Who Makes the Decision about Your Social Security Disability Claim?

Have you applied for Social Security Disability and wonder who will make the decision about your application?

It might surprise you to know that many people may play a role in determining your eligibility for disability benefits. Each disability application goes through a structured process. Various decision-makers will handle your claim throughout each stage of the process.

Below is an overview of the process to help you understand who may play a part in determining your eligibility for disability benefits.

Social Security Administration Field Office

When you first complete your disability application, you must submit it to the Social Security Administration Field Office closest to you. You can submit the application in person, by mailing it, or completing the application online. Sometimes, you can also complete the application over the phone. 

One or more of the claims representatives (CRs) in the local field office will examine your application. They will look to see if your claim meets the necessary nonmedical requirements for disability benefits. The local field office CRs will examine and verify things such as:

  • your age
  • your marital status
  • your work history
  • your proof of income or loss of income

If they determine your application meets the nonmedical requirements, your application will go to the next stage in the process.

Disability Determination Services

A federally funded state agency called Disability Determination Services (DDS) handles the next stage of your application process. The DDS examines the medical aspects of your disability claim.

Once the DDS receives your application, your case gets assigned to a disability examiner (DE). The DE uses the information you provided in your application to get evidence of your medical condition. If the DE cannot get that evidence or thinks it is insufficient, they may require you to have a consultative exam (CE) with your physician or a third-party physician.

After gathering the evidence, the DE will consult with DDS medical staff to determine if your medical condition meets the criteria the SSA has for that condition. The DE may also consult a DDS vocational expert to determine if your medical condition affects your ability to do other types of work. The DE then determines your eligibility for disability benefits.

If the DE denies your eligibility for benefits, you can appeal.

The first step of appealing is to file a “request for reconsideration”. Upon this request, your disability application gets sent back to the DDS. But, this time a different DE will handle your application. You may also send any new supporting documents you may have. It is possible the new DE could make a different determination about your eligibility. They may do this if they see that the previous DE made a mistake. They may also do it if you provided new documentation that better proves you meet the medical requirements.

But, if the new DE also denies your disability claim, you can continue the appeal process.

Administrative Law Judge Hearing

The next step in the disability process is a hearing before an Administrative Law Judge (ALJ). The ALJ is an attorney who works for the Social Security Administration’s Office of Disability Adjudication and Review (ODAR). Before the hearing, the ALJ reviews your application and all documentation you have submitted about your claim. 

At the hearing, the ALJ will question you about the things you have claimed in your application. The ALJ may also question expert witnesses, such as medical and vocational professionals. They question the experts to see if they believe your medical condition meets SSA requirements. The good thing about the ALJ hearing is that you and your legal representative if you have one, have the chance to speak on your behalf. You can also present your own witnesses and cross-examine experts.

Getting Help with Your Disability Claim

As you can see, the Social Security Disability process can be complicated. Your application for disability benefits may go through several stages. During the stages, many officials will look at it to determine if your application meets all the requirements. It can be difficult to understand exactly what these officials will look for when making their determination.

But, an experienced disability lawyer knows more about the documentation needed to help your claim’s approval and how to present it to the officials. Statistics show that claimants who have the help of an attorney have a greater chance of getting approved for benefits.

Brock & Stout’s disability attorneys have over 20 years of experience helping clients file for disability and get the benefits they need. Contact us today for a free evaluation and let us help you and your family.