The Social Security Administration may hire a physician to evaluate an applicants disability

REHABILITATION SERVICES

disability determination services

Mission Statement

We are committed to providing accurate, impartial and timely disability decisions for South Dakota citizens.

The South Dakota Disability Determination Services (DDS) is the State Agency that makes the disability decisions for the Social Security Administration (SSA), according to federal guidelines. When SSA added protection for individuals with disabilities in 1954, the Congress wrote into the law that the disability decision had to be made by a State Agency and not by a federal office. SSA pays the State to run the office and make the decision. The DDS is responsible only for the medical eligibility portion of the disability claim. SSA is responsible for the application process, any other eligibility criteria, and the calculation of benefits if awarded.

The DDS staff gathers medical information from the sources listed by the claimants and any new sources discovered in that process. The agency evaluates that evidence against Social Security Disability criteria . These criteria are very specific. They essentially say that the claimant must have a medically determinable physical or mental impairment that will last for at least 12 consecutive months, and which prevents them from performing the work-related activities of their previous jobs or any other jobs which they might be able to perform based on their age, education, and work experience, or is expected to result in death. Please follow this link to see how DDS decide if you are disabled under the rules of Social Security .

South Dakota DDS Values:

• We take pride in the timeliness, accuracy and cost efficiency of the decisions
• We respond to the claimants in a dignified, courteous and respectful manner
• We embrace change and challenge
• We elicit and value client input
• We demonstrate on an ongoing basis that employees are the most valued asset

South Dakota DDS Goals:

• To employ a highly trained, motivated and productive team
• To provide outstanding public service in the benefit process
• To enhance partnerships with the medical and educational communities
• To utilize state of the art technology

General Information:

The South Dakota DDS employs approximately 22 disability claims analysts and specialists, 15 physicians, and 10 administrative and clerical staff. The DDS makes over 9,000 medical decisions for Social Security Disability annually.

The DDS's address is at 3109 W. 41 st St, Ste. 100, Sioux Falls, SD 57105-8155.

Social Security Disability Programs

There are two Social Security disability programs . They are Social Security Disability Insurance (SSDI, also known as Title II) and Supplemental Security Income (SSI, also known as Title XVI). There are some differences and some similarities in the two programs.

The definition of disability under Social Security is the same under both programs. Disability is defined in Social Security law as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment (or combination of impairments) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

When you apply for either program, the DDS will collect medical and other information from you and make a decision about whether or not you meet Social Security's definition of disability.

SSDI pays disability benefits to you and certain members of your family if you are "insured" meaning that you worked long enough and paid Social Security taxes. Once eligible, there is a five month waiting period before payments begin and Medicare benefits can start no sooner than two years after being allowed.� There are several types of SSDI benefits:

Disability Insurance - These benefits pertain to those people under retirement age who have insured status based on their own earnings.

Disabled Widow(er) - These benefits pertain to people whose deceased spouse paid into the system. This benefit is restricted to people between age 50 and 60. Upon reaching age 60, a widow(er) is no longer eligible for benefits under this category as they are eligible for survivor benefits.

Child Disability - These benefits pertain to people whose parent paid into the system. Eligibility for these benefits can begin at age 16, but in most cases people will not be eligible until they are 18. In order to receive these benefits, a person must be found to have been disabled prior to his or her 22 nd birthday.

SSI pays disability benefits based on financial need. There is no waiting period for payments to begin or Medicaid benefits to start.� There are several types of SSI benefits?

Disabled Individual - These benefits pertain to people over 18 whose Income and Resources fall below a level set by the SSA. Blind Individual benefits pertain to people who are eligible for Disabled Individual benefits because of blindness.

Disabled Spouse- These benefits pertain to those people who have a spouse who qualifies for Title XVI benefits.

Disabled Child- These benefits pertain to children from birth to age 18 whose family income and resources fall below a level set by the SSA. Blind Child benefits pertain to children who are eligible for DC benefits because of blindness.

Basic Steps in the disability determination process

1. Apply for disability benefits under Social Security:

• Online
• By calling the Social Security Administration (SSA) at 1-800-772-1213 (TTY 1-800-325-0778)
• In-person by being seen at your local Social Security Office

2. Once all application materials have been returned, your local SSA office sends your file to the Disability Determination Services (DDS) office.

3. The DDS gathers information from the medical and vocational sources that you listed within your application paperwork.

4. The DDS may arrange for a medical examination at DDS expense if records are deemed insufficient to make a medical determination.

5. When records are sufficient, the DDS accesses the most you can do despite your limitations .

6. The DDS evaluates all of the evidence , work experience and compares it to SSA Program Rules .

7. The DDS makes the medical disability determination.

8. The DDS then sends your claim back to SSA.

9. SSA contacts you with the final results after they made the final determination of eligibility for benefits.

The DDS may contact you to:

• Ask for your assistance in obtaining medical evidence;
• Request clarification about your medical, work or school information in your file;
• Ask you to go for a specific medical examination at DDS expense

The DDS may also contact your medical sources and people you have told us about who know how your condition affects your daily life.

The DDS cannot:

• Discuss your claim or any of the medical evidence with anyone but you or your designated representative.

• Tell you anything about your potential eligibility or payment, as the Social Security must release that information.

You need to call the DDS when:

• You have a new phone number or new address
• You have seen a new doctor or hospital
• You have an appointment to have tests or surgery
• You begin or return to work

How can you expedite your claim?

Make certain that you have proper identification when you make your claim: Birth Certificate, Social Security Card, Driver's License, etc.

Take time to go over your work history and try to list all of your employers for the last 15 years. Company names, addresses where you worked, supervisors' names, and any documentation on how much you were paid will all be helpful.

Know the date that you stopped working due to your impairment. Know the date that your work changed due to your impairment if that is different from the date when you finally quit. Explain any special working conditions that may have been provided by your employer to keep you on the job.

Write down the names, addresses, and telephone numbers of any medical source you have seen. The DDS may have trouble identifying the right doctor if you only state "Dr. Smith in Denver," so it would be most efficient if you would provide accurate names, addresses, and telephone numbers.

If your doctor has given you any written instructions that limit your activities, have a copy placed in your file. The date the restriction started and the date it might end are very important to your decision.

It is also helpful to ask your doctor to write a medical source statement about the facts of your medical condition and how your impairments limit your physical and/or mental functional capacity.

Send forms back to SSA and the DDS as quickly as possible. The vast majority of the time it takes DDS to complete a claim is spent waiting on forms and medical reports.

Keep yourself informed about your claim. Ask questions if something is not clear to you. If the DDS or SSA is waiting for something, see if you can make a call to help expedite the claim. Many times a doctor will respond to a patient before they will respond to a government agency.

The DDS may ask you to explain your "Daily Activities." Answers to these questions are very valuable and may make the difference as to whether your claim is allowed. It is not the length of the answer that helps. What helps is how specifically you answer the questions. Give examples. Mention any limitations. If the DDS asks "Can you go grocery shopping?" an answer of "I can go to the grocery store, but I have to use the electric carts and have people place items in the basket because I can't hold on to anything heavier than a soup can" helps more than just writing "yes" or writing a long paragraph explaining every detail of your experiences.

Appeals Process

Reconsideration Process

If a claimant does not agree with the initial decision, they may file for reconsideration.� Reconsideration can be filed on any claim that is not fully favorable to the applicant.� The most obvious reconsideration filing would be on an initial denial; however, an individual may also file for reconsideration if they disagree with the disability onset date established on the initial determination. You must make your request to appeal within 60 days from the date you receive our letter. A reconsideration claim is assigned to a different DDS staff. The evaluation process remains the same as the initial claim but special emphasis is placed on the evidence to assure that all information related to an individual's claim is evaluated and any new evidence is considered in the evaluation of the claim. The claimant is allowed to submit any new evidence they deem appropriate.

Administrative Appeals Process

Once the DDS has rendered a reconsideration decision, the next level of appeal is to file for a hearing before an SSA Administrative Law Judge (ALJ). The ALJ is an attorney specially trained to conduct administrative hearings and decides disability based upon interpretation of Social Security law. Generally, you have 60 days after you receive the notice of our decision to ask for any type of appeal.

Appeals Council

If a claimant does not agree with the ALJ's decision, they may request their claim be reviewed by the Appeals Council. The Appeals Council is responsible for both quality review of ALJ decisions and reviews requested by the claimant. You will have 60 days from the receipt of the decision notice to file an appeal. The Appeals Council cannot overturn an ALJ decision but can only remand the claimant to the ALJ for additional action.

The Appeals Council is the last administrative appeal process. If the claimant continues to disagree with the determination, they may challenge the final administrative decision in US District Court.

To file an appeal, click here to find the contact information to your local SSA Field Office.

Medical Providers

Medical Providers play a vital role in the disability determination process and participate in the process in a variety of ways:

• As treating sources or other medical sources who provide medical evidence on behalf of their patients;
• As Consultative Examination sources to perform, for a fee paid by the DDS, examinations and/or tests that are needed;
• As full-time or part-time medical or psychological consultants reviewing claims in a DDS, in one of SSA's regional offices, or in SSA central office; or
• As medical experts who testify at administrative law judge hearings

Consultative Examinations (CE) are obtained when the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by re-contacting the treating source for additional information or clarification, or by arranging for a CE.

Please contact the South Dakota DDS Professional Relations Officer at 605-367-5499 or toll-free at 1-800-658-2272 if:

• you are a licensed doctor, psychologist, physician assistant, advanced practice nurse, optometrist, podiatrist, audiologist, or a qualified speech-language pathologist and are interested in doing exams for Disability Determination Services
• you are a provider of medical records and want to provide them electronically

Useful Links

Frequently Asked Questions

Other useful links:

• Apply for SSA Disability
• 1 st Appeal of Initial Decision to Reconsideration Level
• 2 nd Appeal to an Administrative Law Judge
• 3 rd Appeal to Appeals Council
• Consultative Examinations
• Disability Determination Process
• Evidence Requirements
• How we decide if you are disabled
• Residual Functional Capacity
• SSA Disability Criteria
• SSA Disability Definition
• SSA Disability Programs
• SSA Disability Starter Kits for Children & Adults
• SSA Office Locator
• SSA Program Rules
• SSA Publications
• Social Security Disability Insurance
• Supplemental Security Income
• Work Related Questions

When an individual who is insured under a disability income insurance policy can not perform one or more of his or her regular job duties This is known as?

How long can a person continue to draw state disability insurance benefits quizlet?

When an individual who is insured under a disability income insurance policy Cannot perform one or more of his or her regular job duties This is known as quizlet?

What are the sources of disability income coverage?