Disability Examiner

What Is a Disability Examiner?

A disability examiner is specialist that reviews application for disability benefits and determines if an applicant is so disabled that they can’t work. The disability examiner will look at your application for disability benefits and all of the medical evidence that you submit to see if your medical records match the Blue Book listing requirements and if your medical records show that you really are so disabled that you can’t work.

The task of a disability examiner is to determine whether or not you are eligible to receive Social Security Disability benefits. Disability examiners are not federal employees. Instead, they are people who work for state agencies called Disability Determination Services (DDS). DDS agencies are where all Social Security Disability cases are evaluated. While the DDS office reviews applications and makes recommendations to the Social Security Administration (SSA), it is the SSA that makes the final decision to either accept (a.k.a., approve) or reject (a.k.a., deny) applicants' claims for disability benefits.

The medical determinations made by a Social Security Disability examiner are based on the medical records you (as the applicant) supply, additional information you or others may present, and the conclusions of the physicians who conduct consultative examinations if the claimant-supplied information proves to be inadequate or outdated. In addition, the disability examiner will weigh your work history and education.

The disability examiner considers the information provided in light of the disability listing for your specific medical condition in the SSA’s “Blue Book.” This essentially means that the disability examiner will ascertain whether:

  1. Your affliction meets the criteria for the condition as described in the Blue Book, and
  2. The condition is severe enough to qualify you for Social Security Disability benefits because your residual functional capacity (RFC) does not allow you to achieve any type of substantial gainful activity in spite of your medical condition.

If the disability examiner determines that you are eligible to receive disability benefits, he or she must also decide the amount of benefits you will receive and how long you will receive those benefits for, based on your work history and type of disability.

Most Social Security Disability determinations are made by two people—a unit consultant and the disability examiner. The unit consultant is usually a physician (if the disability claim is made for a physical disability) or a psychiatrist/psychologist (if the disability claim is made for a mental disability). While some qualified disability examiners will review cases on their own, a case will almost always receive a second review if it involves mental impairments or a difficult vocational situation. 

The question revolving around the signs your disability claim will be approved is incredibly nuanced, and thus challenging to pinpoint specific ones. This is partially because there are individual differences between people's conditions, applications, preparedness, etc. 

Additionally, to some extent, the determination by a disability examiner is subjective. Therefore, the testimony of friends and/or family members describing how well you are able to function as you go about your daily activities, for example, is information that is also considered. Furthermore, it is not uncommon to have the recommendation of a disability examiner be overruled by a unit case consultant, unit manager, or medical professional. Generally speaking, it is wise to consider meeting with a qualified Social Security Disability attorney or representative before submitting anything to a disability examiner to ensure that all appropriate documentation and medical records are included with your application for disability benefits. Doing so is perhaps one of the strongest possible signs your disability claim will be approved, most likely. 

Who Makes The Final Decision On Social Security Disability?

The person who will make the final decision on your application for disability benefits depends on what state of the process you’re in and whether or not your application has been denied before. When you first submit an application for disability benefits that application will go to a Social Security examiner. They can approve or deny your application. If they approve your application then the examiner has made the final decision on your application. But if your application is denied you have the right to ask for reconsideration. If your claim goes through reconsideration it will then be up to a judge to make the final decision about your application for disability benefits.

When reconsideration is granted a judge that is a specialist in disability cases will look through your application and all of your medical evidence to determine if you meet the requirements set by the SSA and are definitely unable to work because of your illness. Judges are typically lawyers with years of experience in disability cases.


Additional Resources

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