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The role of claims examiners in the SSDI process

On Behalf of | May 31, 2022 | SSDI

Claims examiners play a pivotal role in whether you will be approved or denied for Social Security Disability benefits. They work in consultation with a physician hired by the Social Security Administration to see if you qualify based on strict rules established by the SSA. They look at all the data from attending physicians.

Simply put, your doctor or the physician who diagnosed you following a consultive examination does not play a role in whether you are approved or denied. However, their final diagnosis and assessment of both capabilities and limitations must be supported by the following:

  • Clinical observations
  • Test results
  • Additional supporting medical evidence

A mandatory and highly complex process

The five-step process they undergo will determine if you are or are not eligible for benefits. Those include:

Can you still work?

If you can continue working and earn a certain monthly amount (adjusted each year), you will not be considered disabled. Impairment-related Work Expenses (IRWE) may reduce countable earnings for evaluating work activity. That can include medications subscribed for you.

How severe is your disability?

Monthly earned income below the limit will result in the SSA passing your application to the Disability Determination Services (DDS) in the state where you reside. Their medical examiners determine if you are disabled to a level where you are limited in performing basic work tasks. Should your disability be severe, you move on to the next step.

The list of impairments (LOI)

The DDS reviews the LOI to identify a listed condition. If your disability is on the list, you are disabled as defined explicitly by the law. Not being on the list results in the DDS identifying if your condition equals the severity of conditions on the list. Should they identify one, you will be considered disabled.

Can you work as you did pre-disability?

Should your medical condition prevent you from performing the tasks you did pre-disability or something similar, you will not be considered disabled. If the DDS finds that you can no longer continue with your previous work, you may qualify.

Another type of work?

If you don’t qualify based on the list of disabilities, the DDS will identify other types of work that you could do. Factors include age, education, physical and psychological medical condition, work experience, and skills. If nothing is identified, you will be considered disabled.

The bureaucratic process to secure disability benefits is complicated and lengthy. At times, it doesn’t seem very encouraging. The help of an experienced attorney can provide you with the advocacy you need.