To determine whether you are disabled, and thus qualify for benefits, the Social Security Administration (SSA) will send your claim to a state agency of disability examiners. In many states, the agency is called “Disability Determination Services,” or DDS, but the agency goes by various names. For instance, Florida calls its agency the Division of Disability Determinations, California calls it the Disability Determination Service Division, and Pennsylvania calls it the Bureau of Disability Determination. Claims are reviewed by DDS at the initial and reconsideration stages of the application process.
This is what happens at DDS: A disability claimant’s file arrives from a Social Security office and is assigned to a disability claims examiner. The examiner begins to order medical records from all the treatment sources indicated by the claimant on their application. Once those medical records begin to arrive, the examiner can begin to go about the task of deciding whether or not a person will qualify for disability. These are the questions the claims examiner will ask:
1) Are you currently working?
The first test the examiner will apply to your file has nothing to do with your condition, but whether you are working, and, if so, how much you are working. For both the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program, a disability claimant cannot work and earn more than an amount equal to or greater than what is known as SGA, or substantial gainful activity. If you are currently working and are making this amount or more, DDS assumes you are not disabled.
2) Is your condition severe?
As the second step of the evaluation process, the DDS will assess the severity of your condition and how it limits you. For instance, if you have moderate hearing loss, but with hearing aids you are able to hear 95% of what people are saying, the DDS is not likely to consider your condition severe, and your claim will not move on to the next level of the evaluation process.
3) Does your condition meet a disability listing?
If your medical records indicate that you have a severe medical condition that matches the requirements of an official Social Security disability (“blue book”) listing, you qualify for disability and the claims examiner will immediately put you on “benefit receipt” status. The examiner will forward your file back to the SSA for further processing.
4) Are you able to work full time?
This test has to do with how your medical and/or psychiatric conditions limit your ability to work. If you have a medical impairment or disability that makes to impossible for you to work your prior job full time, or another type of work full time, you can get benefits. Typically, the vast majority of disability claims evaluated by DDS are denied, requiring disability claimants to have their cases heard by an administrative law judge at a disability hearing before they can be approved for benefits.
If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your case!
By: Joyce Trudeau of Premier Disability Services, LLC®