfavorable, since the favorable decision and don't ignore the paperwork.
[11:35] So let's say you send the paperwork back in and they do deny you.
[11:39] Can you walk people through that first sort of the reconsideration phase and the hearing
[11:43] phase so we can sort of give them an idea of what to expect?
[11:46] Absolutely.
[11:48] You've gotten that paperwork in, you filled it out, you sent it back, and you get that
[11:53] initial denial, then you have 60 days to appeal, but this is important.
[12:00] Only 10 days to request benefits be continued.
[12:04] So I always try to make sure that clients know you can actually have your disability benefits
[12:08] and your Medicare continued throughout the continuing disability review process.
[12:14] With the caveat.
[12:15] With the caveat.
[12:16] That you only have 10 days to request benefit continuation from the denial.
[12:22] And an understanding that you can continue those benefits, but at the end of the day, if
[12:29] they determine your medical condition is improved and your benefits are not continued, it's
[12:33] going to produce an overpayment.
[12:34] Yes, you may be on the hook for repaying that.
[12:37] And that probably is not going to be two or three months of overpayment.
[12:41] Right.
[12:42] Because we'll talk about the process here.
[12:43] Yeah.
[12:44] It could be years.
[12:45] So it's not uncommon, especially in past years, there's no reason it's going to be different
[12:52] in the future.
[12:53] It's not uncommon.
[12:54] You could easily produce an 18 to 24 months of overpayment.
[12:58] So it runs some real quick math.
[12:59] If you're drawing $2,000 a month and you produce 24 month overpayment, that's $48,000 that
[13:04] you're going to be responsible for.
[13:07] Not saying don't continue your benefits, just understand there is risk there.
[13:12] There's waiver process as well.
[13:14] That's probably another whole episode or not getting into today, but understand you have
[13:18] 10 days to continue your benefits and understand there's risk there.
[13:24] Right.
[13:25] Okay.
[13:26] So you get your notice, you continue your benefits, you got to reconsideration, what's that?
[13:31] There's a hearing there.
[13:32] Yes, this is a little bit different than the reconsideration on an initial kind of standard
[13:38] run of the milk case.
[13:41] At CDR level, a reconsideration, you can actually request a hearing with a local officer
[13:50] at your local social security office.
[13:52] So we typically do recommend people take advantage of that, have that local officer hearing,
[13:58] and essentially this is usually about an hour, relatively informal interview with a local
[14:04] officer who is not an attorney, who is not a judge or an ALJ.
[14:09] This is somebody who works with social security and sort of has a form that they fill out
[14:14] of questions that they're asking you.
[14:17] Yeah, they're very diligent about completing the form.
[14:20] Yes.
[14:21] Some of the questions you'll be sitting there thinking, this has nothing to do with my case.
[14:25] Why are they asking me that?
[14:26] It's because it's on the form and they must have an answer.
[14:28] Yeah, they must complete the form.
[14:30] So the form will be completed and then they will issue a decision.
[14:35] If they decide there's been medical improvement, then the next step is to appeal that and go
[14:40] in front of an administrative law judge, very similar to the hearing that got you on benefits
[14:44] originally.
[14:45] Yeah, and I think a couple of things, one, I mean, we represent people in CDRs and we will
[14:52] do a local hearing with them.
[14:56] I think it's important to do that hearing.
[15:01] One is it gives you an opportunity for your client to have sort of a dry run at testimony,
[15:07] which is sort of like a deposition almost in some respects.
[15:10] You have a, you know, when you're able to also, well, I've never felt like the hearing officer
[15:17] really cared what we had to say.
[15:19] Maybe they do.
[15:20] That's probably not complete.
[15:21] That doesn't feel like they care.
[15:23] My forms are just so thorough.
[15:24] There's nothing left for us to ask.
[15:25] What could there possibly left for us to ask that wasn't on this wonderfully created government
[15:30] form, but it also gives you an opportunity as an attorney to, because it's a dry run,
[15:37] it's not binding.
[15:38] Right.
[15:39] I mean, just because the hearing officer says you had medical improvement, it's kind of like
[15:43] anyone at DDS saying you have medical improvement, it really doesn't matter.
[15:48] The judge can consider it, but they're not required to follow.
[15:50] Yeah, and in my experience, judges aren't, judges particularly don't feel like they have
[15:56] to be bound by hearing decision and CDR.
[16:01] But it gives you an opportunity also, though, to do an evaluation of the case, you know,
[16:07] what are some things we need to deal with?
[16:10] What are some issues?
[16:11] Do we need to go back and get an additional letter of support to maybe explain why the records
[16:16] that the hearing, the hearing officer is looking at is sort of leaning towards medical improvement,
[16:23] but maybe that's really not indicative of medical improvement.
[16:26] I think it's an opportunity for you to not only evaluate the case, you get a chance to
[16:32] go through the testimony, and you get a very, very thorough decision.
[16:39] It looks nothing like a reconsideration decision in a sort of initial application, and they're
[16:45] going to go through and look at the comparison point decision.
[16:49] But it's going to be very similar to what an ALJ is going to do.
[16:54] So if you see that maybe they're, sometimes they mischaracterize the initial impairments
[17:01] that were part of the underlying decision.
[17:02] It's not uncommon for them to, like you read it and you're like, I don't, I did that
[17:09] hearing, and I know it's four years ago, but I don't think that's what was wrong with
[17:14] them.
[17:15] And sure enough, they've completely sort of just mischaracterized what was going on,
[17:20] or they're like, well, they're really hyper focused on one issue, and you're like, well,
[17:25] that was, you wasn't important when we did the hearing to start with, that's not why they
[17:28] were failed disabled, and sort of sometimes there seems to be a disconnect between their
[17:34] review of the comparison point decision and what actually happened in the comparison point
[17:39] decision.
[17:41] It's just a good way to get clarity on those things and sort of how they work.
[17:45] So to say they didn't eye you again, you're going to go to an ALJ, what's generally would
[17:52] they expect in an ALJ, is it an ALJ hearing?
[17:56] Very similar format wise to a standard run of the meal hearing, the hearing where you
[18:01] got your benefits.
[18:03] The judge is probably going to be asking some questions about sort of what have you been
[18:07] up to in the last couple of years, depending on the judge's interest, they may be, you
[18:12] know, laser focused on the on the impairment that got you disability in the first place.
[18:18] Other judges will want to talk more about things that are new or different.
[18:21] You know, interesting.
[18:22] I think in the ALJ hearings in these cases, there seems to be a sort of a broader look at
[18:30] your ADLs, there's a broader look at your life, there's a broader look at how you've been
[18:35] spending your time, whether you've tried to work, whether maybe you've taken up one
[18:42] of those gig economy jobs that we talked about a number of episodes ago.
[18:46] And so I think it doesn't appear to, you know, in my experience at the local office hearing
[18:52] in the CDR, it's just not a big part of the form, right?
[18:58] But at the hearing level, your judge is going to dive into those.
[19:02] I think the ALJs are also more comfortable than the hearings officers sort of questioning
[19:08] your treatment.
[19:09] So an ALJ is maybe very comfortable coming in and saying, no, why?
[19:13] Now that you've had Medicare for four years, why haven't your doctors done this, that and
[19:16] the other?
[19:17] And so sort of being prepared to explain yourself as far as what treatments you've been having.
[19:23] Even though the regulations clearly say that the ALJ cannot be a doctor, they sure seem
[19:28] to Monday morning quarterback, what's yours if you do it in these CDR hearings?
[19:33] So I think generally, too, just understand what happens from the hearing into the CDR notice
[19:42] matters.
[19:43] And so if you aren't over 55, say, when you get approved, you probably should anticipate,
[19:52] you know, by statute, you should have a CDR.
[19:57] Have a dentiary wise, I think it's sort of the same things we always talk about.
[20:02] You need to have consistent treatment.
[20:04] You need to follow the treatment recommendations of your doctor.
[20:08] If you don't, you need to give good explanations.
[20:13] You need to continually be aware that if you're in a hearing, there's going to be this golden
[20:19] chain of evidentiary progression.
[20:20] We have to have the diagnosis.
[20:22] So if you need to maintain medical treatment to maintain the diagnosis, you have to be able
[20:28] to show the symptoms through your testimony and through the medical treatment.
[20:32] Then you have to be able to clearly describe functional limitation.
[20:38] So it's both detail and really framing it in sort of ways that are believable.
[20:50] So I can't lift this much and I know that because.
[20:54] I can't sit for this long and I can't sit the long because.
[20:58] And so at some levels, it's no different than your original hearing, but at another level,
[21:02] understand, you're now going to be judged not on what happened before your original hearing.
[21:06] You're going to be judged on what happened after it and what the records show and what
[21:09] they did.
[21:10] I think that's one thing sometimes clients get a little bit mixed up on is at the CDR, generally,
[21:16] nobody's questioning that you were disabled back then and so they're not going to undo
[21:22] that decision.
