To receive Social Security disability insurance (SSDI) or Supplemental Security Income (SSI) disability benefits, you must qualify medically (and nonmedically). The Social Security disability claims examiner is the person who makes the initial determination on an applicant's medical eligibility for disability benefits.
Most disability claims examiners work at state agencies rather than at a Social Security Administration (SSA) office. The state agencies are often called Disability Determination Services (DDS) but might also be called something like the Disability Determination Bureau or Bureau of Disability Adjudication.
Each state has at least one DDS facility, and larger states with decentralized systems have several DDS offices. The typical DDS office has several hundred disability examiners.
Here's what a DDS or Social Security disability claims examiner does.
The primary role of the Social Security disability examiner is to decide if your medical condition (whether physical or mental) is severe enough to prevent you from working in any type of job. The disability examiner is also responsible for maintaining contact with you.
To decide your claim, the examiner must first gather all your medical records and any additional information needed. For instance, the examiner might call you or send you a questionnaire asking you to fill out more information about your work history or education.
The claims examiner will want to see medical records covering the entire time you've been disabled, including information about all the medical treatments and therapies you've had. You'll need to sign a release and provide contact information for all the doctors and clinics you've visited.
The examiner might contact both medical and non-medical sources to gather information about your ability to work, including:
Getting support from your treating doctor or psychologist can reinforce your claim. A statement from your doctor that details how and why each of your impairments prevents you from working can be especially helpful, but only if it's backed up with medical evidence like:
The disability examiner might schedule you for a consultative examination (CE) with a doctor or psychologist paid for by Social Security if the examiner determines that either:
Social Security will often schedule your CE with a doctor or psychologist already treating you. But that's not always the case.
The disability examiner then gathers together your medical and vocational information, including the following:
The disability examiner will use this evidence in a five-step evaluation process to determine disability. In each step, the examiner will evaluate the information in your file to answer the following questions:
To answer the last question, the claims examiner will consider your:
Because of special medical-vocational rules for applicants over 50, it's generally easier for older disability applicants to win Social Security disability claims.
The disability examiner uses all the gathered information to make a disability determination with the help of a "medical consultant" (a doctor or psychologist who works for Social Security). The disability examiner and medical consultant must decide if, given the evidence in your file, you qualify as disabled as defined by law (20 C.F.R. § 404.1505(a)).
For you to meet this definition, all of the following must be true:
(Social Security uses slightly different criteria in defining disability in children.)
The medical consultant, or state disability unit psychologist, is supposed to develop your RFC, but this doesn't always happen. The disability examiner should at least consult the doctor on the nature and severity of your medical impairments and the kind of additional medical evidence needed to decide your claim.
The DDS examiner can't decide medical eligibility without consulting the doctor on these points, except in quick disability determination (QDD) cases.
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)—how much you can be expected to do given your medical impairment(s)—is enough to allow you to work at some type of job.
If the claims examiner initially denies your claim, it doesn't mean you can't get SSDI or SSI benefits. The initial denial is often just the beginning of the Social Security disability claims process. Learn what happens next if the disability examiner denies your claim.
Updated September 7, 2023