Overview of Disability

Disability Back Pay

Disability Requirements

Disability Applications

Disability Advice Tips

How long do cases take?

How to win Disability

SSD Mistakes to avoid

Disability for Mental

What if you get denied?

How to file Appeals

Disability through SSA

SSI Disability Benefits

Disability for Children

How do I qualify for it?

Working and Disability

Disability Award Notice

Disability Lawyer Q&A

Disability Conditions List

What is a disability?

Your Medical Evidence

Filing for your Disability

Disability Eligibility

SSD SSI Definitions

Recent Questions

SSDRC Disability Blog

How the Decision on a Disability Application or Appeal Under SSDI or SSI is Made

Social Security Disability and SSI disability claims are taken at local Social Security offices by workers known as CRs. CR stands for claims representative and it is the responsibility of the CR to initiate the claim, conduct the disability application interview, and to make sure that the claimant has submitted all the necessary information including information that pertains to:

A) The individual's disabling impairment, or impairments if there are several.

B) The individual's history of medical treatment.

C) The individual's work history if they are an adult, or academic and testing records if they are a child applicant.

Who makes the decision on the disability claim?

All disability claims begin with the Social Security office. However, decisions on disability claims are not made at the Social Security office, but, instead, at a state agency that has been assigned this responsibility. It is for this reason that all new disability claims are transferred to DDS (disability determination services) and assigned to a case processing specialist known as a disability examiner.

It is the responsibility of the disability examiner to do the following:

A) Gather the claimant's medical records.

B) Identify their past jobs as well as the skills and requirements of their jobs.

C) Obtain information about their ADLs, or activities of daily living (this can be done by contacting directly or mailing a questionaire to either the claimant or a third-party contact, an individual who is knowledgeable about their condition).

D) Assess, in consultation with a medical doctor or a psychologist, the claimant's remaining physical and/or mental functional capabilities, known as their residual functional capacity, or RFC for short.

Processing the Disability Case

Disability examiners, who make decisions on each disability application and reconsideration (the "request for reconsideration" is the first appeal) will generally send out medical record request letters to all the physicians and clinics listed by the claimant on the very first day that they have been assigned a disability case. In fact, this is usually the very first task that is performed on any case after it is received by an examiner.

The wait for requested records can be lengthy and, ultimately, depends on how quickly each hospital or medical practice responds to a request. Not surprisingly, one of the chief reasons for how long a decision may take is the wait for medical records.

Until the records have been received, the SSDI (social security disability insurance) or SSI case will generally sit and wait with no development work being performed. But after the medical records have been received, the examiner's primary focus will be to read and evaluate the records, make notes regarding key information contained in the records, and compare this information to the Social security disability list of impairments (the blue book, or listing manual) to see if the claimant has a condition which satisfies the requirements of a listing.

After all of this has been done, the examiner will take his or her writeup of the particulars of the case to either a medical consultant or a psychological consultant (or both if the claimant has filed on the basis of both mental and physical conditions) who is part of the examiner's case processing unit.

This will be for the purpose of determining what restrictions and limitations the claimant may possess based on their condition, or conditions (as stated, this is the RFC, or residual functional capacity). This is basically the step of the disability evaluation process where the examiner is able to conclude two very important things:

1. Can the claimant return to their past work, meaning any of the "relevant" jobs that they have performed in the last 15 years (note: for a particular job to be relevant, it must also be one in which the claimant was able to earn a livable wage, defined as substantial gainful activity and it must be one for which the claimant was able to learn the required skills of the job).

2. Can the claimant, if they cannot go back to one of their former jobs, do some type of other work for which their skills and work experience might suit them, and which their age, education, and current limitations would not prevent them from doing?

If the claimant can do neither of these (go back to a former job or perform some type of suitable other work), they will be approved for SSDI or approved for SSI, depending on which program their claim has been taken in.

If the Disability Case is denied

If the case is denied, of course, the claimant will need to consider whether or not they should file a disability appeal and whether or not they should consider finding representation in the form of a disability representative or a social security disability lawyer to assist them with their claim.

If the claim is denied at the disability application level, the appeal will be a request for reconsideration. At that appeal level, a proactive attorney or representative can certainly increase the chances of winning benefits, even though the odds are usually against any claimant, represented or not, for winning benefits (reconsideration appeals have an 87 percent denial rate).

However, if the claim is denied at the reconsideration appeal level (as said, this usually occurs), then the next appeal will be to request a disability hearing. Hearings are conducted by federal administrative law judges who often bring in medical and vocational experts to provide hearing testimony. At the hearing level, a claimant is generally advised to seek representation well before the hearing takes place so that proper preparation can be done and so that the case can be presented in the most effective manner possible to the presiding judge.

Return to:  Social Security Disability Resource Center, or read answers to Questions

Related pages:

How to apply for disability and where to apply
Filing an Application for Disability Benefits under SSD or SSI - Step by Step
Tips on how to file for disability
What is the Application Process for Social Security Disability and SSI?
What happens after I file my disability claim with Social Security?
When can I expect my first disability check and my back pay check?
What happens after a Social Security Disability or SSI Claim has been taken and is Pending
If you get denied on a disability application do you have to file a new application?
How the Decision on a Disability Application or Appeal Under SSDI or SSI is Made
Can I get Retroactive SSI Disability Benefits?
Social Security Disability - earned income versus unearned income

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