[21:23] They're just looking forward from there.
[21:25] Yeah.
[21:26] And even though, you know, judge to Nazimal sometimes seems to question that, but even they,
[21:33] even sort of, you know, low approval judges, are really not going to take away your benefits
[21:38] unless there's documented improvement of the condition.
[21:43] And final thing because our lovely producer is calling us, calling us home, yeah, it's
[21:50] time flies me having fun.
[21:51] This is also the one of the times where fraud investigations happen.
[21:56] So obviously CDRs do not happen necessarily because of fraud.
[22:03] That's not the requirement, but they can happen the cause of fraud.
[22:06] Or sometimes in the course of the CDR, they determine they think you're committing fraud.
[22:11] And you talk just briefly about how those investigations work, just what someone might
[22:16] could expect and like, when goodness gracious, they need to shut the door call lawyer.
[22:21] Yes.
[22:22] So the CDI cooperative disability investigation unit, or what I call the fraud squad, may show
[22:28] up at your door and it'll be officers in, it looks like FBI jackets, but it doesn't say
[22:34] FBI.
[22:35] And they will start asking questions.
[22:37] You need to hire a lawyer, right?
[22:40] And they may not just talk to you.
[22:43] They might talk to your neighbor, guy at the corner store.
[22:48] And then there will be a report added to your file.
[22:50] It's usually, I've seen ones that are 30 plus pages long about all of these different interviews
[22:56] that they've conducted and why they think you're committing fraud.
[23:00] The judge is not bound by that report, but it's certainly something the judge can and
[23:04] will consider in your case.
[23:08] Yeah, I think, and the reason it makes, we see it here is that frequently these investigations
[23:13] turn up in CDR cases, because it's not, it's not fraud to continue receiving benefits after
[23:21] you've medically improved, per se, but it is fraud if you know that you've had medical
[23:29] improvement and you're working a side hustle for cash, you never told social security about
[23:36] or you're conducting yourself in a way that gives ready evidence that you know that you're
[23:44] fraudulently receiving these benefits.
[23:46] And once again, they can be, I mean, those investigations can produce hundreds of thousands
[23:51] of dollars in penalties and it's crime.
[23:55] So not only now do you lose your benefits, now you're in a criminal case, which is why
[24:01] you need to call out.
[24:02] All right, I mean, CDRs are coming.
[24:05] I, if you tell me in 2027, there's not more CDRs than I'll buy you a steak dinner or something.
[24:13] Yeah, I'll be shocked because they didn't, they didn't, they didn't change the way these
[24:17] are being done to do less of them.
[24:19] And so be prepared.
[24:21] If your own disability and your receiving benefits, just do the things you need to do.
[24:25] Go to your doctor, maintain your medications.
[24:28] If you go back to work in some capacity and let's subscribe to know, but what you want to
[24:32] do is be able to come into a CDR saying, hey, I've done everything I was supposed to do
[24:36] to maintain my, my health.
[24:39] And I disclosed to you anything that you required to me to disclose to you.
[24:42] And then, you know, you're at least reasonably likely to be protected for fraud, right?
[24:47] Okay, so very good.
[24:48] All right, it's all the time we have today, CDRs.
[24:52] If you get that notice in the mail, I'm sorry, it's no fun get punched in the face.
[24:57] Of course, the mail lips not completely busted.
[25:00] But anyway, it's no fun, but hey, you don't have to do it alone.
[25:02] Try or someone get a good lawyer to help you work through those.
[25:05] And until next time, take care.
[25:06] I'll subscribe.
[25:07] Thanks.
[0:05] has never been more complicated.
[0:07] Welcome to the Disability Expert Podcast, where we tackle the difficult issues and interview
[0:11] the country's top experts to help you better navigate the disability process.
[0:16] Winning a disability case is hard and keeps getting tougher every day.
[0:19] We can't promise you'll win your case by listening, but we sure think it's going to help.
[0:24] This really isn't that complicated.
[0:26] I mean, you want to win your case, don't you?
[0:29] Well, then listen to what I say.
[0:31] Hey, it's Chad Brown.
[0:32] Welcome to the episode of the Disability Expert Podcast, where we talk about all things
[0:36] such as disability, back with my trusted associate Aaron Dalton.
[0:42] Got to be back.
[0:43] Yeah, we are, we're almost going political today.
[0:47] So, one of the things that we've been getting a lot of questions about lately are continuing
[0:55] disability reviews.
[0:56] And we realize we've never done an episode on continuing disability reviews or CDRs.
