Who will decide my Social Security Disability claim?

If your case is at the initial claim level (which is the disability application) or the reconsideration appeal level, your disability claim will be decided by a disability examiner who works at a state claim-processing agency. This agency renders decisions on all types of disability claims for the social security administration, including SSI disability, Social Security Disability, and Medicaid for disabled adults. It is usually called DDS, or disability determination services, though in some states it goes by other names such as the Bureau of Disability Determination.

The job of the disability examiner is to gather your medical evidence and review it, looking for evidence of functional limitations that you might have, either mental or physical or both. In the case of adult claimants, the severity of these limitations will be compared to the types of work the person did in the past. In the case of child claimants, the severity of the limitations will be compared to the child's ability to engage in age-appropriate activities, which generally means the ability to perform at grade-level in school.

The examiner does not perform this task strictly on his own, however. The examiner is actually assigned to a case processing team. And this team includes a unit medical consultant, who is a medical doctor, and a pyschological consultant who is a Ph.D.-level psychologist. Both these individuals provide feedback for the disability examiner.

In some sense, these consultants do exactly what the disability examiner does since they read the available medical records in order to gain some idea of how the individual is physically or mentally limited, as well as how long these limitations may persist. Note: for Social Security Disability and SSI purposes, a person's state of disability must be projected to last for at least 12 months, or have already lasted this long by the time the claim is decided, before ongoing disability benefits may be granted.

The medical consultant and the psychological consultant will review the claimant's medical records and will also review the disability examiner's assessment of the case. In some instances, they may offer insight to the examiner regarding the claimant's specific condition and how the severity of the condition may reduce the individual's ability to engage in normal daily activities.

However, it is the disability examiner who fundamentally makes the decision and who, in the end, will decide to approve or deny a disability case--assuming, of course, that the disability examiner's supervisor does not override his or her decision and also assuming that the quality control unit does not have an issue with the examiner's decision-making process.

Continued at: What tools are used by a Social Security Disability Examiner to Make a Claim Decision?

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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