What is the decision making process on a Social Security Disability or SSI claim?

Generally speaking, the decision making process works like this: a disability examiner at disability determination services (the state agency that handles medical determinations for social security disability, ssi, and even medicaid cases) will request your medical records. Once those records are received, the disability examiner will begin to do a write-up of your case. In one sense, the write-up is a synopsis of the more noteworthy elements found in your medical records. In another sense, the write-up may be seen as a justification for the decision that will, ultimately, be made on a case. I say ultimately because, as most insiders know and realize, the disability examiner does not have the final say on the case, and the final write-up may or may not be the original opinion of the examiner.

Following the examiner's write-up, the examiner will "consult" with the relevant specialist assigned to his working unit. DDS units have a medical consultant (an M.D.) and a psychological consultant (typically a Ph.D, though sometimes this function may be handled by a psychiatrist who is an M.D.) assigned to them and the examiner will need to consult with one or both of these individuals depending on the claimant's particular impairments (for example, depression, back pain, panic attacks, ms, etc). Usually, this consultation occurs in this manner: the examiner will deliver the file and write-up to the consultant's office, the consultant will review the file and the examiner's write-up, and the consultant will return the file and write-up to the examiner either agreeing or disagreeing. In any event, the consultant's opinion is typically the final word on the case and will dictate the outcome, i.e. an approval or denial.

Sometime after the decision is made, of course, the claimant will receive either a notice of approval or a notice of denial. If the decision is a denial, the disability applicant may choose to file an appeal, and, ultimately, the case may go before an administrative law judge.



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