How to Qualify for Disability (What Happens at DDS)

The Social Security Administration (SSA) offers two types of disability benefits: Social Security disability insurance (SSDI) for disabled workers and Supplemental Security Income (SSI) for children and adults with disabilities who have low incomes and few resources.

Whether you apply for SSDI, SSI, or both, getting your disability benefits approved is usually a complex and lengthy process. You must complete many forms and answer seemingly countless questions. And then wait—sometimes months—before anything happens.

Unfortunately, for most applicants, the Social Security disability claims process is often a "hurry up and wait" experience. That's a reflection of the complexity of the disability determination process.

Your application will pass through a series of federal and state offices, starting with your local Social Security field office and moving on to your state disability determination agency. That's where your claim will initially be decided.

How Your Disability Application Is Initially Processed

Whether you submitted your disability application online, by phone, or in person, your application is initially processed at your local Social Security field office. The local SSA office will verify your financial and legal eligibility for disability benefits.

If your local Social Security office determines that you meet the initial legal and financial qualifications for disability benefits, your application moves on to a state agency called Disability Determination Services (DDS) or something similar.

What Is DDS?

Although funded by the federal government, DDS is a state agency that will make the initial medical decision about your disability claim. It's the DDS claims examiner who will decide whether or not you meet the medical requirements for disability benefits. The examiner will base the decision on the following:

• how severe and long-lasting your medical condition is
• how your physical or mental condition affects your daily functioning, and
• whether there's any type of work you can do (or learn to do) full-time.

Learn more about how the Disability Determination Services agencies work.

What Happens to Your Disability Application at DDS?

When your file arrives at DDS from your local Social Security office, it's assigned to a disability claims examiner. The examiner immediately begins gathering medical records from all the health care providers you listed on your application, such as:

• doctors' offices
• hospitals
• diagnostic testing facilities (like labs and imaging centers)
• therapy and rehab centers
• treatment facilities, and
• other medical providers.

You'll likely be asked to provide more details about the information you put on your disability application. The disability examiner might call you for more information about your work or medical history, or you might receive a questionnaire to complete and return. Don't delay answering these questions, as that will slow down the DDS determination process.

Once most of your medical records arrive at DDS, the claims examiner can begin a medical review to assess whether or not you qualify for disability.

What Is a DDS Medical Review?

The DDS claims examiner will work with a medical consultant (a doctor, psychiatrist, or psychologist) to conduct a medical review of the evidence and decide if your condition meets Social Security's definition of a disability. To get the medical review process started, the examiner looks at information from all the health care providers you've seen, such as:

• doctor's notes and diagnosis
• medical testing reports (like X-rays and blood tests)
• treatment records, and
• hospital records.

If the claims examiner needs more information (or more recent information) to decide your claim, the DDS examiner can order a consultative examination (CE), at Social Security's expense. The CE can include an examination by a doctor or psychologist or additional medical testing. You must go to the CE or risk the DDS examiner denying your claim.

The DDS examiner's medical review looks at all the evidence, including your application, medical records, and the CE report, to determine the answers to the following questions:

Are You Currently Working?

If you're still working, the DDS examiner will first determine whether your work amounts to substantial gainful activity (SGA)—that is, whether you're earning more than the SGA limit ($1,550 per month in 2024, or $2,590 if you're blind).

Is Your Condition Severe?

For the DDS examiner to consider whether you're disabled, your file must have objective medical evidence that shows you have a condition that interferes with basic work activities. If none of your medical conditions appear to be severe on their own, DDS will consider whether the combined effect of all your impairments is likely to interfere with work activities.

Does Your Condition Meet a Disability Listing?

Next, the claims examiner will determine, with the help of a DDS doctor (a "medical consultant"), whether your condition meets the requirements of one of the listings in Social Security's "blue book." If you meet a listing, you'll qualify automatically for disability and will send your file back to the field office.

Are You Able to Work Full-Time?

Next, the examiner will assess your physical and mental limitations to determine your residual functional capacity (RFC). Your RFC describes the kind of work you can be expected to do, given your limitations.

The claims examiner will use your RFC to determine if you can still do your past work or any other kind of work. If your condition prevents you from doing any type of work, you'll qualify as disabled.

How Long Does the DDS Process Take?

On average, Social Security says it takes three to five months to get an initial decision on a disability application. If the claims examiner receives your medical records quickly, and they're complete, it might take only a few months for a decision in your case.

Unfortunately, it often takes longer. For example, in 2023, it took DDS agencies an average of seven months (217 days) to process a disability claim (both SSDI and SSI).

A lot of factors can slow the DDS medical review process, such as:

• a backlog of disability claims
• delays in getting your medical records, and
• missing information or paperwork (if you fail to return a requested form or ask to reschedule a CE, it will slow the claims process).

If you think your claim is taking longer than it should—after waiting at least three or four months—you can call DDS to check on it. Checking on your claim's progress can sometimes help move your case along.

What Happens After DDS Decides Your Disability Claim?

Once the state disability determination service has completed your medical review, the claims examiner will decide whether or not you meet Social Security's medical requirements for disability. What happens next depends on which way that decision goes.

If you qualify as disabled, the claims examiner will immediately put you on "benefit receipt" status and send your file back to the Social Security field office. A local SSA representative will calculate how much your SSDI or SSI benefits should be. You'll then receive a letter explaining how much your benefits will be and when you'll begin receiving them.

(Learn how Social Security determines when you'll get your monthly disability payments.)

What If DDS Denies My Social Security Disability Claim?

If DDS denies your disability claim, you'll receive a denial notice that will contain:

• a brief description of your medical impairments
• the records the claims examiner considered in making the decision
• a full explanation of the medical issues involved in the decision, and
• a discussion of your RFC, including your limitations and the work tasks you can and can't do.

The letter will tell you how long you have to appeal the denial (generally 60 days after you receive the denial letter).

Read the letter carefully. The information in your denial notice should help you understand why DDS denied your disability claim and what you need to do to improve your chances for approval on appeal.

If you receive a denial notice, you might consider discussing your claim with a disability lawyer. Having an experienced attorney for your appeal can improve your chance of getting disability benefits.

_{Updated January 17, 2024}