The Social Security Administration (SSA) runs two programs that give benefits to people with disabilities: Social Security Disability Insurance (under Title II of the Social Security Act) and Supplemental Security Income (SSI) (under Title XVI of the Act).
- Title II provides disability benefits to people who have paid into the Social Security system through taxes on their earnings and certain disabled dependents.
- Title XVI offers SSI payments to people with disabilities, including children under 18, who have limited income and resources.
The SSA follows specific rules to determine whether someone is “disabled,” which may differ from how other government or private programs define disability.
What is Disability?
The definition of a disability is the same for anyone applying to get disability benefits that too under Title II or adults applying for the benefits under Title XVI.
The law says a person is considered disabled if they can’t do any substantial work due to a physical or mental condition.
This condition must be expected to result in death or last for at least 12 months in a row.
Disability in Children
Under Title XVI, a child under 18 is considered disabled if they have a physical or mental condition (or a combination of conditions) that seriously limits their ability to function.
The condition must be expected to result in death or last for at least 12 months in a row.
Medically Determinable Impairment
A medically determinable impairment is a physical or mental condition arising from physiological, anatomical, or psychological abnormalities.
It can be proven through medical tests or exams.
This means doctors must use accepted methods, like clinical tests or lab results, to show that a person has the condition.
Simply saying someone has symptoms isn’t enough; there must be medical proof.
The Disability Determination Process
Most disability claims start at local Social Security offices and state agencies. These are often called Disability Determination Services (DDS).
If your claim is denied and you appeal, the decision can be reviewed by the DDS again or by judges in the Social Security Office of Hearing Operations (OHO).
Offices for Social Security Field
When someone applies for disability benefits—whether online, in person, by phone, or by mail—the application is first handled at a Social Security field office.
The application includes various details regarding the person’s condition, doctors or clinics they’ve visited, and other important information about their disability.
The person applying is called the “claimant.”
The field office checks non-medical details like the person’s age, work history, marital status, citizenship, and whether Social Security covers them.
The office also checks income, resources, and living situation for SSI benefits.
After these checks, the case is sent to a Disability Determination Service (DDS) for a review of the disability itself.
State Disability Determination Services
Once the DDS finishes reviewing the case, they decide about the disability. A team, usually composed of a medical or psychological expert and a disability examiner, reviews the information.
They can contact the doctor or medical source for more details if they need more evidence.
If the person applying for benefits might benefit from vocational rehabilitation (help finding work), the DDS will refer them to a State vocational rehabilitation (VR) agency.
After deciding, the DDS sends the case back to the field office. If the claim is approved, the Social Security Administration will finish the remaining paperwork, calculate the benefits, and start payments.
If the claim is denied, the file is kept in the field office in case the person appeals.
If the person appeals, the process is similar to the first review, but a different DDS team will handle the reconsideration.
Office Of Hearing Operations
If someone disagrees with the decision made during the reconsideration, they can request a hearing with an administrative law judge (ALJ) at the Office of Hearing Operations (OHO).
The person can provide new information and evidence, and the judge will decide based on all the available evidence, including what is shared at the hearing.
If the ALJ needs more evidence, they often work with the DDS to get it, but they can also contact doctors or medical sources directly.
Sometimes, the ALJ can issue a subpoena requiring someone to provide evidence or testify at the hearing.