Social Security disability claims examiners make determinations on applicants' medical eligibility for Social Security disability (SSDI or SSDI) claims. Most disability claims examiners work at state agencies rather than Social Security. The agencies are often called Disability Determination Services, or DDS, but some states use a different name, such as Disability Determination Bureau or Bureau of Disability Adjudication. 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 doctors listed in your disability claims file have not provided enough medical information to make a Social Security disability medical determination, the disability examiner will schedule you for a consultative examination with a doctor paid by Social Security.
The disability examiner is also responsible for maintaining contact with you. The examiner may call you or send you a questionnaire asking you to fill out more information about your work history or education.
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 disability examiner will complete a medical decisional write-up and ask the medical consultant to review it and sign it. 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 state disability unit physician, is supposed to develop the RFC, but this does not always happen. The examiner should at least 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 on these points, except in quick disability determination (QDD) cases. (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 physician's 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.