[1:01] That's what we'll call them in the episode, CDRs, but it's somewhat of a political topic
[1:07] right now.
[1:08] It can be.
[1:09] It's on the news.
[1:10] So, historically, CDR, basically what a CDR is, is once you own so secure disability, the
[1:18] government has the ability to come in and review your medical condition to see if it's improved.
[1:23] And if it has improved, then you're going to be eligible for disability.
[1:28] And if it hasn't improved, you get to keep your disability.
[1:31] And as you can imagine, it is not friendly when you get a, I was thinking about this last
[1:37] night.
[1:38] I've been trying to think of what to work this story in all day.
[1:40] So, I've started taking karate with my son and he's like almost a black belt and I'm like
[1:46] I'm a white belt.
[1:47] So, that literally means I don't know anything.
[1:51] And we're sparring last night and literally I got punched in the mouth.
[1:56] So, we're just sparring.
[1:58] It's like 30% effort but still, it's like man, that's stings and I was thinking that's
[2:02] what it's like to get a CDR.
[2:04] Yeah.
[2:05] You're cruising along.
[2:06] Everything's going all right.
[2:07] And then boom, you open the mail, you get a notice, your case is being reviewed.
[2:12] Here we go again.
[2:13] Here we go again.
[2:14] That's right.
[2:15] So, what makes this topic somewhat political at this point is historically disability termination
[2:20] services which is the local or the state level agency that does initial and reconsideration
[2:25] reviews handled the CDR process.
[2:30] But back in March, for reasons I believe other people to speculate about politically, that
[2:38] was moved away from DDS and moved to a federal agency.
[2:42] So, now there will be a federal group that reviews these.
[2:48] I think the only safe assumption that you could make from that decision is that someone
[2:54] up the chain politically doesn't think enough of these cases are being reviewed.
[3:02] There are stats that come out from the government that whether they're accurate or not, I don't
[3:09] know, there's certainly some truth in them.
[3:12] Tens of billions, that's billions with a B. Tens of billions of dollars every year are presumably
[3:19] lost, paying disability benefits to people who are no longer disabled, who have medical
[3:24] improvement.
[3:27] And presumably this is being moved because of the chain somewhere politically.
[3:33] There's a belief that this needs to be given more scrutiny.
[3:37] These cases need to be handled more aggressively.
[3:41] They need to be done more frequently.
[3:43] With the idea being, they will claw back money that's being paid to people in their mind
[3:51] inappropriately.
[3:52] The agency doesn't set up a new department because they're happy with the way that states
[3:56] are doing things.
[3:57] Yeah, I thought, yeah, yeah, for sure.
[4:00] So, therefore, here we are.
[4:03] That was earlier this year, and I said, hey, let's talk about CDRs because the reality is,
[4:10] are there people own disability benefits whose medical condition has improved?
[4:15] Yeah, for sure.
[4:17] Are there people who received benefits who shouldn't?
[4:20] Yeah, for sure.
[4:21] There's people who get approved that shouldn't get approved, right?
[4:23] I mean, it's a massive system full of inefficiencies.
[4:31] But that doesn't change the fact that you're going to feel like I did last night inspiring
[4:36] at Karate when that letter comes in the mail.
[4:38] You're going to feel like you got punched in the mouth.
[4:41] And so, we want to go through today and walk through and help you understand what is a CDR?
[4:46] What's the process sort of look like?
[4:48] Give you a few tips to take away that you can say, this is what you should be doing
[4:53] after you win your case before this CDR potentially happens, even though it may never even happen.
[5:00] And these are the things you should do when you actually get that letter in the mail, all
[5:03] right?
[5:04] So, I'm done talking.
[5:05] It is your turn, tag your it, tell our folks what, tell what is a CDR, just sort of walk
[5:13] through the basics of it.
[5:15] We'll start with the timing.
[5:16] In theory, everyone is supposed to be reviewed five to seven years to determine if those
[5:23] conditions have improved.
[5:25] What we see in practice, though, is that certain groups tend to get a CDR'd more frequently.
[5:31] Young people tend to get reviewed more often than every five to seven years.
[5:36] Folks who are 55 and older very rarely undergo a continuing disability review absent some
[5:43] unusual circumstances we may get to later if we have time.
[5:46] The question with CDRs is, has there been medical improvement since the most recent comparison
[5:54] point decision?
[5:55] So, if the most recent decision on your case was at the administrative law judge level, that's
[6:00] what they'll use.
[6:01] If there's been a CDR in the past that found your disability continued, that's what they'll
[6:07] go off of.
