This is the first class in the Disability Determination Series for positions that analyze medical, vocational and other relevant evidence to process and adjudicate disability claims in accordance with federal guidelines under the Social Security Act. Positions in this class interpret and apply statutes, regulations and rules to approve or deny Social Security disability claims. This class is distinguished from the Disability Quality Assurance Specialist class by the responsibility for managing a large caseload evolving determination of disability benefits rather than having responsibility for case review and/or training and assisting staff.

Complexity of Work: Performs work of moderate difficulty by independently analyzing medical, vocational, educational, and other evidence submitted by claimants or their representatives or obtained from other sources to determine eligibility for disability benefits on claims filed under the provisions of the Social Security Act. Determines the validity, sufficiency, and consistency of the information presented. Confers with medical consultants to resolve complex medical questions and concerns. Researches other sources of information that may provide additional facts regarding claims. Develops written decisions regarding eligibility for disability benefits to include explanations of medical information, residual effects on work and legal basis for decisions. May refer claimant to a rehabilitation agency or community resource agency.

Supervision Given: Supervision is typically not a factor.

Supervision Received: Receives directions from a Disability Determination Unit Supervisor in the form of general assignments and periodic review. Develops work sequence within established policies and procedures while adhering to established time frames.

Scope: Positions perform a wide range of analytical and case management services which affect administration of the disability insurance program through the Social Security Administration. Decisions affect the social, physical, and economic well-being of claimants.

Impact of Actions: Decisions on the extent of the disability and the ability to perform work have a significant impact on claimants’ economic condition and lifestyle. A significant cost in time, money, services, and public goodwill may be incurred through errors in judgment or inappropriate decisions. Effective job performance ensures the integrity of the disability insurance program.

Personal Contacts: Frequent internal and external contacts with doctors, psychologists, mental health agencies, and hospitals to obtain medical evidence; with claimants to verify and clarify allegations of disability and work history; with agency personnel to obtain medical records; with lawyers and congressmen to respond to requests for information or provide status reports on claims; with employers to verify ability to perform a job; and with family, friends, and neighbors of claimants to obtain supplemental information for claims processing.

Knowledge: Working knowledge of the statutes, rules, and regulations applicable to the Disability Determination program; of techniques, or gathering, reviewing, and analyzing medical and vocational information; of disability and medical terminology; and of interviewing techniques.

Skills: None identified for this class.

Abilities: Demonstrated ability to interpret and apply statutes, rules and regulations governing the administration of the disability determination programs; to communicate effectively both orally and in writing; to clearly express reasons for adjudication decisions; to manage a large, complex caseload; and to analyze medical and vocational information.

QUALIFICATION GUIDE*

Licenses or Certification: None.

Education or Training: Graduation from an accredited college or university with course work in a social science, a medically-related discipline, or a related field.

Level and Type of Experience: Experience in adjudication of disability benefit claims, caseload management, or social services work.

Any equivalent combination of training and experience indicating possession of the preceding knowledge and abilities may substitute for this education and experience.

This class specification was revised and re-titled in December 1988 as a result of the Classification Review/Specification Update Program. It was formerly titled Disability Determination Specialist.