Not everyone gets a medical review, but Social Security decides based on your condition

Social Security does not review every SSDI case on the same schedule. Whether you get a review depends on how likely your condition is to improve. When you are approved for SSDI, Social Security assigns your case one of three review categories: medical improvement expected, medical improvement possible, or medical improvement not expected. That category determines if and when the agency will ask you to prove your condition still qualifies.

If your condition is one where improvement is not expected — many permanent disabilities fall here — you may never receive a review notice. If improvement is possible or expected, Social Security will contact you at intervals ranging from every few months to every seven years. The agency does not tell you which category you are in when you are approved, but you can request that information from your local Social Security office.

Key Takeaways

  • Social Security places each approved case into one of three review categories based on whether your condition is likely to improve.
  • Cases where medical improvement is not expected may never be reviewed, while cases where improvement is possible can be reviewed as often as every few months.
  • You will receive a notice in the mail before any review, and you have the right to submit medical records and written statements instead of attending an in-person exam.
  • If Social Security finds your condition has improved enough that you no longer may have access to, you can request reconsideration and appeal their decision.
  • Continuing to work and report your earnings does not automatically trigger a review, but earning above the substantial gainful activity limit may end your benefits.

How Social Security decides which cases to review

The three review categories are based on your medical condition at the time of approval. Medical improvement not expected applies to conditions that are permanent or terminal — for example, total blindness, loss of limbs, or severe intellectual disability. Cases in this category are rarely reviewed unless you report a change yourself or Social Security has reason to believe your circumstances have changed.

Medical improvement possible covers conditions that might improve but are not expected to. These cases are typically reviewed every one to three years. Medical improvement expected applies to conditions that are likely to improve with time or treatment — for example, recovery from a severe injury or a condition being managed with new medication. These cases can be reviewed as often as every six to twelve months.

Social Security does not automatically tell you which category your case falls into. You can call your local Social Security office at 1-800-772-1213 and ask them to look up your case review category. Have your Social Security number ready when you call.

What happens when Social Security sends you a review notice

When Social Security decides to review your case, you will receive a notice in the mail. The notice will ask you to submit medical evidence showing that your condition still qualifies for SSDI. You will have a important date to respond — usually 10 days from the date on the notice, though you can request an extension.

You do not have to attend an appointment in person. You can submit your response by mail, by phone, or through your online Social Security account if you have one. The most straightforward way is to ask your doctor's office to send your recent medical records directly to Social Security. Include the case number from the notice so the records reach the right file.

If Social Security needs more information, they may schedule a consultative exam with a doctor they choose. You will receive notice of the date and location. This exam is free, and Social Security pays the doctor. You can bring someone with you, and you have the right to see the doctor's report after it is completed.

What Social Security looks for during a review

During a review, Social Security compares your current medical condition to the medical evidence from your original approval. They are looking for whether your condition has improved enough that you no longer meet the criteria for SSDI. The standard is not whether you feel better or have fewer symptoms — it is whether your medical records show objective improvement that would allow you to work.

Social Security will examine your treatment history, any changes in medication, test results, and functional limitations. If you have had surgery, started a new treatment, or your doctor has noted improvement in your medical records, Social Security will weigh that evidence. They will also consider whether you have attempted to work or have been working, and how much you earned.

If your medical records show no significant change from your approval, your case will typically be continued. If records show improvement, Social Security will determine whether the improvement is enough to end your benefits. You will receive a written decision explaining their finding.

What to do if Social Security says you no longer may have access to

If Social Security decides your condition has improved and you no longer may have access to for SSDI, you have the right to challenge that decision. You can request reconsideration, which means Social Security will review the case again with a different examiner. You have 10 days from the date of the notice to request reconsideration, though you can ask for an extension.

When you request reconsideration, submit any new medical evidence that shows your condition has not improved as much as Social Security believes. You can also explain in writing why you disagree with their decision. If reconsideration is denied, you can request a hearing before an administrative law judge. At a hearing, you can present testimony and evidence, and you can have a representative — such as a lawyer or advocate — speak on your behalf.

While your appeal is pending, your benefits will continue. If you eventually win your appeal, you will receive back pay for the months your benefits were stopped. If your appeal is denied and benefits end, you will have a grace period before your Medicare or Medicaid coverage ends, depending on which program you receive.

How work and earnings affect your review

Reporting your work and earnings does not automatically trigger a review. However, if you earn above the substantial gainful activity (SGA) limit, Social Security may end your benefits regardless of whether a review is scheduled. The SGA limit changes each year — in 2024 it is $1,550 per month for non-blind individuals and $2,590 for blind individuals, but these amounts change annually.

If you are working and earning close to the SGA limit, report your earnings to Social Security. You can work and still receive SSDI as long as you stay under the limit, and there is a trial work period that allows you to test your ability to work without when ready losing benefits. During the trial work period, you can earn any amount and keep your full SSDI payment for nine months.

After the trial work period ends, if your earnings exceed the SGA limit, your benefits will stop. You will receive notice of the change. If you stop working or your earnings drop below SGA, you can request that your benefits restart — you do not have to reapply for SSDI.

What you can do to prepare for a review

Keep copies of all medical records and test results related to your condition. When you receive a review notice, gather these documents and give them to your doctor's office with a request to send them to Social Security. Write down the case number from the notice so the records are filed correctly.

If your condition has changed — whether it has improved or worsened — tell Social Security. You can report changes by calling 1-800-772-1213, by visiting your local Social Security office, or by logging into your online account. Do not wait for a review notice to report significant changes.

If you have a representative — a lawyer, advocate, or other authorized person — let them know you have received a review notice. They can help you gather medical evidence and prepare your response. If you do not have a representative and want one, you can find a lawyer or advocate through the National Organization of Social Security Claimants' Representatives (NOSSCR) or your state's disability advocacy organization.

Frequently Asked Questions

How often will Social Security review my case?

The frequency depends on your review category. Cases where medical improvement is not expected may never be reviewed. Cases where improvement is possible are typically reviewed every one to three years. Cases where improvement is expected can be reviewed as often as every six to twelve months. You can ask your local Social Security office which category your case is in.

What if I miss the important date to respond to a review notice?

If you miss the important date, Social Security may stop your benefits. However, you can request an extension before the important date passes, or you can request reinstatement after the important date if you have good reason for missing it. Contact Social Security when ready if you miss a important date — do not ignore the notice.

Can I work while my case is being reviewed?

Yes. Working does not stop a review from happening, and a review does not stop you from working. However, if you earn above the substantial gainful activity limit, your benefits may end regardless of the review outcome. Report your earnings to Social Security so they have accurate information.

Will a review affect my Medicare or Medicaid?

If your SSDI benefits continue, your Medicare or Medicaid continues. If Social Security stops your benefits after a review, you will have a grace period before your coverage ends — usually several months. You can also request Medicaid continuation in most states even after SSDI ends. Ask Social Security about your state's rules when you receive a notice that benefits are stopping.

Do I need a lawyer to respond to a review notice?

No. You can respond on your own by submitting medical records and a written statement. However, if Social Security denies your case after a review, having a representative can help with the appeal process. Many representatives work on contingency, meaning they are paid only if you win your appeal.