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Who actually decides Social Security Disability claims?

On Behalf of | Jun 24, 2023 | Social Security Disability

When you initially apply for SSD benefits, your application is typically reviewed by Kentucky’s Disability Determination Services (DDS), which works in conjunction with the Social Security Administration (SSA) to process these claims. A team of DDS employees, including a doctor, is responsible for collecting and evaluating your medical evidence and making the initial determination to approve or deny your claim.

If your claim is approved at this level, the local SSA field office will process your application to completion and get your benefits started.

What happens if your claim is denied?

If your claim is denied at the initial level, you have the right to appeal the decision within 60 days of the denial. At subsequent stages of appeal, the decision-making authority can shift. Here are the decision-makers at each level of the appeal process:

  • Reconsideration: At this stage, a different disability examination team and doctor from DDS will review your application and any new or updated evidence you provide. They will make an independent decision on your claim.
  • Administrative Law Judge (ALJ) Hearing: If your reconsideration is denied, you again have appeal rights. This time around, your case will be heard by an ALJ who works for the SSA’s Office of Hearings Operations. The ALJ is an independent decision-maker who will conduct a formal hearing, listen to your testimony, review your medical records and consider any additional evidence before rendering their decision.
  • Appeals Council Review: If the ALJ’s decision isn’t favorable in some way, you can request an Appeals Council review. SSA’s Appeals Council may decline to review the case, review your case themselves and issue their own decision, uphold the ALJ’s decision or return it to an ALJ for further consideration.
  • Federal Court Review: If the Appeals Council won’t review your case or they do and you are unhappy with its decision, you may have the option to file a lawsuit in federal district court. This is often used to address failures in the system or challenge unfair regulations.

It’s important to note that the decision-makers at each level are independent of each other and evaluate the evidence and law to make their determinations. It’s also wise to remember that these steps are very time-consuming. If you don’t want to wait around for months or years to get your SSD claim approved, it’s often wisest to proceed only after seeking legal guidance.