[6:08] And what they're looking for is, has there been medical improvement related to the ability
[6:14] to work?
[6:15] So, sometimes we see decisions where there's maybe been a little bit of medical improvement,
[6:20] but it was so slight they don't even really proceed further.
[6:23] They say that's not even related to the ability to work.
[6:26] You're almost as bad off as you were last time, we're going to leave you alone.
[6:30] They sort of start their review process.
[6:33] It's not quite the five-step sequential evaluation process, but it's somewhat similar.
[6:38] They sort of start off looking at the conditions that you had at the comparison point decision.
[6:44] And if those conditions remain disabling, that's all they look at.
[6:49] But if they're looking at your file and they say, well, you know, there's been some improvement
[6:53] in those same conditions from last time, we don't think those ones by themselves remain
[6:57] disabling.
[6:59] Then the next question is, well, what's new?
[7:02] And so, they'll look at any new conditions that have arisen since the last time they're
[7:05] a future file.
[7:06] So they'll look at it and basically say, I mean, there's a bunch of different possible
[7:11] outcomes.
[7:12] They could look at it initially and say, you haven't gotten any better or frequently you've
[7:16] gotten worse.
[7:17] Got worse.
[7:18] So that, you know, you'll be approved, you'll be continued, your benefits will be continued.
[7:23] They can look at it and say, well, we think your medical conditions have improved, but
[7:28] not necessarily improved to the point, I mean, you rarely see this, but this is what they're
[7:32] doing, not the point to the, you could return to stanchions like activity, your benefits
[7:37] will be continued.
[7:38] They could review it and say, well, we think your condition has improved such that you could
[7:42] return to substantial gain flight activity, but there's new conditions and they look at
[7:47] those, those new conditions in and of themselves could be disabling or in conjunction with whatever
[7:53] level of disability you residually have from the impairments that led you to be disabled
[7:59] to start with.
[8:00] Or they could look at all that and say, hey, you know, you're just not, you're not
[8:05] to say, yeah, new conditions, your new conditions aren't enough either.
[8:09] So I think one thing to remember, and this is sort of at the points at the end, but sometimes
[8:16] we run out of time, and I want to make sure people understand this, when you get that letter
[8:22] in the mail, you cannot ignore it.
[8:26] So for example, would you tell someone when they receive this letter in the mail, this is
[8:31] what's coming, this review process we just described, primarily what are the advice you're
[8:37] going to give someone, because our clients call our former clients and we have thousands
[8:40] of them, our former clients call in when this happens, and we do, and there are attorneys
[8:45] who help people with CDR cases, our firm does CDR cases, you know, for our former clients
[8:52] and for other clients, what generally are you making sure, hey, make sure you don't do
[8:57] this, and these are the things we need to do.
[9:00] The first thing, if they're one of our former clients and we, you know, maybe they're younger,
[9:04] we sort of expected that there might be a CDR in the near future.
[9:09] What I try to remind clients, when we get that favorable decision way back when, is go ahead
[9:15] and start keeping a notebook now, and anytime you see a new medical provider go to the hospital,
[9:22] anything like that, put that in your notebook, so when we have that CDR, you have a quick reference
[9:27] point.
[9:28] So one of the things to stop right there, one of the things people need to understand
[9:31] is preparing for a CDR starts the day you get your favorable decision initially.
[9:38] Yes.
[9:38] Yeah, and that seems, that's not the most, that's not the favorite advice we give people,
[9:45] because they just got up through the process, they're like, oh, by the way, you could have
[9:47] to do this again.
[9:48] We're not optimistic people.
[9:49] Yeah, but, but at the same time, that is really when it starts.
[9:53] Yes.
[9:53] Yeah, okay, so let's say you've done that and you've kept your evidence and you've gone to
[9:57] the doctor and you've complied and all the things you're supposed to do, and you actually
[10:00] get the letter, what are some tips you're going to get people at that point?
[10:03] Yes.
[10:04] Get that letter back as quick as you can.
[10:08] What it's going to be asking for is essentially updated treatment since the time of the favorable
[10:12] decision or the last time they reviewed your file, and sometimes like we said, that could
[10:17] be five to seven years of doctor's visits that you're trying to go back and remember who
[10:20] all you've seen, but it's very important to be thorough there because this is the basis
[10:25] for the continuing disability review is the medical improvement.
[10:29] So take your time filling that out, make sure it's very thorough, but also hurry up and get
[10:33] it back in the mail.
