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Who Makes the Final Decision on Social Security Disability?

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The Social Security Administration (SSA) is the government agency tasked with managing Social Security benefits for qualified claimants. Everyone who works in the United States contributes to their own Social Security fund through taxation and work credits accumulated over time. When individuals suffer a severe injury that prevents them from working or are otherwise unable to continue working due to medical reasons beyond their control, they can file a claim for Social Security Disability benefits.

While Social Security aims to be a social safety net, ensuring disabled Americans have the financial assistance they need to make ends meet when they cannot work, the unfortunate reality of Social Security Disability claims is that the overwhelming majority of initial claims for benefits are flatly denied by the SSA.

If you plan to file a claim for Social Security Disability benefits, it is understandable to wonder who makes the final decision on Social Security Disability claims. Only claimants with qualifying disabilities and medical conditions can receive Social Security Disability benefits, and they must file their claim accurately and completely and meet all applicable deadlines. Many claims are denied due to mistakes with paperwork, lack of supporting documentation, or inability to prove a qualifying disability.

Who makes the final decision on Social Security disability?

How Is Eligibility for Social Security Disability Benefits Determined?

The SSA partners with a wide network of contracted Disability Determination Services (DDS) and state agencies responsible for handling claims for disability benefits. Disability examiners from DDS offices work closely with the SSA to evaluate every claim for disability benefits. DDS examiners are not federal employees, but they provide the results of their investigations to their local SSA field offices so claims may be processed.

When an individual applies for Social Security benefits, they must complete several forms and compile supporting documentation, submitting all required materials to the SSA for consideration. The SSA will then assign a disability examiner from a local DDS to investigate the claim. The disability examiner will carefully review the claimant’s provided medical records, claim forms, and all other materials. They are responsible for first determining whether the claimant has a qualifying medical condition or disability listed in the SSA’s “Blue Book,” a detailed list of all medical conditions and disabilities that can potentially qualify for Disability benefits.

It’s important to remember that determining eligibility is a two-step process for a disability examiner. They must not only determine if the claimant’s condition qualifies for benefits but also whether the claimant has residual functional capacity that enables gainful employment. If the claimant can perform alternative work in light of their disability, they likely will not qualify for benefits. The disability examiner handling a claim will likely work with an SSA unit consultant, typically a medical professional tasked with reviewing the examiner’s findings.

Why Are So Many Social Security Disability Claims Denied?

The SSA processes thousands of claims for benefits each year, and the majority of them are denied. The SSA upholds strict laws and regulations regarding eligibility for benefits, and navigating the claim process is often more challenging than most claimants expect. The most commonly cited reasons for Social Security Disability benefits claim denials are errors in claim paperwork, ineligibility due to residual functional capacity, or lack of a qualifying condition. Some people believe they are eligible for Social Security benefits when they are actually capable of alternative work, while others may not realize their conditions qualify for benefits.

If you are planning to file a claim for Social Security Disability benefits or are unsure whether you qualify, it’s best to work with an experienced Social Security Disability attorney. An attorney can potentially save you a great deal of time, stress, and frustration when it comes to your claim. First, they can assess whether you qualify for benefits based on your condition. Second, they will help you complete all required claim forms and gather the supporting documents and medical records you will need to submit to the SSA. Third, they can handle interactions with the SSA on your behalf, helping you understand the process and address any unforeseen delays, denials, or disputes over your claim.

What Happens When a Social Security Disability Claim Is Denied?

There is no limit to the number of times an individual can apply for Social Security Disability benefits. However, if your initial claim was denied and you do not fully understand why, or if you disagree with the SSA’s determination of your claim, you should work with an experienced attorney if you intend to refile and try again. Your attorney can review the determination letter from the SSA and explain why your claim was denied. If the reason was something simple such as a claim form error or missing supporting paperwork, they can assist you in addressing these issues.

Some claimants will need to file appeals for their claims when they are denied or when the SSA offers a lower-than-expected disability eligibility determination. The two most commonly requested forms of Social Security Disability benefits are Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI). Both of these benefits programs have different eligibility requirements. If a claimant is already receiving any form of workers’ compensation or state-level disability benefits, these payments influence how much they can receive from the SSA. A claim for Social Security Disability benefits can be denied based on the claimant already receiving too much assistance from other programs.

If you or a loved one are struggling with a severe medical condition or disability that interferes with your ability to work and support yourself, let us help. It’s vital to know the benefits programs available to you and how to navigate the claim process when you must file a claim for Social Security Disability benefits. While a disabled person may be eligible to claim various forms of state-level benefits, disability benefits at the federal level are much harder to obtain.

The attorneys at Gade & Parekh, LLP have years of experience helping clients navigate the complex Social Security Disability benefits claim process, and we can put this experience to work for you. Contact us today if you have any concerns about your Social Security Disability benefits determination or if you want legal counsel as you navigate this complex process.

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