The Disability Expert

A Free Guide to Social Security Disability Insurance and Supplemental Security Income Disability Benefits


 

 


 

Who Makes the Decision on Your Claim for Social Security Disability Benefits?

By R. M. Bottger

When you apply for Social Security or Supplemental Security Income (SSI) disability benefits, many people are involved in making the decision on your case. Here is a description of who makes the decision on your case.

You can apply for Social Security disability benefits by visiting or calling your local Social Security office.  Or you can call Social Security's 1-800 number.  Or, you can visit www.ssa.gov.  However you start the process, your case will be handled by a claimís representative in your local office. Your local Social Security office makes the decision as to whether or not you meet the non-medical requirements for Social Security disability benefits. For example, you must be earning less than $800 per month in 2003 to qualify for disability benefits (the amount is higher if you are blind). For Social Security Disability Insurance, you must have paid into Social Security at least 20 of the last 40 quarters to be insured for disability benefits. For Supplemental Security Income disability benefits, you must have below a certain level of income and resources.

            Your local Social Security office sends the case to the state agency that makes the medical decision on claims for Social Security disability benefits in your state. This agency is called the Disability Determination Services (DDS).  This agency is part of your stateís vocational rehabilitation agency. The employees of this agency are state employees. Although this is a state agency, it is 100% federally funded.

            When your case arrives at the state agency, it is assigned to a disability determination specialist. The disability determination specialist sends letters to your doctors, hospitals, and other sources of treatment to obtain copies of all of your medical records. If more information is needed about your condition, the disability determination specialist may schedule examinations or tests for you at Social Securityís expense. Your disability determination specialist may contact you or people who know you by phone or letter in order to find out more information about your claim for Social Security disability benefits. The disability determination specialist evaluates your medical condition. The disability determination specialist evaluates your vocational information (age, education, and past work). A medical doctor also reviews the evidence in your file to determine how your condition affects your ability to work. If you have a mental condition, a psychiatrist or psychologist will review your case to evaluate how your mental condition affects your ability to work. Management staff and quality assurance staff may also look at your claim for Social Security disability benefits.

You will probably never meet any of the people at the state agency. They make their decision based on the evidence in your claim file. The decision on your claim for Social Security disability benefits is based on laws, regulations, and court rulings. The decision is not based on the whim of the people looking at your case. These people decide which laws, regulations, and court rulings are relevant to your case and use them as a basis for the decision. When I was a disability determination specialist, there were times I thought a person was unable to work, but I still had to deny the case because the person did not meet SSAís requirements for Social Security disability benefits. There were other times that I had to allow the case of someone I thought could work because the person met SSAís requirements for Social Security disability benefits. I didnít always agree with all of SSAís laws and regulations, but I always did my best to follow them.

Sometimes when I was a disability determination specialist, I would talk on the phone to people who assumed that SSA and I personally were out to deny as many people as possible. I can assure you this is not true. SSA does not discourage the state agencies from allowing cases. In fact, if a case is going to eventually be an allowance, SSA wants to allow it as early in the process as possible to save the cost of appeals. As a disability determination specialist, I liked to allow cases. When I allowed a case, I felt like I had helped somebody. Also, there was less paperwork to fill out on allowances than denials. SSA certainly never did anything to discourage me from allowing cases. I hope you will not assume that your disability determination specialist is trying to deny as many people as possible.

When I was a disability determination specialist, I was always pressured to get out cases as quickly as possible. The longer a case takes, the more it costs. Also, from a public relations standpoint, SSA wants to keep processing time as short as possible. I used to be assigned 4 new cases per day whether I was in the office or not. Even when I was out on sick leave, I was assigned 4 new cases per day. If I did not make decisions on at least 4 cases per day, my caseload would grow. Also, my job performance evaluations were also based partly on how fast I got out cases. The large caseloads and pressure to make decisions quickly can cause your disability determination specialist to fail to give your case the attention it deserves. The pressure to move quickly can cause your disability determination specialist to do sloppy work. I know some of you are thinking that you have been waiting months for your decision, and you donít think SSA is concerned with speed. Keep in mind that some of the most time consuming aspects of case development are beyond the disability determination specialistís control in terms of time. Obtaining copies of medical records is often very time consuming. Some doctors and hospitals take months to respond to request for records. If you have additional hospitalizations or treatment while SSA is working on your case, SSA may take additional time to try to obtain these records. Scheduling examinations for people and waiting for reports on these examinations are often time consuming. If you take a long time to send in forms or request that your examinations be rescheduled, your case will take even longer. Even though it may take your case longer than you would like, I can assure you that your disability determination specialist is mindful of trying to do the case as quickly as possible.

After the state agency makes the medical decision on your claim for Social SEcurity disability benefits, it sends the case back to your local Social Security office. A small percentage of cases are sent to a regional quality assurance unit that checks the cases to make sure that the state agency is making accurate decisions. If the medical decision is a denial, you will be sent a letter telling you why the case is denied. If the case is a medical allowance, the local Social Security office finishes making sure that you meet the non-medical requirements for disability. The local Social Security office initiates payments on cases that are allowed.

If you appeal the decision on your claim for Social Security disability benefits, the first level of appeal is called a reconsideration. This appeal is handled in the state agency just like your initial case was. A different disability determination specialist, medical doctor, and psychologist or psychiatrist will look at your case than looked at it at the initial level.

If you appeal the decision made at reconsideration, the claim for Social Security disability benefits then goes before an administrative law judge. You can meet the judge in person.

Lots of different people will work on your claim for Social Security disability benefits.  Making the decision on your case is a very complex procedure.

           

 

 

 


 
 

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