Disability Determination Services (DDS) evaluates claims after the representative in the SSA local office obtains applications for disability benefits from claimants. The SSA field office (local offices) are responsible for verifying the non-medical eligibility requirements which include age, employment, marital status, and resources. Once the SSA field office completes the non-medical eligibility, they send the claim file to Disability Determination Services (DDS) to evaluate the claim in accordance with the law. It is important to understand that SSA requires the following elements of the claim be met: 1) the impairment must be severe – meaning the condition interferes with basic work-related activities; 2) the condition is expected to last at least one year; and that 3) the claimant is no longer able to perform substantial gainful activity for at least one year.
The Importance of Medical Evidence
The DDS office is a state office that is funded by the Federal government and is responsible for developing the medical evidence and to make initial determinations on whether a claimant is disabled or blind under the law (for Title II and Supplemental Security Income – Title XVI). DDS will obtain medical evidence from the claimant’s medical providers first and then arrange for a consultative exam (CE) to obtain additional information if needed. DDS also sends forms out to the claimant to complete such as the Adult Function Report, Work History Report and various condition questionnaires.
Medical evidence is necessary to prove a social security disability claim, and SSA relies heavily on such evidence to determine if the claimant is disabled. Medical evidence comes in many forms including physical exams and treatment notes, mental health records, bloodwork panels, hospitalization records, and different types of imaging studies. There are three key types of medical evidence used to prove a disability claim: subjective findings, objective findings and medical opinions.
The administration assesses the overall ability of the claimant to engage in employment. During this analysis of whether the claimant receives disability benefits, the administration uses a specific set of regulations and listings describing certain conditions or diseases.
These conditions include musculoskeletal disorders, vision disorders, balance and hearing disorders, speech disorders, breathing disorders, heart and blood vessel diseases, digestive systems diseases, kidney diseases, blood and lymphatic diseases, endocrine disorders, congenital disorders, neurological disorders, mental disorders, cancers and immune system disorders.
After all medical evidence is received and the claimant has attended the CE (if ordered), DDS will decide on the claim and determine the amount of social security disability insurance. The timeframe for DDS to process claims varies, but it typically takes anywhere from three to six months for a reviewer with DDS to perform a case evaluation and make a decision. (Note: this can vary by geographic area depending on the caseload)
The Determination Process
If the claimant is found to be disabled at the end of the disability determination process, the local SSA office will complete any outstanding non-disability development, computes the benefit amount, and begins paying the benefits to the claimant. On average, field offices (SSA) should take a combined total of 19 days to check the non-medical requirements and make a decision. If DDS finds that the claimant is not disabled, then the SSA office will send out a determination letter with instructions on what the claimant can do next—such as try to work or appeal the decision.
Appealing a Disability Determination Decision
If your claim for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) is denied, you have multiple opportunities to appeal these decisions. While this can be a lengthy process, months to years, claimants do have a chance of succeeding. There are four stages in the appeals process and generally the claimant has 60 days from the date on the decision to ask for any type of appeal:
- Reconsideration– medical eligibility is reviewed again at the DDS level once a reconsideration appeal is filed. An examiner and a medical team from the claimant’s DDS who were not involved in the initial review, will review the claim and gather additional evidence such as additional medical records and opinions from the claimant’s treating provider.
- Hearing Before an Administrative Law Judge – If DDS does not change their mind, you can request a hearing before an administrative law judge (ALJ), who will review the evidence in the claimant’s file and listen to testimony from the claimant and that of an expert witness.
- Appeals Council – If the Administrative Law Judge denied the claimant’s case, the next step is to ask for a review by SSA’s Appeals Council. The Appeals Council will review the ALJ’s findings and the evidence, and any additional evidence that the claimant wants to add. The Appeals Council can uphold, modify, or reverse the ALJ’s decision; or order the ALJ hold a new hearing and issue another decision.
- Federal Bench – this is the last resort in the disability claim process. If the Appeals Council turns down the claim. This appeal is not available to complete online. To learn more about this process, visit Federal Court Review Process.
You can find more information about the appeals process at the SSA’s Hearings and Appeals site.
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