What Does a Disability Claims Examiner Look For?

After you complete your initial application for Social Security Disability benefits or Supplemental Security Income, your claim is sent to the Disability Determination Services Office in your state.  Your case is assigned to a Disability Claims Examiner to determine your eligibility for disability benefits.

Who is the Claims Examiner?

The disability claims Examiner is not one person but actually but is actually a team.  This team consists of a medical or psychological consultant and a lay disability evaluation specialist.  This team is responsible for making the disability determination.

How is your disability claim evaluated?

The disability claims examiner must apply a five step process set out in Federal rules and regulations to determine whether a claim meets the medical requirements for a finding of disability. You can be found to be disabled at any stage in the process.

• Are currently employed - If you are working and your earnings average more than a certain amount each month, you will generally not be considered disabled.  This amount changes every year.  If you are not working or your income does not meet the level of substantial gainful employment you progress to the next step.
• Is your 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.  Social Security will request information from your doctor to determine this.  If it is determined that your condition is severe you go to step three.
• Does your condition meet the Listing of Impairments:  conditions on this list are considered so severe that you are disabled as a matter of law.  If the severity of your medical condition or combination of conditions 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. 
• Are able to do your previous employment?  At this step, 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. 
• Are you able to do any work?  Social Security 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?

Social Security rules and regulations can be complicated for the layperson.  You will have a much better chance of a successful claim if you seek competent legal counsel from an experienced disability attorney.