February 22, 2020

Who Makes the Decision About Whether I Qualify for Disability?

When you first apply for disability, your claim will be evaluated by a decision maker called an adjudicator who works for your state government.  Interestingly, it is not the Social Security Administration, but an agency of the state where you live that has been given the task of determining whether you qualify for disability in this early period of your claim (right after you file for disability).

  • Each state has an independent agency – commonly known as the disability determination service – that will make the first decision as to whether you qualify for benefits. In most states, the disability determination service, commonly referred to as DDS, is part of your state’s Department of Labor or Department of Health and Human Services.  These folks are the ones issuing decisions as to whether you are considered disabled.
  • state agency adjudicators are not judges but they have been trained to apply Social Security law.

Regardless of your location and the exact name of the DDS, the federal rules governing each state are the same, meaning that these state agencies do follow certain criteria established by the SSA in determining whether you are disabled. And once the determination has been made by the state agency, it will be the SSA who will mail you your decision letter.

State Agency adjudicators generally approve around 25-30% of applications they see.  Most of these approvals involve claimants with severe, life threatening medical conditions.  Many legitimate, strong claims are denied by adjudicators, so if your claim is denied, you should file an appeal (called a Request for Reconsideration) and not give up.

When Does a Judge Get Involved?

If the state agency adjudicator denies your claim following your initial application and you appeal, your claim will go back to a different adjudicator for what is called reconsideration.  Here, only about 10% of files are approved and 90% are denied again.  If your claim is denied at reconsideration, do not give up. This is where you file your appeal and request a hearing before a Social Security judge.

When you appeal your reconsideration denial, your file will be transferred by the state agency adjudication office to the Social Security Office of Disability and Review (ODAR).  Judges have significantly more training than adjudicators and much more authority to evaluate your case.  Currently statistics show that nationally, judges approve about 40% of claims that they see.

Since every case that a judge approves has been denied twice by adjudicators, you can see why it makes sense to appeal.  You have a much better chance at approval before a judge than you do with a non-judge adjudicator.