Who Determines Whether I’m Disabled?

While the Social Security Administration (SSA) is the agency in charge of processing disability benefit applications, a separate, federally funded state agency called the Disability Determination Services (DDS) determines whether you are disabled.

Applying and getting approved for Social Security disability benefits is a multi-step process that involves several representatives at the SSA and DDS. Below is a basic overview of how DDS makes the decision about whether an applicant is disabled. For more specific questions about disability determinations or for help applying for benefits, call the Law Offices of Ogle, Elrod & Baril, PLLC at 866-628-8179 for a free consultation.

What does the SSA do when it receives an application?

When the SSA receives your application for disability benefits, it will check to see if you meet a few basic requirements. It will make sure you have enough work credits on your record to qualify for Social Security Disability Insurance (SSDI) benefits or that you meet certain financial requirements for needs-based Supplemental Security Income (SSI) benefits. It will also look at your current work activities to see whether you are engaged in substantial gainful activity (SGA).

If you meet these initial basic requirements, the SSA will then forward your case to the Disability Determination Services office in your state, which will complete the disability determination process for the SSA.

How does the DDS evaluate cases for disability determinations?

Many people mistakenly think that it is their doctors who decide whether they are disabled. Not so. While your doctor does play an important role in the decision by providing her professional opinion (and your medical records), the DDS is the agency responsible for assessing and developing medical evidence and making the initial determination about whether claimants are disabled.

When the DDS receives your case file from the SSA, it will assign your case to a claims examiner who will begin evaluating your records with a doctor in the agency. The internal doctor and examiner will consider all the facts of your case and review your medical evidence from your doctors, specialists, hospitals, and any other places you have received care for your impairment.

She will also contact your doctor and ask specific questions about:

  • Your medical or mental condition
  • When you began seeking care for your condition
  • The ways in which your condition limits your activities
  • Medical tests and examination results
  • Treatments you have undergone and your response to them
  • Information regarding your residual functional capacities, e.g., your ability to do work-related activities such as walking, sitting, lifting, bending, and remembering instructions.

What if the DDS needs additional medical evidence to make a decision?

If your doctors cannot provide all the information the DDS needs, the agency might contact you and ask you to undergo a consultative exam (CE). Consultative exams are specialized exams not performed your doctor or by SSA doctors. Rather, independent, contracted medical professionals conduct these exams, paid for by the SSA.

The kinds of tests and evaluations applicants undergo at a CE depends on the specifics of their case. Your DDS claims examiner who orders the exam will tell the CE provider what information she needs to finish making her determination. Your CE may be physical or psychiatric in nature, depending on your particular impairments and the information the DDS needs.

After the appointment, the CE provider will then send a written report about you to the DDS, complete with results of the exam, test results, a diagnosis, a prognosis, statements about your functional capacities and limitations, and his input about whether your symptoms are as serious as you say they are.

What happens after the DDS makes a disability determination?

“After completing its development, the DDS makes the disability determination. An adjudicative team consisting of a medical or psychological consultant and a disability examiner usually makes the determination,” explains the SSA.

Once the DDS has made a determination and sent your file back to the SSA, the SSA will send you a decision letter in the mail.

  • Approval: If the SSA approves your application for benefits, the letter will tell you how much your benefit will be and when it will commence.
  • Denial: If the SSA denies your application for benefits, the letter will tell you why the SSA denied you and how to appeal the decision if you disagree with it.

What do I do if the SSA denied my disability benefits?

If the SSA sends you a letter of denial in the mail, you have the right to appeal the decision. There are several levels of appeals you can use, if necessary. Each level of appeals provides you with another opportunity to give the SSA new or additional evidence to support your claim. Note, appeals are very time sensitive. You have only 60 days from the date on the letter to take action. Failure to do so can nullify your case.

Careful preparation for the appeal and thorough evidence are key to getting approved for benefits. To ensure your appeal is handled correctly, have one of our disability attorneys at the Law Offices of Ogle, Elrod & Baril, PLLC help you.

Get a free consultation with a disability attorney today.

The Law Offices of Ogle, Elrod & Baril, PLLC have handled countless disability claims and appeals for people all across the nation. We fight diligently to help our clients collect the disability benefits they are entitled to. Call our office today at 866-628-8179 for a free, no-obligation consultation to discuss your case.