Social Security Disability Resource Center
Who makes the Determination of a Social Security Disability Claim?
There are various decision-makers for Social Security disability and SSI claims. Who decides whether or not a claim meets the SSA disability qualifications depends upon what level of the disability process the claim is at.
The Social Security disability, SSI system has the initial disability claim level (this is the disability application), the reconsideration appeal level (the appeal is known as a "request for reconsideration"), administrative law judge hearing level (the appeal is known as a "request for hearing before an administrative law judge), the Appeal Council review level, and finally the Federal district court level. Each level of the disability process has individuals who are responsible for making disability determinations.
The first two levels of the Social Security Disability, SSI system
At the initial disability claim and reconsideration appeal levels, the disability determination will be made by a team of sorts. Once a case has been transmitted from a local Social Security office to the state disability agency (see Disability Determination Services), the disability claim is assigned to a disability examiner. The examiner is a case processing specialist who will be responsible for gathering your medical evidence and making a disability determination.
Generally, after gathering the medical evidence, reviewing it, and also reviewing the claimant's work history (academic history if the claimant is a school-age minor child), the disability examiner writes up the determination for the case.
In some cases, the examiner will have complete authority as to whether her or she will issue a disability denial or an approval of the claim. Social Security does have SDN, or single-decision-maker disability examiners. These examiners have the freedom to make disability determinations without consultation and review (by medical consultants who are attached to their case-processing units) provided, of course, that the case is not complex and does involve significant mental health allegations.
Most claims, however, will not involve just a disability examiner, but a disability examiner who receives consultation from a medical doctor and a psychologist who both work in the disability examiner's unit.
Additionally, there are times at most state disability agencies when unit managers become involved in the disability determination process themselves. Often, managers have to worry about statistical information that may say they are approving or denying too many disability claims. And unfortunately, there seems to be more concentration on whether or not their unit make too many disability approvals.
If the disability claim is not approved at either of these levels (disability application and reconsideration appeal), it will move to the administrative law judge hearing appeal level.
The hearing level
At the disability hearing level, an administrative law judge will make the actual determination on the disability claim. Although the judge makes the final disability determination, they may use a medical or vocational expert to help them make their determination.
If the disability claim is not approved by the administrative law judge, it may move to the Appeals Council Review appeal level. The Appeals Council reviews disability determinations that are made by judges.
Most Appeals council reviews are denied without much of a "review" actually happening. If they are not denied, most are simply remanded back to the administrative law judge who made the original disability hearing decision for a second hearing, or "remand hearing". Appeals Council judges do approve a very small percentage of the appeals, but this is somewhat rare.
The last level of the Social Security disability process is Federal district court. Of course, the disability determination at this level will be made by a federal judge. This level of the disability process is rarely used because of the time it takes and the expense of trying the case in federal court.
Social Security Disability and SSI Resource Center
The Most Basic questions about Getting Disability Benefits
Social Security Disability and SSI Back Pay Benefits
Social Security Disability SSI and whether or not you can work
How long does it take for Social Security Disability or SSI?
Social Security Disability SSI Awards and Award Notices
Tips, Mistakes, How to Qualify, and How to Win Disability
Tips and Advice for Social Security Disability and SSI Claims
Common Mistakes to avoid after being denied for Disability
Disability Qualifications and How to Qualify for Disability Benefits
Winning Social Security Disability or SSI, How to Win
Denials, Appeals, and Getting a Disability Lawyer or Representative
What you should know about Social Security Disability and SSI Denials
Social Security Disability and SSI Appeal Process - How to file appeals
Questions about Disability Lawyers and Hiring a Disability Attorney
Various Types of Benefits including SSI, Mental, and Child benefits
SSI Disability Benefits, Questions and Answers
Social Security and SSI based on Mental Disability
Social Security Disability or SSI Benefits for Children
Disability Benefits through Social Security
Information to start with regarding Disability Claims
An Overview of Social Security Disability and SSI
What is considered a Disabling condition by Social Security?
The Disability Requirements to be eligible for SSD and SSI Benefits
Filing for Social Security Disability or SSI Benefits
Social Security Disability and SSI Applications
Social Security Disability SSI List of Conditions and Impairments
Social Security Disability SSI: Medical Evidence and Records
Filing your claim for disability benefits
Eligibility for receiving disability benefits
Resources on this site
Social Security Disability, SSI Terms and Definitions
Previously answered questions regarding SSD and SSI
About the Author of SSDRC, Tim Moore
The SSDRC Disability Blog
For Individuals living in North Carolina
Disability in North Carolina
North Carolina Disability Lawyer
Getting disability in North Carolina
The Steps of The Social Security Disability Determination Process
How is the Determination for Disability made by Social Security?
Appealing A Social Security Disability Determination
Who makes the Determination of a Social Security Disability Claim?
Getting a Social Security Disability Determination After Seeing a Psychologist at a Mental Evaluation
Disability determination services in North Carolina
How does the North Carolina Social Security disability determination process work?
Can I work if I have not received my disability award letter?
How does age affect a Social Security Disability or SSI case?
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages answer some of the most basic questions for individuals who are considering filing a claim.
Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?
What happens if I file a disability application and it is denied by a disability examiner or Judge?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria