Role of the Disability Examiner (DE) and the Medical Consultant (MC) in the Disability Determination Process

The Disability Examiner or Claims examiner is the person who handles and manages your claim at the DDS office. This is the person who you can call to get updates on your claim status, or the person who might call you if there is any missing information on your application.

In most cases, after all necessary information is collected by the disability examiner, your medical records are then summarized by the examiner handling your claim, and routed to one or more medical consultant(s) for review. If you are alleging a physical disability, it will be routed to a medical doctor who might or might not hold a specialty. If you are alleging a mental disability, you claim will be summarized and routed to a psychologist for review. Or, if you are alleging a combination of both physical and mental impairments, your claim will go to both MCs, and each will enter his/her findings separately.

Medical consultants – which include medical doctors, physicians, specialists or psychologists-- serve as direct staff to or contract with the state DDS. They are usually housed in the DDS offices.  A Medical Consultant will either handle claims of all examiners assigned to a particular unit, or they will review claims agency-wide, based on their specialty.

Their duty is to use their professional expertise in determining the extent of a claimant’s functional ability in light of his or her medical condition(s). These doctors and psychologists never see you in person so they must rely solely on your medical records (MER) in file to assess your limitations.

After a review of the summary provided by the examiner and your medical records, the medical consultant (MC) will either concur with the disability examiner or revise the summary findings based on their judgment. In some cases, they will send the case back to the examiner and request they collect further medical information or they may require the results of certain medical tests or psychological assessments be performed before they issue a final assessment on your functional abilities.

When the medical consultants have completed their review of your file, the case is then forwarded back to disability examiner who then assesses your vocational/work history. Based on the level of your restrictions as determined by the physician or psychologist, the disability examiner looks at your past work history to determine whether you can or cannot return to your past work. If your medical restrictions indicate that you can not, based on the specific requirements of that type work, the examiner then has to determine if you can do any other type of work, based on your age, educational level and physical and/or psychological limitations.

If it is determined that you cannot do your past job or other work, your disability claim will be “allowed”. If you can do your past work or can do other work or it is determined that your disability is not severe or not expected to last at least a year or that your severe condition will resolve itself in less than a year, then your claim will be “denied.”

Excerpt from Getting Social Security Disability: Your 9 Step Guide