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The local office initially determines SSDI eligibility based on Social Security "credits" earned by working in covered employment, and eligibility for SSI based on income/assets level.
The local office obtains information from the claimant on the nature of the disability and past medical treatment. If the claimant meets the work credit (SSDI) or income/asset criteria (SSI) the case file is sent to the DDS in Boston or Worcester for development of the medical and other evidence and for a medical determination of eligibility.
If you think you may be eligible for payments, call 1-800-772-1213 to file a claim or contact your local Social Security Office .
Each case is assigned to a disability examiner who writes to all appropriate medical and other sources listed by the applicant. Often the treating sources' medical records provide enough documentation for the determination of disability. In some cases, the DDS purchases a consultative examination. The treating physician/psychologist is asked if he/she would like to do the consultative exam if one is needed. If the treating source is not qualified or unwilling to perform the consultative examination, it is scheduled with an independent source. The DDS also asks the claimant to complete a form that describes the job duties, skills and exertional levels of all jobs the claimant performed in the last 15 years.
When all required medical and vocational information is received, the disability examiner and staff physician and/or psychologist carefully evaluates each claim, using the sequential evaluation process.
Disability examiners decide each case by considering the case evidence and answering a series of ordered questions based on the facts in each case. The answer to each question determines whether a decision on disability can be made at that point or whether the adjudication should go on to the next step. The Sequential Evaluation Process assures consistency among levels of adjudication, allows considerable degree of individual claimant consideration, is logical rather than intuitive, and addresses the claimant's right to expect the same consideration, regardless of who adjudicates the claims.
Once a medical decision is made on a case, the case is returned to the servicing Social Security Office for payment or appeal. The letter you receive from Social Security will explain how to appeal if you are not satisfied with the decision. You should read it carefully. Cases are NOT stored in the DDS after a medical decision is made.