Who decides whether I'm disabled enough to qualify for SSDI benefits?


Who decides whether I'm disabled enough to qualify for SSDI benefits?


Social Security Disability Insurance (SSDI) benefits are disability benefits offered through the Social Security Administration (SSA) to qualifying workers who become disabled with a severe health condition. To qualify for SSDI benefits, the worker must meet specific medical and non-medical requirements, including:

  • Claimants must have sufficient work credits to be considered insured.
  • Claimants must have a severe condition lasting 12 continuous months.
  • Claimants cannot be currently working and making too much money.

What does the SSA field office do?

When a disability applicant first submits their disability application, it is initially reviewed and processed through a network of local SSA field offices. Applications may be submitted in person, by mail, online or by telephone.

The claimant is responsible for accurately completing an application and submitting information about their treating sources. The SSA representatives at the field office also have very specific duties, including:

  • Ensuring that the SSDI application is correctly completed
  • Notifying the applicant of their rights and responsibilities
  • Conducting the disability interview
  • Reviewing the non-medical components of the SSDI claim and verifying the claimant’s non-medical eligibility requirements (i.e., age, employment, marital status and SS coverage)

The SSA field office may, under specific conditions, immediately deny the claimant’s application. For example, if a claimant doesn't respond to repeated requests for information, they don't attend the disability review, or they don't meet the non-medical requirements for SSDI benefits, the claim may be denied even before the claimant’s medical condition is reviewed.

Disability Determination Services

Assuming that the claimant completes their application and meets the non-medical requirements for SSDI benefits, their application is then sent to the Disability Determination Services (DDS) office for a medical determination.

Although the DDS office is a state disability agency, it is fully funded by the federal government. All states have at least one DDS office (some states have more than one), and some states refer to this office as the Bureau of Disability Determination or the Disability Determination Division.

Regardless of the name, however, each of these offices serves the same purpose: to make the disability determination decision for the claimant.

How does the disability examiner make their disability decision?

When the DDS receives a claimant’s application, it is assigned to a disability examiner. The examiner must request the claimant’s medical records from their treating sources, review the work history of each claimant, review the medical records of each claimant, and schedule a consultative evaluation for the claimant (only if there is insufficient medical evidence to make a disability determination).

After the disability examiner has completed all the tasks listed above, they will determine whether the claimant is disabled. To make this determination, they will first determine if the claimant’s condition “meets or equals” a listing in the SSA's guidebook, "Disability Evaluation under Social Security" (also referred to as the Listing of Impairments or the Blue Book).

Claimants whose condition is not listed in the Blue Book may also be approved for disability benefits through a process called a medical vocational allowance.

What happens after the DDS makes their disability determination?

After determining whether a claimant is disabled, the DDS will send the case back to the appropriate field office. The SSA field office will notify the claimant whether they have been approved or denied.

If the claimant is approved, the field office will send them a letter that details the SSDI benefit amount and the date that the payments will be paid. If the claimant is denied, however, they will be sent a denial letter. The letter details the reason for which their claim has been denied and, if available, the steps that the claimant may take to appeal the denial.

All denial appeals must be filed within 30 days from the date of the denial letter. Claimants who do not file their appeal within the specified time will have to submit a new disability application (exceptions exist).

When will I hear from the SSA?

Although the SSA attempts to make contact within 90 days from the date that they receive the SSDI application, because there are millions of disability applications each year, it can take months to hear from the SSA field office.

Claimants who do not meet the non-medical requirements for SSDI benefits may, however, receive notification immediately. Other claimants may wait months to hear the status of their application, especially if it takes the DDS several months to gather medical records from the claimant’s doctors.

Claimants who have applied online can use their case reference number to track the progress of their disability claim. Claimants can also call the SSA office for information about their case.

Bottom line: Non-medical disability requirements are reviewed by the SSA field offices. Medical disability requirements are reviewed by the appropriate DDS office in your state.

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Whether you're facing a legal issue or just seeking information, Justipedia aims to be your most trusted resource for legal information on the Web. With the help of legal professionals across the country, we put the law in plain language to help answer your top legal questions.

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