SSA how do they make a disability decision?

Recently on our legal forum a user asked, “I have submitted my Social Security Disability Insurance (SSDI) application, and I was told that it had been sent to the Disability Determinations Service’s office (DDS). What does this mean and who exactly makes the disability decision?” 

Proving disability to the Social Security Administration (SSA)

Millions of disability applicants submit their disability application to the SSA each year. Unfortunately, not only is the process confusing, it can take months or years to be approved for disability.

What’s worse is many claimants have no idea who will be making their disability decision or how they will determine whether or not a claimant is disabled. To understand the process, claimants need to know what it means to be disabled according to the SSA, where the SSDI application is sent for processing, who reviews the SSDI application, and the criteria they use to determine disability.

What does it mean to be disabled?

Not all claimants who submit a SSDI application will be considered disabled. In fact, claimants are only considered disabled if they have a severe health condition which is expected to last at least 12 continuous months and does not allow them to work or perform substantial gainful activity (SGA). Claimants must also have earned work credits and be considered “insured” for SSDI benefits.

Assuming you have sufficient work credits and meet some of the other nonmedical requirements for SSDI benefits, your application is sent from the SSA field office to the Disability Determination Services or DDS office in your state.

This office may have a different name such as the Division of Disability Determinations (DDD), Disability Determination Service Division (DDSD), or the Bureau of Disability Determination (BDD), but each office is supposed to follow the same process for determining disability.

What does the DDS do with the disability application?

Now you asked what happens to the SSDI application after it reaches the Disability Determination Services (DDS) office. Once the SSDI application is at the DDS is will be reviewed by a disability examiner.

The examiner will request your medical information from your treating sources (doctors) and will review your medical records. They will also request employment information about your past employment and evaluate your current ability to work.

Some claimants may also be required to attend a medical evaluation from a medical doctor (referred to as a consultative examiner) if their treating doctors do not send information or the DDS needs more information to make a decision.

Regardless of whether or not a claimant is sent to a consultative examiner, however, it is the DDS examiner who is tasked with determining whether or not a claimant is disabled.

Will I be approved for SSDI benefits?

Unfortunately, the DDS denies the majority of the disability applications. In fact, the denial rate for first time disability applications can be as high as 70%. If your application is denied, however, you may be able to request a reconsideration. Under this process your disability application is sent to another disability examiner for another disability review.

Bottom line:

It’s great you are asking questions. In fact, the more you understand about how the SSA makes a disability determination and what requirements you must meet to win SSDI benefits, the greater chance you have of getting approved for benefits.