The Role a Disability Claims Examiner Plays

After you complete an application for SSDI or SSI benefits, the application is sent to the Disability Determination Services Agency for your state.  Your claim is evaluated by this agency.

Disability Claims Examiners

An evaluation team reviews disability claims.  This team consists of a medical or psychological consultant and a lay disability evaluation specialist.  This team is responsible for making the disability determination.  The disability claims examiners review your initial application.  They determine if there is enough medical evidence to make a decision on the claim.  A claims examiner can

• Contact the applicant for additional information about their condition,
• Request additional records
• Set up consultative examinations

It is important that an applicant be responsive to the claims examiner.  If medical records are requested, they should be sent directly to the claims examiner to prevent delays on the decision on the application.  The claims examiner makes the initial decision on your disability application.

How is the decision made?

Claims examiners apply a five-step process as set out in Social Security Rules and regulations.

• Are you working - If you are working and your earnings average more than a certain amount each month, you are not disabled.  This amount changes every year.
• Is your medical condition “severe” - your medical condition must significantly limit your ability to do basic work activities—such as walking, sitting, and remembering—for at least one year.
• Is your medical condition on the List of Impairments:  conditions on this list are considered so severe that they automatically mean that you are disabled as defined by law.  If the severity of your medical condition meets or equals that of a listed impairment, the state agency will decide that you are disabled.  If it does not, the state agency goes on to step four. 
• Can you do the work you did before?  The state agency decides if your medical condition prevents you from being able to do the work you did before.  If yes, you qualify, if not you go to the last step.
• Can you do any other type of work?  The agency  evaluates your medical condition, your age, education, past work experience and any skills you may have that could be used to do other work.  If you cannot do other work, the state agency will decide that you are disabled.

Do You Need a Lawyer?

All decisions made by the Disability Determination Service are subject to appeal.  It is wise to consult an experienced attorney to assist you with your claim for benefits.