The Social Security Disability Examiner Evaluates Your Claim
Social Security Disability claims examiners make the initial determination (decision) on an applicant’s medical eligibility for Social Security Disability Insurance (SSDI or SSD) and Supplemental Security Income (SSI) claims. In Florida, disability claims examiners work at the state agency called Disability Determination Services, or DDS. Although the Federal Government fully funds DDS, it is still a State agency responsible for developing medical evidence and issuing the initial determination as to whether the claimant is disabled under the law. Given the size of the State of Florida, our DDS office has several hundred disability examiners. The following provides a basic outline of what the DDS claims examiner does in evaluating a claim.
Gathering Medical Evidence
First, the disability examiner gathers all your medical records and reviews any additional information from you, your representative, or your doctor. In other words, the DDS first tries to obtain evidence from the claimant’s medical sources. In the alternative, the disability examiner may schedule you for a consultative examination (CE) under any of the following circumstances:
- The records are unavailable,
- The records are insufficient to evaluate the claim adequately or
- You have not seen any doctors (also called “medical treating sources”) within the recent past (typically the past three months).
The claimant’s treating provider is the preferred source for the CE; however, the DDS may also obtain the CE from an independent source.
The disability examiner should maintain contact with you to coordinate the proper gathering of medical evidence in your claim.
Adding Vocational Information
The disability examiner will then gather together your:
- Medical treatment records and notes;
- Residual functional capacity opinions from your treating medical providers;
- Consultative examination results;
- Your relevant past work history (jobs that you performed in the fifteen (15) years before the onset of your disability) and
- Your educational background.
Making the Disability Determination
After completing its initial development, the DDS makes the disability determination. The determination is made by a two-person adjudicative team consisting of a medical or psychological consultant and a disability examiner. If the adjudicative team finds that additional evidence is still needed, the consultant or examiner may contact a medical source(s) and ask for additional/supplemental information. The DDS also decides whether the claimant is a candidate for vocational rehabilitation (VR). If so, the DDS makes a referral to the State VR agency.
In most cases, the disability examiner completes a medical decision write-up for the state disability physician to review. In writing the medical decision, the examiner will discuss whether your impairment meets the requirements of a disability Listing of Impairment, and if not, whether your residual functional capacity (RFC) is enough to allow you to work any other type of job. The medical consultant, or unit physician, is typically called upon to develop the RFC, but it does not always happen that way.
The examiner is expected to consult the doctor on the nature and severity of the claimant’s medical impairments and what additional medical evidence is required to decide the claim. The examiner is not permitted to make decisions on medical eligibility without consulting the doctor, except in quick disability determination cases (QDD). QDD cases are those with very straightforward facts that warrant obvious outcomes. In QDD cases, a single decision maker (the examiner) can only approve a case (and cannot deny a case) without a unit physician review.
After the DDS makes the disability determination, it returns the case to the field office for appropriate action, depending on whether the claim is allowed or denied. If the DDS finds the claimant disabled, SSA will complete any outstanding non-disability development, compute the benefit amount, and begin paying benefits. If the claimant is found not disabled, the file is retained in the field office in case the claimant decides to appeal the determination.
If the claimant files an appeal of an initial unfavorable determination, the appeal is usually handled much the same as the initial claim, except that the disability determination is made by a different adjudicative team in the DDS than the one that handled the original case.