[10:34] Well, and I think, too, is say, you know, don't, don't that, Pam, please, don't do this.
[10:41] Don't assume that it's just about the conditions that got you on disability to start with, because
[10:46] a lot of times what people will come to us and they've been denied, they did their own CDR
[10:50] initial review and they've been denied, or even they did a hearing, they initial hearing
[10:54] and got denied.
[10:56] And we start talking to them and realize they only updated the medical evidence related
[11:00] to their cancer, but like two years after they had disability, they had, you know, bilateral
[11:06] knee replacements.
[11:07] And they're like, well, I didn't think that was relevant because that wasn't what my initial
[11:11] case was cited on.
[11:12] So understand, not only do you need to update that record initially, I mean, this, you
[11:16] just, you know, fire the shotgun, anything that's going on with you, just, you need to go
[11:20] ahead and get all that evidence in, okay?
[11:22] So I think two big takeaways are be prepared to give a full, the full medical history since
[11:28] the unfavorable, since the favorable decision and don't ignore the paperwork.
[11:35] So let's say you send the paperwork back in and they do deny you.
[11:39] Can you walk people through that first sort of the reconsideration phase and the hearing
[11:43] phase so we can sort of give them an idea of what to expect?
[11:46] Absolutely.
[11:48] You've gotten that paperwork in, you filled it out, you sent it back, and you get that
[11:53] initial denial, then you have 60 days to appeal, but this is important.
[12:00] Only 10 days to request benefits be continued.
[12:04] So I always try to make sure that clients know you can actually have your disability benefits
[12:08] and your Medicare continued throughout the continuing disability review process.
[12:14] With the caveat.
[12:15] With the caveat.
[12:16] That you only have 10 days to request benefit continuation from the denial.
[12:22] And an understanding that you can continue those benefits, but at the end of the day, if
[12:29] they determine your medical condition is improved and your benefits are not continued, it's
[12:33] going to produce an overpayment.
[12:34] Yes, you may be on the hook for repaying that.
[12:37] And that probably is not going to be two or three months of overpayment.
[12:41] Right.
[12:42] Because we'll talk about the process here.
[12:43] Yeah.
[12:44] It could be years.
[12:45] So it's not uncommon, especially in past years, there's no reason it's going to be different
[12:52] in the future.
[12:53] It's not uncommon.
[12:54] You could easily produce an 18 to 24 months of overpayment.
[12:58] So it runs some real quick math.
[12:59] If you're drawing $2,000 a month and you produce 24 month overpayment, that's $48,000 that
[13:04] you're going to be responsible for.
[13:07] Not saying don't continue your benefits, just understand there is risk there.
[13:12] There's waiver process as well.
[13:14] That's probably another whole episode or not getting into today, but understand you have
[13:18] 10 days to continue your benefits and understand there's risk there.
[13:24] Right.
[13:25] Okay.
[13:26] So you get your notice, you continue your benefits, you got to reconsideration, what's that?
[13:31] There's a hearing there.
[13:32] Yes, this is a little bit different than the reconsideration on an initial kind of standard
[13:38] run of the milk case.
[13:41] At CDR level, a reconsideration, you can actually request a hearing with a local officer
[13:50] at your local social security office.
[13:52] So we typically do recommend people take advantage of that, have that local officer hearing,
[13:58] and essentially this is usually about an hour, relatively informal interview with a local
[14:04] officer who is not an attorney, who is not a judge or an ALJ.
[14:09] This is somebody who works with social security and sort of has a form that they fill out
[14:14] of questions that they're asking you.
[14:17] Yeah, they're very diligent about completing the form.
[14:20] Yes.
[14:21] Some of the questions you'll be sitting there thinking, this has nothing to do with my case.
[14:25] Why are they asking me that?
[14:26] It's because it's on the form and they must have an answer.
[14:28] Yeah, they must complete the form.
[14:30] So the form will be completed and then they will issue a decision.
[14:35] If they decide there's been medical improvement, then the next step is to appeal that and go
[14:40] in front of an administrative law judge, very similar to the hearing that got you on benefits
[14:44] originally.
[14:45] Yeah, and I think a couple of things, one, I mean, we represent people in CDRs and we will
[14:52] do a local hearing with them.
[14:56] I think it's important to do that hearing.
[15:01] One is it gives you an opportunity for your client to have sort of a dry run at testimony,
[15:07] which is sort of like a deposition almost in some respects.
[15:10] You have a, you know, when you're able to also, well, I've never felt like the hearing officer
[15:17] really cared what we had to say.
