Wednesday, September 15, 2010

Does A Doctor Make The Decision On My Social Security Claim Or A Case Worker?

The Social Security Administration does not have caseworkers; it is not a Social Services agency. When you file a disability claim, a Social Security Claims Representative takes your disability information and forwards your claim to the state disability agency for a medical decision. At that point, the Social Security claims representative no longer controls the development of your disability claim. Once in the state agency, your disability claim is assigned to a disability examiner for medical development. The disability examiner is responsible for gathering the medical records from the medical source information you provided at your initial disability interview or your online disability application.

Once the disability examiner gets your medical records, they must determine if a consultative medical examination is needed to make a decision (consultative medical examinations are used when an individual has old medical information, very little information, or no medical information). If a consultative examination is required, the disability examiner will wait for the medical report from the examining physician prior to making a their medical disability determination.

Now does a doctor make the decision or does the disability examiner? All disability decisions or determinations are “written up” by disability examiners. Most disability examiners have to have their decision reviewed by a unit medical professional (medical physician, psychologist, or psychiatrist). However there are disability examiners who are considered “single decision makers” meaning they can make the medical decision in certain types of disability claims.

Now you may be wondering what types of disability claims require no review by a medical professional. For the most part, disability claims that involve impairments that do not involve mental allegations and are most likely to be a clear cut denial or approval can be decided without a doctor’s review if the disability examiner is a qualified single decision maker.

Conversely, most disability claims that are not clear denials, approvals, or involve mental impairments are routinely reviewed by a medical professional before a final medical decision is made. Social Security can use this process because physicians and disability examiners alike must follow the criteria outlined in the impairment listing book “ Disability Evaluation Under Social Security” or as it is more commonly known, the blue book. Consequently, a review by a physician is not always needed for Social Security disability determinations.

Return to the Social Security Disability SSI Benefits Blog

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