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Who Makes The Decision About My SSDI Claim?

When you file a claim for Social Security Disability Insurance (SSDI) benefits, you are beginning an often complex and frustrating process. About two-thirds of all SSDI applicants are denied the first time, and most deal with two or more denials. Many applicants wonder just who decided to deny their SSDI claim. Was it a doctor? How did they decide to deny my SSDI benefits?

If you’re confused about why you’ve been denied Social Security Disability benefits in Virginia or NC, schedule an SSDI consultation with an experienced Virginia SSDI attorney at Kalfus & Nachman PC to find out how we can help. Call (855) 880-8163 today.

What is a Disability Examiner?

The first person to take your claim for Social Security Disability Insurance is the Social Security Claims representative who receives your application. This is not the person who decides if you get SSDI benefits. The claims representative simply forwards your claim to the state disability agency, where it is assigned to a Disability Examiner.

The Disability Examiner is the one who writes up the decision about your SSDI benefits, and she is charged with deciding if a consultative medical examination is necessary. If so, the Disability Examiner will wait until seeing the examining physician’s medical report before determining if you have a qualifying disability for SSDI. Usually, the Disability Examiner’s decision will be reviewed by a medical professional before being finalized. However, if the Disability Examiner is considered a “single decision maker,” he may decide to approve or deny your SSDI claim without that review step.

The decision process for SSDI claims is quite different from the decision process for Supplemental Security Income (SSI) claims, which is based primarily on your financial situation after you have been declared disabled. The Virginia lawyers of Kalfus & Nachman PC are also qualified in helping you get approval for SSI.

Virginia DDS and its Role in SSDI claims

In Virginia, the Disability Determination Services (DDS) is a division within the Virginia Department of Rehabilitative Services (DRS). This state agency processes SSDI claims based on medical and psychological evidence, vocational criteria, consultative evaluation, and continuing disability review. It works in partnership with the Social Security Administration and follows federal regulations in making its decisions.

A claimant can file a disability benefits application online, by phone, or in local SSA field offices. The field office verifies basic requirements like age, employment, or marital status. After the verification, if the application is complete, they forward the disability application to the Disability Determination Services office. The DDS then completes the disability determination for Social Security. However, it is responsible only for the medical eligibility portion of the disability claim.

Types of disability claims handled by DDS:

  • Initial applications for disability benefits.
  • Subsequent initial applications for disability benefits
  • Reconsideration requests
  • Continuing disability reviews (CDRs)
  • Medicaid claims based on disability status

Basic Steps DDS follows in the Disability Determination Process

The DDS staff usually begins by gathering medical information from the claimant's listed medical sources. The agency evaluates that evidence against SSA's specific Social Security Disability criteria. If that evidence is unavailable or insufficient, they will schedule a consultative examination (CE) to gather more information about the applicant's medical condition. The CE can be performed by an independent source or the claimant's treating medical provider. After reviewing the medical report from the examining physician, DDS decides if you are disabled under the rules of Social Security. They then send your claim back to SSA, which performs a quality assurance review of initial DDS disability decisions to determine eligibility for benefits. However, if the DDS is considered a "single decision-maker," it may decide to approve or deny SSDI claims without going through the SSA's review process.

What Happens After DDS Makes a Disability Decision

After initial determination, the state agency (DDS) returns the case to the SSA field office for appropriate action on your SSD claim. If the DDS determines the claimant is disabled, the Social Security Administration completes any outstanding non-disability development, computes the benefit amount, and begins making payment of SSDI benefits to the claimant. If DDS finds the claimant is not disabled, the file is kept in the local SSA field office, and claimants can appeal the decision.

DDS denies the majority of Social Security disability claims at the initial and reconsideration levels, compelling applicants to request a hearing before an administrative law judge before being approved for Social Security disability benefits. Thus, seeking legal help before even filing a disability claim will ensure that your case receives the consideration that it deserves. A qualified and competent SSDI attorney will thoroughly analyze your case and recommend any extra documentation that may be beneficial to your case.

How Long Does it Take to Decide on an SSDI application?

It takes DDS about three to four months from the application date to make an initial disability determination. Reconsideration appeal takes about the same time, and ALJ hearing decision from six months to two years. However, with no deadlines for applications or appeals in the federal disability program, it is hard to forecast how long a case will take. Kalfus & Nachman's experienced social security attorneys may help you expedite your SSDI claim with their extensive knowledge in filing Social Security claims in Virginia.

Kalfus & Nachman PC Helps You Get Through the SSDI Claims Process

If this seems like a complex and convoluted process to you, our Social Security Disability Insurance attorneys can explain how each step relates to your specific case. Without the help of an SSDI law firm like Kalfus & Nachman PC, the Social Security Disability claims process can be extremely frustrating. You already know you can’t work because of your disability, but the government seems to need all kinds of paperwork and documentation to prove what seems obvious to you.

We will help you get all of the required paperwork and medical documentation together, making sure your claim is targeted for the appropriate type of SSDI benefits. In addition, we will take the necessary steps to file appeals if your claim is denied.

If your SSDI claim has been denied or you are planning to apply for Social Security Disability Insurance in Virginia or NC, please contact Kalfus & Nachman PC online or by calling (855) 880-8163 to arrange a free review of your claim.

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