What does a Social Security Disability Examiner do?
The answer to this question depends on what level of the social security appeal system your particular claim happens to be at. If you have filed a disability application, then the decision on your claim will be made, principally, by a disability examiner.
What is a disability examiner? A disability examiner is a specialist who works at a state agency whose function is to evaluate disablity claims (both Social Security Disability and SSI disability) for the social security administration. These state agencies are disability determination services. Each state has at least one DDS and some have several (North Carolina, for example, has a centralized system that uses one DDS, while South Carolina has a decentralized system that uses multiple DDS facilities).
What happens at DDS and what does the disability examiner do? DDS is where claims go after they have been opened in local social security offices. There at DDS, cases are assigned to disability examiners who have caseloads of pending claims.
Disability examiners are responsible for requesting a claimant's medical records from all the various medical treatment sources listed on the claimant's disability application. Getting the records, of course, can take quite some time in many instances.
However, once the records are received, the disability examiner will be responsible for evaluating them. This usually entails reading them and taking notes to ascertain whether or not the claimant meets the necessary qualifications to satisfy a listing in the blue book (the Social Security Disability list of impairments).
The claimant's remaining physical and mental capabilities (in light of their various physical and mental conditions) is known as their RFC, or residual functional capacity. Residual functional capacity is expressed in terms of a rating, either physical or mental.
How does a disability examiner determine a claimant's functional limitations?
Disability examiners begin the process by requesting medical treatment records from all the medical sources provided by the person at their disability interview (conducted by a CR, or claims representative, at a Social Security office).
When filing for disability, claimants do not have to provide their actual medical records themselves (though it is possible for a claimant to personally deliver their medical records at the time of application--which can have the effect of speeding up the disability case) just the names of their treating medical sources, i.e. the various clinics, hospitals, and doctor's offices where they have received treatment.
For more on the topic of how an determines what a person can and cannot do (functional limitations), visit this page: Examiners must decide an individual's currently level of physical and/or mental functioning.
Can you speak to your disability examiner?
Yes, you can speak to the examiner handling your case. You can contact Social Security (the office you applied at) and get the number for your state's DDS agency. When you call DDS, they will confirm your identity and then put you in touch with the examiner. For more on this topic: Can I Talk To the Disability Examiner Working On My Case?
What if the examiner cannot locate all the medical records?
Answer A): If the examiner cannot find medical records that show treatment for a particular condition, the examiner will probably have to schedule a CE, otherwise known as a consultative examination, and often referrred to as a social security medical exam.
Answer B): If the examiner cannot find current medical records, the examiner will also probably have to schedule a CE. This is because the social security administration requires that the decision on the disability claim is based on at least some current information. Current information is defined as information that is not older than 90 days. Why is current medical information important? Because to establish disability benefits, there must be sufficient proof that the claimant currently has limitations that are significant enough to prevent work activity.
For more on this specific topic: What if the examiner can't get all my medical records?
How long does it take a disability examiner to work on a case
SSA usually quotes 90-120 days as the average amount of time for a decision on a disability claim. Most cases get decided in that time frame. However, some cases take longer due to a number of factors, including how long it may take to get medical records gathered and whether or not a person has to go to consultative medical exams for their claim. Some applications will only take several weeks. Some can actually take half a year or longer, though this is usually not true.
However, to avoid unnecessary slowdowns, you may wish to view some of these tips: Social Security application tips.
The main topic of this page is continued here: How does Social Security Disability decide that you cannot work?
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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