What Should I Do If My Medical Condition Changes After I Have Been Approved for Disability Benefits?

Submitted by rsg on

If you are currently receiving disability benefits and your medical condition changes, it is important to notify the Social Security Administration (SSA). This is because eligibility for disability benefits is based on you having a medical condition that prevents you from working. If the medical condition has improved and you are now able to work then you cannot expect the same support from the SSA. However, if your medical condition has worsened then there may be more assistance available to you.

Understanding Disability Benefits

Social Security Disability Insurance (SSDI)

This is a federal insurance program designed to provide income support to individuals who are unable to work due to a disability. Obtaining disability benefits through the SSDI program depends on having a work history and enough social security payments over the time employed to satisfy the SSA’s criteria.

Eligibility criteria

  • You must have a qualifying medical condition that causes a disability that prevents substantial gainful activity (SGA), meaning the inability to earn a certain amount of income. The relevant medical conditions can be found in the SSA’s Blue Book.
  • You must have worked and paid social security taxes for a certain number of years, resulting in accumulating work credits. The exact number of credits required depends on your age at the time of disability.
  • Your disability is normally expected to last for at least one year or result in death.
  • Benefits are based on your earnings history, similar to retirement benefits.
  • There is typically a 5 month waiting period from the onset of a disability before benefits begin.

Supplemental Security Income (SSI)

SSI is a federal income supplement program funded by revenue gained through general taxes and not social security taxes. It provides cash assistance to individuals with limited income and resources who are old, blind, or disabled. It is not necessary to have accumulated work credits to qualify for SSI, but there are income and assets tests which determine whether you are eligible. You must have less than the cut off limits to qualify for benefits through this program.

Eligibility criteria

  • Must have a qualifying disability that prevents being able to reach the SSA’s stated limit of substantial gainful activity (SGA).
  • Must have limited income and resources, including assets such as cash, bank accounts, stocks, and property. There are strict asset and income limits to qualify for SSI. The main home isn’t normally assessed when applying for SSI.
  • Citizenship or legal U.S. residency requirements also apply.

SSI benefits are set by the federal government and are adjusted every year based on changes in the cost of living.

Maximum Federal Supplemental Security Income (SSI) payment amounts increase with the cost-of-living increases that apply to social security benefits. The latest such increase was 3.2 percent which became effective in January 2024. The monthly maximum Federal amounts for SSI in 2024 are $943 for an eligible individual, $1,415 for an eligible individual with an eligible spouse, and $472 for an essential person.

What Constitutes a Change in a Medical Condition?

A change in a medical condition is defined as when your medical condition has improved, worsened or you have been informed of a new diagnosis.

Reporting medical changes when receiving disability benefits is vital to ensure continued eligibility and the calculation of accurate benefit amounts. Failure to report changes may result in overpayments, underpayments, or loss of benefits. By staying proactive, individuals can prevent financial penalties, receive the appropriate level of support, and maintain compliance with regulations.

This helps uphold the integrity of the disability benefits system and ensures fair distribution of resources to those who truly need them. Reporting changes in medical condition ensures that individuals continue to meet the eligibility criteria for disability benefits. Conditions may improve, worsen, or change over time, affecting eligibility for benefits.

It's a legal requirement to report changes in medical condition to the SSA. Failure to do so can result in penalties or even loss of benefits. Overall, staying proactive and keeping authorities informed of changes in a medical condition ensures that individuals receive the appropriate level of support and helps maintain the integrity of the disability benefits system.

Steps to Take if your Medical Condition Changes

Notify the Social Security Administration (SSA) of medical changes, individuals can contact their local SSA office by phone or visit their website. They should be prepared to provide their Social Security number and details of the medical changes. Alternatively, they can report changes through their personal SSA online account.

For specific instructions and contact information, visit the SSA's official website or call the SSA toll-free at 1-800-772-1213 (TTY 1-800-325-0778 for the deaf or hard of hearing). Additionally, individuals can schedule an in-person appointment at their local SSA office for assistance with reporting changes.

Submit Updated Medical Documentation

Providing updated medical records and reports is vital for substantiating changes in condition when updating disability benefits. These documents serve as evidence to support the severity and impact of the disability, ensuring accurate evaluation by authorities. Forms such as the Disability Update Report (SSA-455) or Continuing Disability Review Report (SSA-454-BK) may be required, along with medical evidence such as doctor's notes, test results, and treatment records. Timely submission of updated information helps maintain eligibility and ensures individuals receive appropriate benefits reflective of their current health status, facilitating fair and efficient assistance allocation.

What to Expect After Reporting a Change

After reporting a medical condition change to the SSA, a reassessment of eligibility typically follows. This involves a review of updated medical records and may include additional examinations or consultations. Depending on the severity of the change, benefit adjustments may occur.