How do examiners make disability decisions in California?

This is a fairly simple question, but probably one that at least a few people are curious about. How does a disability examiner (examiners are the individuals who render decisions on SSI and Social Security Disability claims) evaluate a claim and determine the decision that is to be made on a case?

Well, first of all, the examiner orders what is known as MER. This is simply a fancy way to say "your records" (MER - medical evidence of record). Typically, a disability examiner will do this as soon as they are assigned a disability case. At the DDS I was at, cases were assigned each morning and the first thing I always did was get the medical evidence ordered.

What does it mean when I say "order the medical evidence"? It simply means that letters are sent off to each and every doctor, hospital, and clinic that is listed on the disability application (this tells you how important it is to list all your medical sources on your disability application when you file your disability claim in California with social security).

After the MER letters (medical record request letters) are sent off, a claimant's case will typically go into a holding pattern. After all, without the medical records in hand, there's nothing to do on a case other than wait (this also tells you that its not a bad idea to send in your records, including your most recent records, when you apply).

Once the records have arrived, however (this can take weeks or months), a disability examiner will read them and evaluate them. Typically, the records come in at different points, so an examiner may choose to wait until they have all arrived and read them then, or the examiner may read them individually as they arrive and make notes along the way.

At some point, though, enough of the records will have come in so that a decision can be made (you might be surprised to know this, but decisions are sometimes made before all the records arrive, if what has come in is deemed to be sufficient---and, yes, this is a bad practice to follow and not a fair one).

How does the examiner make the decision? They read the records to see if the requirements for a listing in the impairment listing manual are met (this manual doesn't include every physical or mental impairment, by the way). If the requirements of a listing cannot be met or equaled, the examiner will determine whether or not a medical vocational allowance can be made. In other words, the examiner will consider the functional limitations a claimant has and will then consider whether or not the claimant can return to their past work or perform some form of other work (age and education are also factors). If the answer to both those questions is no, the claimant will be approved for disability.

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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