Sunday, June 11, 2006



Who makes the Social Security Disability decision ?

Actually, the answer to this question depends on the level your claim is at. If your social security disability or SSI disability claim is being processed at the intial claim level, the decision will be made by a disability examiner who works at the state agency that handles medical evaluations for the social security administration in your particular state (in most states, this agency is known as either the bureau of disability determination or disability determination services). If your claim is being heard (or already has been heard) at a disability hearing, the decision will be made by an administrative law judge.

Of course, decisions by examiners are not nearly so absolute as decisions made by judges.

Disability examiners process SSDI (social security disability insurance) and SSI disability claims by gathering a claimant's medical records and analyzing them to see if the claimant meets the social security administration's disability approval standards. In the course of processing a claim, an examiner will read a claimant's records and compose a synopsis, or write-up, that reflects the examiner's recommendation (approval or denial) for the case. The examiner will then typically consult with either a medical or psychological consultant (an M.D. or a Ph.D.) who is assigned to his or her processing unit.

After the consultation is completed (and many cases will require a consultation with both types of consultants), a decision on the claim will be finalized and the case file will be reviewed by either the examiner's supervisor or the assistant supervisor (sometimes known as a case consultant)...for "more finalization". In other words, if one of these indvidual's has an issue with the examiner's conclusions, the examiner may have some additional work to do.

However, once the claim finally makes it through the supervisory gauntlet, it can begin to make it's way out of the state agency and back to the social security office. That is...if the file is not intercepted by quality control. If a regional quality control office "selects" the file for review, a claimant may have to wait several more weeks before learning what the decision on their claim is.

By marked contrast, when a federal administrative law judge makes a decision on a social security disability or SSI disability claim, the decision is simply the decision. Of course, if the decision is a denial, this may be appealed. But unlike the system in which disability examiners adjudicate disability claims, there is no one present to "second guess" the judge. Examiners, by comparison, are often second guessed by their unit consultants and supervisors as well as by quality control staff.



Return to the Social Security Disability SSI Benefits Blog




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Social security appeal
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