The Social Security Disability Claim Evaluation Process

April 12, 2011

Once a claimant files for Social Security Disability Benefits, the disability evaluation process begins. Social Security will use the information that the applicant provides on the application forms to attempt to gather medical evidence of the disability from doctors, hospitals and schools. Social Security may also send the claimant to doctors chosen by Social Security for examinations and/or tests that are called consultative examinations if Social Security has insufficient information to evaluate whether the claimant is disabled.

Once evidence is received by Social Security it is evaluated by examiners at the local state agency which is called the Disability Determination Services [DDS] or Disability Adjudication Services [DAS]. Social Security is looking for more than just a diagnosis by a doctor that a claimant has a medical condition. For adult claims, they are looking for whether the claimant has physical or mental problems that prevent the person from working any job. For children, they are looking for whether the child has physical, mental or growth problems that seriously limit the child from doing things other children in the child's age group is able to do.

In fact, Social Security will deny more claims that it will grant at this initial level. Most of the time Social Security will send a letter called a Notice of Determination or Notice of Disapproved Claim finding that the adult applicant is not disabled because he or she is able to do the work they used to do or able to do some other less stressful or less demanding work. In a child's claim, Social Security often denies the claim finding that the child has no severe or marked limitations on functioning as other children of the same age function.

The key is to not give up if you feel that you are unable to work or that your child is not functioning normally. If you receive an initial denial notice, you must appeal within 60 days of the date on the notice. In most states, including Georgia, Florida, North and South Carolina and Tennessee, the first level of appeal is called "Request for Reconsideration". Once such an appeal is filed with the local Social Security office, the claim will be reconsidered along with any new information that the claimant provides on the appeal forms. In most cases, the Social Security Administration will then again deny the claim, sending a Notice of Reconsideration or Reconsideration Denial Notice. The claimant will then have another 60 days to file a "Request for a Hearing" - the second level of appeal - that will give the claimant an opportunity to be heard by an Administrative Law Judge and the best chance for a favorable decision.