[15:19] Maybe they do.
[15:20] That's probably not complete.
[15:21] That doesn't feel like they care.
[15:23] My forms are just so thorough.
[15:24] There's nothing left for us to ask.
[15:25] What could there possibly left for us to ask that wasn't on this wonderfully created government
[15:30] form, but it also gives you an opportunity as an attorney to, because it's a dry run,
[15:37] it's not binding.
[15:38] Right.
[15:39] I mean, just because the hearing officer says you had medical improvement, it's kind of like
[15:43] anyone at DDS saying you have medical improvement, it really doesn't matter.
[15:48] The judge can consider it, but they're not required to follow.
[15:50] Yeah, and in my experience, judges aren't, judges particularly don't feel like they have
[15:56] to be bound by hearing decision and CDR.
[16:01] But it gives you an opportunity also, though, to do an evaluation of the case, you know,
[16:07] what are some things we need to deal with?
[16:10] What are some issues?
[16:11] Do we need to go back and get an additional letter of support to maybe explain why the records
[16:16] that the hearing, the hearing officer is looking at is sort of leaning towards medical improvement,
[16:23] but maybe that's really not indicative of medical improvement.
[16:26] I think it's an opportunity for you to not only evaluate the case, you get a chance to
[16:32] go through the testimony, and you get a very, very thorough decision.
[16:39] It looks nothing like a reconsideration decision in a sort of initial application, and they're
[16:45] going to go through and look at the comparison point decision.
[16:49] But it's going to be very similar to what an ALJ is going to do.
[16:54] So if you see that maybe they're, sometimes they mischaracterize the initial impairments
[17:01] that were part of the underlying decision.
[17:02] It's not uncommon for them to, like you read it and you're like, I don't, I did that
[17:09] hearing, and I know it's four years ago, but I don't think that's what was wrong with
[17:14] them.
[17:15] And sure enough, they've completely sort of just mischaracterized what was going on,
[17:20] or they're like, well, they're really hyper focused on one issue, and you're like, well,
[17:25] that was, you wasn't important when we did the hearing to start with, that's not why they
[17:28] were failed disabled, and sort of sometimes there seems to be a disconnect between their
[17:34] review of the comparison point decision and what actually happened in the comparison point
[17:39] decision.
[17:41] It's just a good way to get clarity on those things and sort of how they work.
[17:45] So to say they didn't eye you again, you're going to go to an ALJ, what's generally would
[17:52] they expect in an ALJ, is it an ALJ hearing?
[17:56] Very similar format wise to a standard run of the meal hearing, the hearing where you
[18:01] got your benefits.
[18:03] The judge is probably going to be asking some questions about sort of what have you been
[18:07] up to in the last couple of years, depending on the judge's interest, they may be, you
[18:12] know, laser focused on the on the impairment that got you disability in the first place.
[18:18] Other judges will want to talk more about things that are new or different.
[18:21] You know, interesting.
[18:22] I think in the ALJ hearings in these cases, there seems to be a sort of a broader look at
[18:30] your ADLs, there's a broader look at your life, there's a broader look at how you've been
[18:35] spending your time, whether you've tried to work, whether maybe you've taken up one
[18:42] of those gig economy jobs that we talked about a number of episodes ago.
[18:46] And so I think it doesn't appear to, you know, in my experience at the local office hearing
[18:52] in the CDR, it's just not a big part of the form, right?
[18:58] But at the hearing level, your judge is going to dive into those.
[19:02] I think the ALJs are also more comfortable than the hearings officers sort of questioning
[19:08] your treatment.
[19:09] So an ALJ is maybe very comfortable coming in and saying, no, why?
[19:13] Now that you've had Medicare for four years, why haven't your doctors done this, that and
[19:16] the other?
[19:17] And so sort of being prepared to explain yourself as far as what treatments you've been having.
[19:23] Even though the regulations clearly say that the ALJ cannot be a doctor, they sure seem
[19:28] to Monday morning quarterback, what's yours if you do it in these CDR hearings?
[19:33] So I think generally, too, just understand what happens from the hearing into the CDR notice
[19:42] matters.
[19:43] And so if you aren't over 55, say, when you get approved, you probably should anticipate,
[19:52] you know, by statute, you should have a CDR.
[19:57] Have a dentiary wise, I think it's sort of the same things we always talk about.
[20:02] You need to have consistent treatment.
[20:04] You need to follow the treatment recommendations of your doctor.
[20:08] If you don't, you need to give good explanations.
