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What Happens When The Disability Determination Service Begins A Medical Review Of Your Social Security Disability Application?

Navigating the Social Security Disability Insurance (SSDI) claims process can be a complex and sometimes overwhelming journey. After weeks, maybe even months of waiting and providing extensive documentation, you find that Social Security’s “status” bar has updated. It says “We started step 3 of 5 of the review process. The Disability Determination Service (DDS) started a medical review of your application.” Here’s an in-depth look at what to expect moving forward.

Initial Review and Collection of Medical Evidence

Once your application is received by the Social Security Administration (SSA), it is forwarded to the DDS in your state. The DDS is responsible for assessing the medical aspects of your claim. Here’s what happens next:

  1. Review of Your Application: The DDS examiner assigned to your case will start by reviewing the information you provided in your SSDI application. This includes your description of your disabling condition, your work history, and any medical evidence you have submitted.
  2. Request for Medical Records: The DDS will request your medical records from the healthcare providers you listed in your application. This includes hospitals, clinics, and doctors who have treated you. It’s essential that you provide accurate and complete information about your medical history and treatment providers to avoid delays.

Consultative Examination (CE)

In some cases, the medical evidence provided may be insufficient for the DDS to make a determination. When this happens, the DDS may schedule a Consultative Examination (CE).

  1. Purpose of the CE: The CE is performed by an independent medical professional, often a doctor who contracts with the SSA. The purpose of the CE is to obtain additional information about your condition, your functional limitations, and how your disability affects your ability to work.
  2. What to Expect: During the CE, the doctor will perform a physical or psychological examination, depending on your condition. They may also ask you questions about your symptoms, daily activities, and medical history. It’s important to attend the CE and provide honest and thorough answers.

Analysis and Decision-Making

After gathering all necessary medical evidence, the DDS examiner and a medical consultant will analyze your case. They will consider several factors to determine whether you meet the SSA’s criteria for disability.

  1. Review of Medical Evidence: The DDS team will review your medical records, CE results (if applicable), and any other relevant information. They will assess the severity of your condition and how it limits your ability to perform basic work activities.
  2. Assessment of Work Capacity: The DDS will evaluate whether your condition prevents you from performing your past work or any other type of work that exists in significant numbers in the national economy. They use a process called the Sequential Evaluation Process, which involves five steps to determine disability.

There is no deadline for the DDS to complete its review and issue a decision, but the SSA status bar provides an average timeframe for your state.

Communication of Decision

Once the DDS has made a determination, they will send their findings to the SSA, which will then communicate the decision to you.

  1. Approval: If your claim is approved, the SSA will send you a letter detailing the amount of your monthly benefits, the date payments will begin, and information about any back pay and healthcare benefits you may be entitled to.
  2. Denial: If your claim is denied, the letter will explain the reasons for the denial and provide information on your right to appeal. It’s important to carefully review this information and consider filing an appeal if you believe your claim was wrongfully denied.

Preparing for the DDS Medical Review

To improve your chances of a favorable outcome, take the following steps:

  • Provide Complete Information: Ensure your application is thorough and includes all relevant medical information and treatment providers.
  • Follow Up on Medical Records: Confirm that your healthcare providers have sent your records to the DDS.
  • Attend All Appointments: If you are scheduled for a CE, make sure to attend and cooperate fully.
  • Stay Informed: Keep track of your application status and respond promptly to any requests for additional information.

Get Help with Your Social Security Disability Claim

If you have questions or need assistance, consider consulting with a disability attorney who can provide expert guidance throughout the process. Navigating the Social Security Disability Insurance claim process can be daunting, but with the right preparation and support, you can get the benefits you need and deserve. Call the Ortiz Law Firm today at (888) 321-8131 to schedule a free case evaluation.