How Social Security Disability Eligibility Is Determined
115.1 How does SSA determine disability cases?
State Disability Determination Services (DDS) generally make decisions on disability cases. DDSs are state agencies in every state that SSA funds and administers for the purpose of making disability determinations. SSA makes disability insurance determinations for persons living outside the U.S., and for a few other applicants whose cases are not covered under the Federal-State regulations. Generally, an evaluation team composed of a medical or psychological consultant and a lay disability evaluation specialist is responsible for making the disability determination. The evaluation team makes every reasonable effort to obtain medical evidence from your treatment sources.
115.2 Who checks to make sure that determinations made on disability cases are correct?
Our Office of Quality Assurance and Performance Assessment reviews a continuing sample of DDS determinations in the Disability Quality Branches (DQB) in our ten regions. These DQBs ensure that DDS determinations are correct, consistent, and in line with national policies and standards. As a result of a Quality Assurance review, a DDS’s findings may be reversed.
115.3 What can you do if you do not agree with our determination about your claim?
If you are not satisfied with the determination made on your claim, you may appeal. In most states, you may request reconsideration and submit new evidence if it is available. A reconsideration determination for disability claims is made by a different decision maker, not connected with the initial determination in the DDS where the original determination was made. Again, the DQBs review the DDS reconsideration determinations. If you appeal your case further, an administrative law judge (ALJ) may hear your case in a face-to-face or video teleconference hearing, unless you indicate in writing that you do not wish to appear before an ALJ at an in-person hearing. If the ALJ’s decision is not favorable to you, you may request review of the decision by the the Appeals Council of the Office of Disability Adjudication and Review. (See Chapter 20.)
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