[20:13] You need to continually be aware that if you're in a hearing, there's going to be this golden
[20:19] chain of evidentiary progression.
[20:20] We have to have the diagnosis.
[20:22] So if you need to maintain medical treatment to maintain the diagnosis, you have to be able
[20:28] to show the symptoms through your testimony and through the medical treatment.
[20:32] Then you have to be able to clearly describe functional limitation.
[20:38] So it's both detail and really framing it in sort of ways that are believable.
[20:50] So I can't lift this much and I know that because.
[20:54] I can't sit for this long and I can't sit the long because.
[20:58] And so at some levels, it's no different than your original hearing, but at another level,
[21:02] understand, you're now going to be judged not on what happened before your original hearing.
[21:06] You're going to be judged on what happened after it and what the records show and what
[21:09] they did.
[21:10] I think that's one thing sometimes clients get a little bit mixed up on is at the CDR, generally,
[21:16] nobody's questioning that you were disabled back then and so they're not going to undo
[21:22] that decision.
[21:23] They're just looking forward from there.
[21:25] Yeah.
[21:26] And even though, you know, judge to Nazimal sometimes seems to question that, but even they,
[21:33] even sort of, you know, low approval judges, are really not going to take away your benefits
[21:38] unless there's documented improvement of the condition.
[21:43] And final thing because our lovely producer is calling us, calling us home, yeah, it's
[21:50] time flies me having fun.
[21:51] This is also the one of the times where fraud investigations happen.
[21:56] So obviously CDRs do not happen necessarily because of fraud.
[22:03] That's not the requirement, but they can happen the cause of fraud.
[22:06] Or sometimes in the course of the CDR, they determine they think you're committing fraud.
[22:11] And you talk just briefly about how those investigations work, just what someone might
[22:16] could expect and like, when goodness gracious, they need to shut the door call lawyer.
[22:21] Yes.
[22:22] So the CDI cooperative disability investigation unit, or what I call the fraud squad, may show
[22:28] up at your door and it'll be officers in, it looks like FBI jackets, but it doesn't say
[22:34] FBI.
[22:35] And they will start asking questions.
[22:37] You need to hire a lawyer, right?
[22:40] And they may not just talk to you.
[22:43] They might talk to your neighbor, guy at the corner store.
[22:48] And then there will be a report added to your file.
[22:50] It's usually, I've seen ones that are 30 plus pages long about all of these different interviews
[22:56] that they've conducted and why they think you're committing fraud.
[23:00] The judge is not bound by that report, but it's certainly something the judge can and
[23:04] will consider in your case.
[23:08] Yeah, I think, and the reason it makes, we see it here is that frequently these investigations
[23:13] turn up in CDR cases, because it's not, it's not fraud to continue receiving benefits after
[23:21] you've medically improved, per se, but it is fraud if you know that you've had medical
[23:29] improvement and you're working a side hustle for cash, you never told social security about
[23:36] or you're conducting yourself in a way that gives ready evidence that you know that you're
[23:44] fraudulently receiving these benefits.
[23:46] And once again, they can be, I mean, those investigations can produce hundreds of thousands
[23:51] of dollars in penalties and it's crime.
[23:55] So not only now do you lose your benefits, now you're in a criminal case, which is why
[24:01] you need to call out.
[24:02] All right, I mean, CDRs are coming.
[24:05] I, if you tell me in 2027, there's not more CDRs than I'll buy you a steak dinner or something.
[24:13] Yeah, I'll be shocked because they didn't, they didn't, they didn't change the way these
[24:17] are being done to do less of them.
[24:19] And so be prepared.
[24:21] If your own disability and your receiving benefits, just do the things you need to do.
[24:25] Go to your doctor, maintain your medications.
[24:28] If you go back to work in some capacity and let's subscribe to know, but what you want to
[24:32] do is be able to come into a CDR saying, hey, I've done everything I was supposed to do
[24:36] to maintain my, my health.
[24:39] And I disclosed to you anything that you required to me to disclose to you.
[24:42] And then, you know, you're at least reasonably likely to be protected for fraud, right?
[24:47] Okay, so very good.
[24:48] All right, it's all the time we have today, CDRs.
[24:52] If you get that notice in the mail, I'm sorry, it's no fun get punched in the face.
[24:57] Of course, the mail lips not completely busted.
[25:00] But anyway, it's no fun, but hey, you don't have to do it alone.
[25:02] Try or someone get a good lawyer to help you work through those.
[25:05] And until next time, take care.
[25:06] I'll subscribe.
[25:07] Thanks.
