Claims E.S.P.

Disability Club Newsletter 



   Ex Disability Examiner Reveals How to Get an Accurate Decision in the Least Amount of Time!  


9 Steps Disability Guide

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Medical Consultants in the DDS Office


Medical Consultants (MC) at the DDS office are medical doctors or psychologists employed by the DDS offices in each state, either as staff or as independent contractors.

They are trained by the SSA to do a paper review of the medical evidence that is present in a claimant’s file. Because of this special training, MCs have the authority to make disability determinations (i.e. assessments of your functional abilities) based on the evidence in your file which supports your claim for disability benefits.

Generally, MCs will review a case record only after all the medical information that is expected has been received and summarized by the Claims Examiner who manages your disability claim.

It is important that the disability examiner present a complete summary of all the pertinent factors that will be necessary for the Medical Consultant to reach a good determination of your abilities and residual functional capacity based on the evidence in file.

This case summary that the Claims Examiner writes up can be as long as it needs to be, but is generally no longer than one typed page. The summary is placed on a Residual Functioning Capacity Form (RFC) which Claims Examiners complete on the majority of claims alleging a physical impairment. The form is designed as an assessment tool that indicates a claimant’s remaining functional capacity based on their particular limitations.

Once the MC receives the claim record, he will review the completed RFC form which includes the case summary. After which, he will either concur with the assessment of the Claims Examiner or will revise the assessment based on his medical expertise.

MCs may also send the claim back to the claims examiner if they conclude more information or medical testing is needed to support a claims decision.


Note: As an ex-Claims Examiner, I can say that this process works well when you have an examiner who is knowledgeable of all the SS regulations that pertain to your specific impairment as outlined in the SSA Blue Book Listings of Impairments.

It also works well when you have a competent Medical Consultant who will go beyond the summary that is presented by the examiner and review the actual medical records in file if he feels the claims examiner may have omitted pertinent information from the summary, either through lack of knowledge or inexperience.

Ideally, as a claimant, you would be better served if the Medical Consultant was responsible for reviewing all your medical records in file and writing up his/her own summary of the case record. This would ensure that they have looked at and reviewed all the medical evidence in file.

But, in reality, Claims Examiners are used to review all your medical records and create the summary as a cost cutting measure used by the SSA. They reason that the time of a claims examiner is much cheaper than the time of a Medical Consultant. And while money is saved by the SSA in doing it this way, the expertise of a claims examiner in assessing your particular medical problems generally does not approach the expertise that a medical doctor could provide in making that same assessment.

So you can see that if you combine an inexperience Claims Examiner (or one with a high caseload) together with a MC who does not take the time to go beyond the one-page summary provided on the RFC form, then errors can be anticipated in the final assessment of what you can or can not be expected to still be able to do based on your impairments.

Medical Consultants work in conjunction with Disability Examiners to make a disability decision on your claim. After they have rendered a decision on how your medical condition affects your ability to function in various areas, the examiner takes these findings and then determines how your limitations affect you vocationally. They look at the functional requirements of your past jobs, jobs in the national economy, your age and education, and use the SSA Grid Rules to determine if you are or are not physically disabled.

A similar process occurs for claims alleging mental impairments, but a different assessment form is used, and the Medical Consultant reviewing the claim will be one trained in the assessment of mental disabilities.

Part 2 ...Consultative Examiners and Examinations in the DDS Adjudication Process

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