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Disability Determination for Social Security Disability Benefits

Claimants who are working or who have a partial or short-term disability that is not expected to last at least 12 months will not qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Social Security Disability benefits, administered by the United States Federal government, are long-term disability benefits available for claimants who are completely disabled by one or more mental or physical health conditions and are unable to work for at least 12 months.

How does the Social Security Administration make their disability determination? First they will ensure each claimant meets the non-medical criteria for the applicable disability program. Claimants who have enough work credits for Social Security Disability Insurance or meet the resource and income limitations for Supplemental Security Income will have their Social Security Disability application sent to the Disability Determination Services office for further review.

The Disability Determination Services office gathers all relevant medical documentation from the claimant’s medical sources (hospitals, clinics, doctor’s statements and lab reports). Social Security Disability claimants who lack the proper medical information to prove their medical claim are sent to a Consultative Examiner for a diagnostic review. The Consultative Examiner is responsible for sending a medical report to the disability examiner for review. After the disability examiner has reviewed the claimant’s medical case file and the report from the Consultative Examiner, they will make a disability determination.

How is the disability determination made? The disability examiner uses what the Social Security Administration calls the “sequential evaluation process” to determine disability. The main points of the sequential evaluation are as follows:

The disability determination process is complicated, and the Social Security Administration has very specific rules and processes they must follow to make a disability decision. If you have questions regarding the disability decision process contact the Social Security Administration or a Social Security Disability lawyer for more information.