How is the Determination for Disability made by Social Security?

How is the determination for disability made by the social security administration? The process used by the social security administration in both programs (SSD, or Social Security Disability, and SSI, also known as supplemental security income) follows the following steps:

1. An individual will file a disability claim with SSA, either:

A) online (not a preferred option since it does not allow for one-to-one contact with a social security representative who can directly answer questions and ALSO since many claims will be concurrent--meaning for both Social Security Disability and SSI--and an SSI disability application cannot be filed online),

B) over the phone with a representative at a local social security office,

C) in person at a local social security office, or D) over the phone via the teleclaims center--again, not a preferred option since a claimant will not have option to meet with, and address questions to, the representative at the teleclaims center.

2. The disability claim will be transferred to DDS (disability determination services) where it will be assigned to a disability examiner. The examiner will request all applicable records (medical records, school records, testing records, and, in some cases, employment records) and once these records have arrived the examiner will begin processing the case.

3. The disability examiner will determine what mental or physical functional limitations exist for the claimant (based on the information contained in the medical and/or school records). These limitations will then be compared to the demands of the claimant's work history and a decision will be made as to whether or not the claimant can return to their past work or perform some type of other work. An applicant who can do neither will satisfy the requirements for disability and will be granted disability benefits.

For a child filing for disability, the determination will be made as to whether or not the child is able to perform age-appropriate activities at the same pace as their peers and, if unable, will also be granted disability benefits assuming that the child also meets the non-medical requirements for disability.

Note: since SSI is a need based program, the child and his or her parents must also fall under certain income and asset level restrictions in addition to satisfying the actual disability eligibility requirements

Individuals who apply for disability, whether this involves an application for a disabled adult, or an application filed on behalf of a child, should understand from the outset that social security will base all decisions on information obtained from medical providers and potentially schools in the case of children, as well employers in some cases.

Though disability examiners do not routinely gather information from past employers this does occasionally happen when the examiner cannot resolve certain questions about a claimant's past jobs from the information supplied by the claimant.

For this reason, it is never a bad idea for a claimant or potential claimant to review their records beforehand to see what information is contained and how it is presented.

In the case of medical records, this may lead to a discussion with one's doctor or doctors as to whether or not the physician might seem inclined to provide a supporting statement, or even to include statements in future medical records as to the possibility of referencing the claimant's functional limitations within the treatment notes created by the doctor (because evidence regarding functional limitations provides the foundation for the approval of a disability claim, or a disability case being denied.

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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