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How are disability decisions made?

If you apply for coverage under Social Security Disability Insurance (SSDI) Supplemental Security Income (SSI), Medicaid, Medicaid Purchase Plan (MAPP), or Katie Beckett, your claim will first be reviewed to determine if non-disability eligibility requirements are met. If so, your application is then sent to the Disability Determination Bureau (DDB).

  • DDB collects medical evidence from your doctors, clinics, and hospitals along with other information about your condition.
  • You may be asked to provide additional information.
  • You may also be asked to have a medical examination, free of charge, which will help DDB make a decision.
  • Disability examiners and medical professionals at DDB evaluate the evidence to decide if you are disabled under the disability rules.
  • If you are asked to provide additional information or have a medical examination but fail to do so, DDB may not have enough evidence to make a disability decision, which could mean that your application will be denied.

The disability rules used for SSDI, SSI, Medicaid, MAPP, and Katie Beckett are the federal rules established by the Social Security Administration (SSA). For adults, the rules require the presence of a physical and/or mental condition that is severe enough to prevent any substantial work activity and is expected to last 12 months or result in death. For children, the rules require a physical and/or mental condition that causes severe limitations in the ability to function like other children of the same age and is expected to last 12 months or result in death.

How do I apply?

What if my claim is denied?

More information about the rules used in determining disabilities (SSA publication No. 05-10029).

 

Wisconsin Department of Health Services
Division of Health Care Access and Accountability
Disability Determination Bureau