What Happens to a disability claim after you file? How is the decision made?
When you file your disability benefits in either the Social Security Disability or SSI program, you generally complete a disability interview with your local Social Security office, which can be done in person, or over the phone.
If you choose to have your local Social Security office take your disability claim (versus filing online, for instance), you will know have a clear idea of what has occurred simply because you will have interacted with a field office claims representative (a CR) and also because you will have completed and returned all the information needed for your disability claim. But what happens after you file your disability claim, and what is is involved in processing it?
Many people think that the claims representative who completed their disability interview and did the intake work for their application is responsible for making the medical determination on their disability claim, but that is not the case. Once your disability interview is completed, your file is sent to a state disability agency for a medical determination and processing.
The agency is, in most states, referred to as DDS or disability determination services although in some states it may be known as the bureau of disability determination or something similar to this (although, it is interesting to note that the social security act which empowers the social security administration and its handling of the federal government's disability programs clearly uses the terminology "disability determination services").
When the claim is received at the disability agency (DDS), it is assigned to a disability examiner who is responsible for developing your case. The disability examiner first reviews your medical source information (the doctors and hospitals that you listed on the application) and determines if they have enough current medical information (treatment records within the past three months) in order to make a Social Security Disability determination.
If they determine that more current medical information is needed, they will immediately schedule a consultative examination, or CE.
Consultative examinations are used to get a current status of a disability applicant's disabling condition, or conditions. Private practive physicians contracted by Social Security perform these examinations, so as you might imagine, consultative examinations are generally just the basics. They are usually short perfunctory examinations that many disability claimants have felt did not address their disabling condition.
Whether or not the disability examiner schedules a consultative examination, the disability examiners will nevertheless request medical information from any source you provided on your disability application. In doing so, they will be asking for older and newer records. The reason disability examiners request older medical information for their disability determination is because in addition to the need to learn if a claimant is currently disabled, there is the matter of onset.
Onset, or how far back a disability can be established will have an impact on how much back pay the claimant may be owed when the case is finally approved.
In addition to requesting medical source information and scheduling consultative examinations, the disability examiner usually sends out questionnaires to address your ability to function and perform routine daily activities. These are sent to you and your third party contact-person (the person you listed your application as someone who knows about your conditions).
Disability examiners use these questionnaires along with your medical records to determine your residual functional capacity (what you are able to do in spite of your disabling condition or conditions). Your residual functional capacity along with your education, age, and job skills are used to make a decision as to whether you can perform any of your past work, or do any other work in the general economy.
If the disability examiner determines that you meet or equal a Social Security impairment listing (Listings, which are contained in the blue book, the Social Security Disability list of impairments, involve body systems and address numerous, though not all, conditions), your disability claim will most likely be approved.
If you do not meet or equal an impairment listing, the disability examiner may approve you based upon how restrictive your residual functional capacity is, as well as the impact your education, age, and the transferability of your work skills has on your ability to do some type of work. This type of disability approval is called a medical vocational allowance.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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