This information may help claimants with representation, as well as claimants who are not represented by an attorney or non attorney representative. Understanding how the Social Security Disability system works can make the difference between winning or not winning the continuing disability benefits and backpay to which a person is entitled. In pursuing a claim for ongoing and past due benefits, claimants should learn about the disability process to improve their chances of winning. |
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Who makes the Social Security Disability or ssi decision? The answer to the question "Who makes the disability decision?" depends on the level a claim is currently at. If a case is at the initial stage, then the disability determination is made by a DDS examiner (at the risk of being redundant, DDS is the state-level agency which adjudicates disability claims filed through the Social Security Administration). If the case is at the reconsideration level (a number of states, however, have suspended the recon step as part of a test project), the decision is also made by a DDS examiner, this time an Examiner Level II. Basically, the process for decision-making does not change at all in the first two stages. In the third stage of the disability process, however, the hearing before an administrative law judge (ALJ, for short), things change significantly. ALJ's make decisions on social security claims after hearing testimony from a representative or attorney, sometimes the claimant, and occasionally from a medical or vocational expert (who is essentially paid by the hearing office to be present and give testimony). These are the most basic answers to this question. But, truthfully, it's a little more complicated than that. For one thing, regarding the first two disability stages, it can be argued that the Disability Examiner does not really make the claim decision at all. Why? Because Disability Examiners are required to consult with physicians, or medical consultants, rather, who work in the same DDS units as the examiners (often, they are right down the hall from each other). Without a medical consultant "signing off" on an examiner's "decision", a case cannot be decided and closed. So, who really makes the decision? The medical consultant or the examiner? I would have to say the medical consultant does, because examiners seldom ever make decisions that they think their medical consultants will not sign off on. Making this process even more complicated is the fact that an Examiner's unit supervisor and assistant supervisor both have the authority to overturn any decision an examiner makes---even if the medical consultant agreed with the examiner's decision!! But it doesn't end there. Before a case can be shipped out of DDS and sent back to the social security office, it will be screened by the quality control specialists at DDS---who may also decide there is "something" about the examiner's decision which they do not agree with. And, beyond even this level of scrutiny, all disability cases decided by DDS are subject to being randomly pulled (and torn apart) by something called DQB, the disability quality branch. DQB offices generally serve an entire Social Security region; that is, several DDS facilities and social security branch offices across several states. Technically, DQB exists to make sure things are done right. But for the most part, the only decisions made by Disability examiners that DQB overturns are approvals. Undoubtedly, this makes the entire process somewhat suspect, and hardly fair to disability claimants. The answer to the question, "who really makes the decision for a disability case?" is, obviously, not a simple one. Disability Advocates Help with Claims Free Case Evaluation |
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SOCIAL SECURITY DISABILITY ATTORNEY, REPRESENTATIVE LAWYER LIST ANSWERS TO YOUR SSD & SSI QUESTIONS PAGE 4 ANSWERS TO YOUR SSD & SSI QUESTIONS PAGE 5 |
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If you suffer from a medical disability such as hip, neck, shoulder, ankle, wrist, back, or other joint problems, disc herniation, degenerative disc disease, spinal stenosis, carpal tunnel syndrome, rsi or repetetive stress injury, inflammatory bowel disease, ulcerative colitis, irritable bowel syndrome, arthritis, dysthymia, depression or other mood disorders, congestive or chronic heart failure, type 1 diabetes, type 2 diabetes, diabetic neuropathy, high blood pressure (hypertension), seizure disorder, stroke, copd, emphysema, hearing loss or poor hearing, statutory blindness, peripheral field problems or other vision loss, clinical obesity, attention deficit hyperactivity or, simply, adhd, bipolar disorder or manic depression, panic disorder, schizophrenia, autism, head trauma, memory loss, low iq, mental retardation, learning disability, epilepsy, cancer, chronic fatigue, multiple sclerosis, lupus, anxiety, inner ear problems, meniere's, vertigo or dizziness, kidney failure requiring dialysis or other renal problems, cirrhosis, hepatitis, or other liver disease, pancreatitis, osteoarthritis, osteoporosis, asthma, bronchitis, cystic fibrosis, rsd or reflex sympathetic dystrophy, crohn's disease, sarcoidosis, peripheral vascular disease, lyme disease, cerebral palsy, down syndrome, hiv, aids, anemia, sickle cell, thyroid problems including hypothyroidism, esrd or end stage renal disease, reflux, gerd (gastroesophageal reflux disease), cfids, muscular dystrophy, coronary artery disease, cardiomyopathy, or tachycardia, bradycardia or other arrhythmia and have initiated or been denied on a social security disability, or ssi, claim for benefits, this site may assist you with your case. Social Security Disability benefits are often difficult to win; however many claims for social security disability are lost simply because a claimant did not know enough about the disability process to their social security or ssi claim. For information re: representation on a social security disability or ssi claim (attorney or non attorney representative), see the "questions" & "how" pages. |
| Social Security Disability If I win a disability claim, how much will I get and for how long ? |