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How is Disability Determined?

Once you’ve filed your disability benefits claim, you probably find yourself wondering how the Social Security Administration will determine whether or not to grant your claim.

When you first file the claim for disability insurance benefits with the Social Security office, it will be reviewed to make sure that you worked enough years to qualify for benefits. That office also reviews your current work activity to determine whether someone with your claimed medical problem would have difficulty doing that work.

If the Social Security office determines that your claim meets these preliminary tests for disability insurance benefits and always for a claim for supplemental security income benefits, SSA sends the claim to the Disability Determination Services (DDS) office in California. That office reviews your medical records and ask your doctors for information about your condition.

The doctors and disability specialists in the DDS office consider your medical condition, when it began, how it limits your daily activities and work activities, what the medical tests show, your prognosis and what treatments you have received and how much they did or did not help your condition.

The DDS office asks your doctors about your ability to do certain things like walking, sitting, lifting and remembering instructions. If the DDS office does not have enough information from your doctors, it will ask you to go to another doctor for further evaluation. If this is necessary, the Social Security Administration pays for the doctor visit.

Once the DDS office has all of your medical information, DDS makes a determination about your disability on five criteria:

  • Are you working currently? Full time or part time? How much are you making? If you make more than a certain base amount (it changes each year), you are not entitled to disability benefits.
  • Is your medical condition severe? Does it limit your ability to do basic things such as walking, sitting or remembering instructions? Has this been going on for at least a year?
  • Is your condition on a List of Impairments that automatically qualify you for disability benefits? If your condition is not on this list, is your condition as severe as one or more of the impairments on the list?
  • Can you do the type of work you did before the medical condition began?
  • Can you do other types of work? The DDS will look at your age, education, skills and the limitations of your medical condition to determine whether you may be able to do a different type of work.

The results of this evaluation determine whether you are entitled to receive disability benefits under the law.