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Social Security Disability Insurance: Who Determines Your Benefits? (Part A)

Many disabled workers are surprised to learn that their doctors do not determine whether their Social Security Disability Insurance (SSDI) benefits are granted or denied. Treating physicians and psychologists are only a few of the players in the overall process of providing monthly stipends for disabled workers or children. While medical professionals understand the causes and effects of disease or impairment, they are not legal experts.

Federal Code Regulations combine with medical definitions as guidelines for determining whether individuals qualify for Social Security Administration (SSA) disability insurance benefits. This means that your qualifications are not determined by one person, but a collective of individuals who are trained to assess how an individual's disabilities coincide with federal law.

The Social Security Act is the applicable law that covers Old Age Insurance and Survivors' Insurance, in addition to Social Security disability insurance. While the first two focus on providing living expenses for aging citizens, SSDI provides monthly payments to those whose medical impairments won't allow them to work and earn a living.

Initial Decision Makers in the SSDI Process

Your treating physician will have an initial impact on your SSDI eligibility because your medical records provide the background for the history of your physical and mental condition. This is the basis upon which the SSA makes its determinations. Representatives in regional field offices review claimant applications and personal information to confirm basic eligibility.

Claimant criteria may include:

• Age
• Descriptions of disabilities
• Work history
• Occupational education history
• Proof of residency
• Verification of contact numbers
• Marital status
• Citizenship

These government officials confirm your information and give the nod to your finished application so that the next step in the SSDI eligibility process can be completed.

Your claim is sent to a state agency for medical evaluation. State Disability Determination Services (DDS) evaluate your medical history and work requirements to see how your impairment affects your ability to earn wages and care for yourself. If past records don't shed enough light on your current condition, your state DDS may request a consultative exam. That means a trip to the doctor or psychologist to record more detailed medical information.

When the appropriate data has been compiled, two DDS officials decide whether to approve or deny your claim. A state medical or psychological consultant and a disability examiner who is familiar with federal guidelines make the call on your initial eligibility.

A physical or mental disability can ruin and completely change your life. If you are disabled and can no longer work because of your condition, you should contact a Social Security Disability attorney to learn about your rights and determine eligibility. Social Security has strict deadlines on when you can file or appeal a disability claim.

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