Who decides if I am disabled? If both my doctor and the Social Security disability doctors say I am unable to work, will I be approved?
See who decides if you are disabled and how Social Security uses your doctors’ and the consultative examination doctors’ opinions in their decision.
The Decision Maker for Your Social Security Claim
Claims examiners in consultation with a physician decide whether you are disabled according to Social Security Disability rules. These employees of the Disability Determining Services, called DDS for short, make the disability decision because they are trained in Social Security law and regulations including Social Security’s specific definition of disability. Neither your own doctors nor a doctor you might see in a consultative examination (whom some people call “Social Security disability doctors”) make the decision. If your claim has progressed to a hearing appeal, the administrative law judge (ALJ) who hears your case makes the decision.
What About Your Doctor’s Opinion?
The claims examiner and DDS doctor consider all the information from your attending physicians. However, to be accepted as valid evidence for your claim, your doctor’s assessments must be supported by clinical observations, test results, or other supporting medical evidence. In other words, your doctor has to explain how he arrived at his diagnosis and his assessment of your capabilities and limitations.
The Consultative Examiner’s Opinion
When Social Security hires a doctor to examine you, the claims examiner instructs the doctor to evaluate whether you have the illness or injury that you claim and to identify any limitations and restrictions you may have. The doctor is not asked to make a disability decision and when the consulting doctor’s report is received, the DDS examiner reviews the report to be sure that the conclusions the doctor has drawn from the examination are supported by clinical observations or testing cited in the report.
Our article How Does the Social Security Administration Apply Social Security Laws to Determine If I Am Disabled? describes some of the information that Social Security requests from your doctors for its disability evaluation process. Our article When Applying for Disability Benefits Will I Have to See a Social Security Doctor? describes when Social Security will ask you to attend a Consultative Examination.