Social Security disability claims examiners make determinations on applicants' medical eligibility for Social Security disability (SSDI or SSD) claims. Most disability claims examiners work at state agencies called Disability Determination Services, or DDS. Each state has at least one DDS facility, and some states that have a decentralized system have several DDS offices. The typical DDS office has several hundred disability examiners. Here is what a DDS claims examiner does.
First, the disability examiner is responsible for gathering all of your medical records and acquiring additional information from you, your representative, or your doctor. If the disability examiner determines that you haven't seen any doctors (called "medical treating sources") within the past three months, or that the medical sources listed in your disability claims file will not provide enough medical information to make a Social Security disability medical determination, the disability examiner will schedule you for a consultative examination. The disability examiner is also responsible for maintaining contact with you.
The disability examiner then gathers together:
The disability examiner uses this information to make a disability determination, with the help of a medical consultant, a doctor who works for Social Security. In most cases, the job of the disability examiner involves completing a medical decisional write-up for the state disability unit physician to review. In writing up the medical decision, the examiner will discuss whether your impairment meets the requirements of a disability listing, and if not, whether your residual functional capacity (RFC) is enough to allow you to work some type of job. The medical consultant, or unit physician, is supposed to develop the RFC, but this does not always happen.
The examiner should consult the doctor on the nature and severity of your medical impairments as well as what kind of additional medical evidence is needed to decide your claim. The examiner is not allowed to make decisions on medical eligibility without consulting the doctor, except in quick disability determination cases (QDD). (QDD cases are those with straightforward facts and obvious outcomes. In QDD cases, a single decision maker (the examiner) is allowed only to approve a case, not to deny a case, without a unit physician review. For details, see our article on quick disability determinations.)
To learn about how the examiner and medical consultant make these medical determinations, visit our section on medical eligibility for disability benefits.