If your disability benefits were stopped because your medical condition improved, you can continue to receive SSDI or SSI benefits while you appeal the cessation of disability benefits. The rules for SSDI and SSI benefits pending appeal are similar but not identical. Here are the details.
Timelines for Requesting Continued Benefits
The following deadlines for requesting that your disaiblity benefits continue (called statutory benefit continuation, or SBC) apply to both SSDI and SSI.
Request for Reconsideration
To receive continuing benefits, you must file a request for reconsideration (appeal) within 10 days of receiving your notice of cessation along with your request for continuing cash benefits, Medicare, or both. (In practice, this means you must file your request for reconsideration and your request for continuing benefits within 15 days after the date on the notice you are appealing from, since Social Security allows 5 days for mail.) Note this time limit is much shorter than the 60 days you have to appeal. Social Security will ask you for a statement of which benefits you want continued or that you are declining continuing benefits.
The form to file to request continuing benefits if SSA Form 795, Benefit Continuation Election Statement.
If your benefits were stopped because of medical improvement, you can get a face-to-face hearing with a disability hearing officer (DHO) even at the reconsideration stage.
Request for Hearing
If your request for reconsideration is denied, you must file a request for hearing and another request for continuing benefits within 10 days after you receive your notice of reconsideration. You may elect continuing benefits with your hearing request even if you did not elect continuing benefits with your request for reconsideration.
If you file your request for continuing benefits later than 10 days after you received the notice of cessation or reconsideration, Social Security will deny your request for continuing benefits, unless you can show good cause for the late filing.
If your appeal is denied at the hearing level and you wish to appeal to the Appeals Council, you will no longer continue to receive disability benefits. However, if the Appeals Council remands your case for a new hearing, your benefits will continue with no action on your part.
You can also choose to continue benefits for anybody else receiving benefits based on your earnings record (such as your children); more on this below.
Filing Out the Benefit Election Request Form
Ask Social Security for SSA Form 795, Benefit Continuation Election Statement (you won't be able to get it online). The form has a simple check box format, but you should also explain briefly why your benefits should continue. Be specific but keep your comments brief.
Continuing SSDI Benefits for Others
When you request to have your benefits continued while you are appealing the cessation of your benefits, you need to request to continue benefits for others on your earnings record as well. However, the other persons receiving benefits on your earnings record must also make their own election to receive continuing benefits: Your election to receive continuing benefits does not automatically their benefits; each beneficiary must also make his or her own election to receive continuing benefits.
After you elect continuing benefits for others receiving benefits on your earnings record, Social Security will advise those people of their right to elect to receive continuing benefits, and they then can respond with their own elections to receive (or not receive) continuing benefits.
Continuing SSI and Medicaid Benefits
If you elect continuing SSI benefits and you were eligible for Medicaid before you received a cessation notice, your Medicaid will continue automatically.
Your SSI benefits may be suspended or changed while your appeal is pending if you're living circumstances change (for example, you have changes in income, excess resources, or different living arrangements).
Working While Appealing
If you receive SSDI and work at the SGA level during a trial work period while waiting for an appeal, your SSDI benefits can be suspended.
When Your Benefits Will End
The general rule is that your disability ceases in the month that the cessation notice is mailed to you. If you don't request a continuation of benefits, your SSDI or SSI benefits will continue during the disability cessation month and the following 2 months (the "grace period").
EXAMPLE: On July 15, you receive an SSDI cessation notice (because you've had medical improvement). September is the last month for which you are eligible for disability benefits unless you elect continuing benefits within 10 days after you received the notice of cessation.
However, your disability benefits might be ceased or suspended at an earlier time for specified reasons during the continuing disability review process, such as your failure to cooperate with Social Security by attending a medical exam, the failure of Social Security to establish your whereabouts, or your unjustified failure to follow prescribed treatment. Even in these cases, you have the same ten-day period from the receipt of your notice to elect continuing benefits.
EXAMPLE: You receive an SSDI cessation notice on July 15 because you failed to attend, without good cause, a medical exam scheduled by Social Security on May 15. Your disability ceased in May, and your benefits continue until the end of July. You have the same 10 days after receipt of your notice to elect continuing benefits.
Repayment of Benefits
If your appeal is unsuccessful at any level, Social Security will ask you to repay the SSDI or SSI cash benefits paid to you while your appeal was pending (but you can ask for a waiver--see below). Social Security will not ask you to repay the value of any Medicare or Medicaid benefits that continued while your appeal was pending.
Social Security will consider waiving the recovery of disability benefits paid to you pending appeal as long as you appealed the cessation of benefits "in good faith." An appeal is presumed to be made in good faith unless you failed to cooperate with Social Security during the appeal by, for example, failing without good reason to provide medical or other information requested by Social Security, or failing without good reason to attend a physical or mental examination when requested to do so by Social Security. When determining whether you had good cause for failure to cooperate, Social Security must take into account any physical, mental, educational or linguistic limitations (such as inability to speak English) that may have caused your failure to cooperate.