Who is The Doctor for a Social Security Disability Claim or SSI Case?

How to prove you are disabled
and win disability benefits

Many people who file for disability are confused about “Social Security doctors.” They assume that Social Security has physicians on its payroll who examine applicants and, perhaps, work with them to find reasons to deny the application.

This is not entirely true. Social Security does have physicians whom it employs to help make decisions on claims. These physicians are indeed employees of the SSA, and are assigned to a particular unit at the state disability determination services (DDS) agency.

Disability examiners at DDS review all initial applications and first appeals based on both physical and mental conditions for the SSA upon reviewing the applicants’ medical records. However, after the disability examiner has made a decision, the decision is then reviewed by the unit doctor.

These SSA-employed physicians review claims based on physical impairments, while a psychological consultant (usually a licensed psychologist versus a psychiatrist) reviews examiners’ decisions regarding claims based on mental conditions such as depression, mania, bipolar disorder, schizophrenia, etc.

These physicians and psychologists are Social Security doctors in the true sense, as they are solely in the employment of the Social Security Administration. In addition, the opinions of unit doctors within DDS are given more weight than those of the disability examiners themselves, and often ultimately override the examiners’ decisions.

There is another type of doctor, one which disability applicants may be required to meet with (claimants never meet the doctors that are assigned to the case processing units of disability examiners, just as claimants typically never meet the disability examiners themselves), and this type of doctor is not truly a "Social Security doctor".

In cases in which a disability applicant has no recent (within the past three months) medical documentation to support the claim that he or she is currently disabled, a consultative exam (CE) is typically required by the disability examiner before rendering a decision on a claim.

Doctors who perform CEs are independent doctors, in that they have their own private practices, and have only contracted with Social Security to perform exams in disability cases. The idea is to have a non-biased opinion regarding the applicant’s present state of health, though this is somewhat debatable.

Many, many individuals have reported that the “independent” physicians performing these exams are unnecessarily rude, and that the exams are so brief and perfunctory they could not possibly provide a true picture of a disability claimant’s true physical or mental limitations. In fact, the average CE takes about 15 to 20 minutes, which certainly appears to be little more than a mere formality.

Your best bet, if you are considering applying for Social Security disability, is to establish a relationship with a treating physician who is sympathetic to your bid for disability, and keep regular appointments with him, so that you will have no need to rely on the opinion of Social Security disability doctors, independent or otherwise.

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Individual Questions and Answers

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SSD and SSI are Federal Programs

The title II Social Security Disability and title 16 SSI Disability programs operate under federal guidelines and, therefore, the program requirements--medical and non-medical--apply to all states:

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming

Recent approval and denial statistics for various states can be viewed here:

Social Security Disability, SSI Approval and Denial Statistics by state

Special Section: Disability Lawyers and unnecessary claim denials