While the Social Security Administration (SSA) is a federal agency that manages disability benefit programs, they don’t usually review people’s claims. Instead, most claim reviews happen at the state level using other government employees. This may confuse you, since the SSA handles Social Security Disability Insurance (SSDI) as well as Supplemental Security Income (SSI) payments. When you apply for disability benefits, your state’s Disability Determination Services (DDS) office usually completes your claim review. We’ll explain how and why a state-based agency determines who’s eligible for disability benefits below.
Where Does Disability Determination Services Operate?
Because many states have their own unique disability benefits laws, the SSA uses local offices to operate more efficiently. The SSA employee handling your specific disability application usually has no say in whether or not you qualify for benefits. Instead, SSA field offices typically gather information on each claim’s non-medical eligibility requirements. Once that office confirms your claim meets those requirements, it moves on to Disability Determination Services for your medical review.
What Does Disability Determination Services Do?
Disability Determination Services then confirms whether or not you meet all medical requirements. This is the required next step before DDS can approve your claim for disability benefits. Disability Determination Services workers have two main responsibilities for confirming you’re medically eligible for benefits, which we’ll explain below.
DDS Responsibility #1: Develop Medical Evidence for Social Security Disability Claims
Your application asks you to describe your condition(s) in detail. It should also list all healthcare providers that treat your condition. Disability Determination Services will review this information, along with any medical records you submit along with your claim. If DDS needs more information to determine your eligibility, their doctor will schedule a new medical exam. Gathering medical evidence takes time, and the DDS office’s review process is thorough. If any test or result is unclear, they’ll ask for another one before making any decisions.
DDS Responsibility #2: Determine Whether or Not Each Applicant’s Blind or Disabled
In addition to all medical evidence, your DDS claims examiner reviews your personal statement. DDS also reviews any statements from your friends or family. They do this in order to learn how much your condition limits your ability to work 40 hours each week. From there, DDS decides whether or not you qualify for disability benefits.
Because each person’s employment history and abilities are unique, DDS makes determination decisions on a case-by-case basis. That’s also why two people filing disability claims for identical conditions may get different outcomes.
Who Works for Disability Determination Services?
The government employs all Disability Determination Services claims examiners and medical officers. These two departments work together to obtain all required medical evidence for SSD claim reviews. They also verify your application meets all non-medical eligibility requirements, including:
- Age
- Employment history
- Job skills
- Marital status
- Social Security disability insurance (SSDI) coverage
Why Does Disability Determination Services Get Final Say About Your SSD Claim?
DDS officers make disability claim decisions every day. Not your doctor, any SSA field agent or federal employee. There are several reasons for this. It’s mostly because DDS examiners know what valid disability claims look like. They consider your age, education, and work experience, then look for a less demanding job. DDS claims examiners do this so you can keep working, if possible. If they cannot find a full-time job you can do with your current mental or physical limitations, you may receive disability benefits. The DDS must consider hundreds of factors before making a final decision about your case.
Once you receive your initial approval for disability benefits, DDS also handles routine follow-up reviews. These are known as continuing disability reviews and must happen every 3, 5 or 7 years. DDS conducts these regular check-ins to ensure you still meet all medical eligibility requirements for disability benefits. In other words, if your symptoms improve enough, the SSA assumes you can return back to work. If this happens, the SSA terminates your benefit payments immediately.
What If Disability Determination Services Denies My Benefits Claim?
DDS denies most initial SSD claims (about 80%, according to the most recent annual report). If that happens to you, don’t give up. You still have four chances to appeal your case, as long as you do so within 60 days. Once you get to this stage in the claims process, we strongly recommend consulting an attorney.
You May Qualify for Legal Assistance
Having an experienced Social Security attorney file your application makes you nearly 3x more likely to get approved for benefits right away. All lawyers in our network offer free, no-obligation consultations to anyone with disability claim questions. And since they also work on contingency, you pay nothing for legal assistance until after you’re approved for benefits. Unless you win benefits, you owe the lawyer $0. And if you do win, federal law says that you’ll only pay a small, one-time fee.
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Mandy Voisin is a freelance writer, blogger, and author of Girls of the Ocean and Star of Deliverance. As an accomplished content marketing consultant, mom of four and doctor's wife, Mandy has written hundreds of articles about dangerous drugs and medical devices, medical issues that impact disabled Americans, veterans' healthcare and workers' compensation issues since 2016.