What Does a Disability Claims Examiner Do?

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When a person applies for Social Security Disability (either SSI or SSDI), a claims examiner plays a large role in the process. Applicants hoping to qualify for disability will initially have their claims approved or denied by a Social Security disability claims examiner.

These examiners are in charge of determining whether or not an applicant possesses the medical qualifications necessary to receive SSI or SSDI. Examiners do so by gathering and examining your medical records and by speaking with you and your doctors. If, for some reason, you have not recently seen a doctor or do not have any recent medical records, the examiner will set up a consultative medical examination for you. These exams, when required by the Social Security Administration, can be performed either by your personal doctor or by a doctor who contracts with the SSA.

After disability claims examiners have gathered your medical records, they will also gather information about your past work history and your educational background. These pieces of information will help the examiner understand the type of jobs you performed before your disability and determine the level of work you are qualified to do.

Disabilitysecrets.com author Beth Laurence explains how the disability claims examiner then puts all this information together to make a decision:

“The disability examiner uses this information to make a disability determination, with the help of a medical consultant, a doctor who works for Social Security. In most cases, the job of a disability examiner involves completing a medical decisional write-up for the state disability unit physician to review. In writing up the medical decision, the examiner will discuss whether your impairment meets the requirements of a disability listing, and if not, whether your residual functional capacity (RFC) is enough to allow  you to work some type of job.”

Disability claims examiners are trained specifically to understand and assess medical conditions and impairment levels. Examiners have a handful of responsibilities that they must perform with each application. According to the website for The Law Offices of Nancy L. Cavey, a law firm in St. Petersburg, Florida, there are 7 things a claims examiner must do when evaluating your disability claim:

  1. Send medical records request letters to your medical providers
  2. Read and evaluate the medical records after they have been received
  3. Determine if you have a medical condition, either physical or mental, that meets the requirements of a listing in the blue book. If you do not initially meet a listing, the examiner will use your medical records to determine your functional capabilities
  4. Submit his or her assessment of your Residual Functional Capacity (RFC) to a staff physician. This physician will review the assessment and determine your physical and mental abilities and limitations
  5. Review this physician-approved RFC and determine if you are able to return to the lightest job you held in the past 15 years or if your limitations prevent you from returning to this job
  6. Determine if your limitations make it possible or impossible for you to return to other types of work
  7. If the claims examiner then determines that it is impossible for you to return to the lightest job you held in the last 15 years and that it is impossible for you to return to other types of suitable work, you will be approved for Social Security Disability benefits

If you are unfamiliar with the world of Social Security Disability, it can be difficult to navigate through the claims process. If your initial claim is denied by an examiner, there are still several steps that can be taken to re-apply for benefits. At Summit Disability Law Group, we want to help you make the claims process as simple and pain-free as possible. We will work with you to help give you the best chance at receiving as many disability benefits as possible. Call us today at (801) 890-1030.