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

Who Processes Your Social Security Disability Application?


Field Office, Your Local Branch of the Social Security Administration

The Field Office of the Social Security Administration receives your application initially and determines if you are eligible for benefits based on non-medical criteria.

This office determines whether you are covered under the Social Security Disability Insurance (SSDI) program, or whether you are eligible to apply under the Supplemental Security Income (SSI) program, if you do not meet the SSDI criteria.

SSI is a program for the disabled who have not worked enough quarters to qualify for regular SSDI and who have low income or limited resources.

Once it is decided that you do meet the non medical requirements for the program(s), your claim is then forwarded to a state agency to determine your medical and vocational eligibility for disability benefits.

The DDS Office

The Disability Determination Services (DDS) or Disability Adjudication Services (DAS) office is a state agency which contracts with the Social Security Administration to make decisions on the medical and vocational aspects of your disability claim.

Disability Examiners in the office are primarily responsible for coordinating and gathering all the information necessary to make and issue a decision on your application for benefits.

Examiners send requests to your treating doctors, hospitals, schools, mental health professional, third party representatives, employers and anyone else who can assist in providing needed information in order to adjudicate your claim.

They are your primary contact persons if you havequestions about the status of your claimonce it reaches the DDS office, questions about any scheduled .consultative medical exams, or other general concerns about your claim can be answered by the examiner.

Because disability examiners write up summaries of your medical records to be reviewed by a medical consultant (see below), it is important that they understand human anatomy and disease processes, as well as legal and administrative policies of the SSA. Therefore, examiners must have a minimal of a four year college degree, and receive extensive “classroom” training before they become certified to adjudicate disability claims. This training is generally two to three full months of classroom and on the job training.

In some states, a disability examiner can be certified as a “Single Decision Maker” (SDM) which means that they have the experience and expertise to make decisions on physical disability claims without the input of a medical consultant. These SDMs, however, are not allowed to make independent decisions on the severity of any mental impairment that a claimant has or alleges. Those claims would have to be routed to a psychologist with a PhD for adjudication.

Medical Consultants-- licensed medical doctors of various specialties, osteopaths and psychologists with a PhD-- are pivotal in the decision making process of your disability claim. Depending on your state, medical consultants (MCs) will either serve as independent contractors with the DDS office or serve as staff with the DDS office. In the two states I worked in, all medical consultants were housed in the DDS offices. Their role is to do a paper review of your claim once the examiner determines that the necessary medical information has been received in order to render a decision.

Though it would be ideal if medical consultants reviewed all of the medical records in your file, in reality, they generally depend on the summary that the disability examiners writes up about your medical condition in order to reach their decision.

So if the examiner is new or inexperienced and misses pertinent information in his summary write-up, the medical consultant might not be aware of this information, and thus may make an incorrect decision on your claim.

Nonetheless, MCs have access to all your medical records in your file, and some will take the time to review it all if they do not trust the summary of the disability examiner or if the summary appears incomplete.

Once a medical consultant reviews the summary of your medical file which is written by the disability examiner, he or she will either concur with it, disagree with it, or request that the examiner obtain more medical information to support a decision on the claim.

If the medical consultant concurs with the summary of the examiner, than the examiner processes the decision and forwards the claim back to the Field Office so SSA can notify the claimant of the decision.

It should be noted that at this point, a certain number of claims will be randomly selected after the disability examiner processes a decision, and an internal review of the claim will be made to determine if it is in keeping with all SSA rules and regulations. These quality reviews can delay a decision if there is anything that needs to be corrected in a claim. They can also result in a claim decision being reversed or in the claim being returned to the examiner to collect additional or missing information needed to support the claim.

The Disability Unit is made up of a supervisor and a number of disability examiners and clerical staff. In some agencies, medical consultants are attached to a unit, and review all the claims generated by the examiners in that unit. In other states, MCs are agency wide and reviews claims by their specialty area. For example, an internist might receive most of the heart cases, while an oncologist would be referred the cancer claims for review. Both arrangements are workable, but as a claimant I would prefer the agency wide MC arrangement because a specialist knows more about a particular impairment than a generalist does and might be better able to determine the severity of my particular impairments.

Supervisors also play a major role in claim processing because they can generally be consulted by a disability examiner who is having trouble figuring out how to approach a particular disability claim. Because of their experience in claims processing, they can direct the examiner to the best approach to take in getting needed information for a claim expeditiously.

Supervisors can also be called when a claimant encounters an unresponsive disability examiner. Claimants can always request to speak to a supervisor about their claims if the examiner can not or will not cooperate with them.

Disclaimer: The writer is not affiliated with the Social Security Administration or the Disability Determination Service in any capacity. The views expressed in this article are the opinions of the writer and may or may not be accurate. If you need assistance with your disability claim, contact an attorney who specializes in Social Security disability cases, a disability paralegal or other qualified advocate or representative to assist you.


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