Workflow — Disability Determination

Disability decisions in days, not months.

SSDI / SSI application, medical records, work history, function reports → SSA Listings match or RFC (Residual Functional Capacity) assessment, decision rationale drafted with the medical evidence cited per Listing or RFC element. Determination memo into the SSA case file for adjudicator sign-off. Replaces state-DDS-office and federal-contractor adjudicator labor at a fraction of the per-case cost — and cuts the multi-month DDS backlog.

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Months

Typical SSA disability-decision backlog

$45–$85

Per hour, DDS adjudicator (loaded)

60–85%

Routine case prep off the adjudicator desk after AI cutover

What This Replaces

The DDS Adjudicator on Every SSDI / SSI Case

The work the disability adjudicator does on every case — and the cost of leaving it there.

The labor

Disability determination today moves through state DDS office adjudicators (state-employee status, federally funded under the Social Security Act) plus federal contractor support — backlogs are multi-month and have been a recurring SSA congressional-oversight issue. Adjudicators are state-employee disability examiners at $45–$85 per hour fully loaded plus federal-contractor support that handles overflow during backlog spikes. SSA disability budgets routinely run into the billions across SSDI and SSI program-administrative cost.

The cycle time

Standard DDS cycle runs months from initial application to decision, with longer cycles when medical evidence requires consultative-examination scheduling, when functional capacity needs vocational review, or when the case progresses through reconsideration and ALJ hearings. Multi-month backlogs translate directly to applicant-experience pain — claimants wait months without income while medical evidence sits in the case-file queue. Per-case cycle compression has direct claimant-quality-of-life impact.

The Workflow

Input · Analysis · Output

What goes into DDS case prep, what we do to it, and what shows up in the SSA case file.

Input

SSA application + medical evidence

SSDI / SSI application
Medical records (treating sources, hospitals)
Work history (SSA-3369)
Function report (SSA-3373)
Activities of daily living (ADL) statements
Consultative examination (CE) reports where ordered
Prior SSA case file (re-applications)

Analysis

Match Listings, assess RFC, contend

SSA Listings match (Blue Book) by impairment
Severity assessment per durational requirement (12-month rule)
Residual Functional Capacity (RFC) drafting
Past Relevant Work (PRW) and step-4 / step-5 analysis
Vocational adjustment under medical-vocational guidelines
Insured-status verification (SSDI) / SSI income / resource check
Confidence score per finding; exceptions to adjudicator queue

Output

Determination memo into the SoR

Determination memo to SSA
Listings-match basis or RFC assessment with citations
Vocational analysis where applicable
Case file ready for adjudicator review and sign-off
CE-order recommendation if evidence insufficient
Per-case audit trail with Listing / RFC citation basis
Cycle-time tracking for SSA backlog management

Side by Side

Disability Determination Today vs. With Last Rev

The numbers that matter: cycle time, per-case cost, accuracy, and applicant-experience impact.

Dimension	DDS Adjudicator Processing	Last Rev DDS
Cycle time, application to determination	Multi-month backlog at DDS	Days to weeks per case
Per-case unit cost	$45–$85/hr adjudicator translated per-case	Per-case, benchmarked at 25–45% of adjudicator unit cost
SSA Listings match consistency	Variable — adjudicator judgment, drift across regions	SSA Blue Book Listings applied identically per case
RFC assessment quality	Templated RFC narratives with manual evidence fill-in	Per-case RFC with medical-evidence citation per element
Medical evidence-completeness check	CE-order decisions delayed when evidence is patchy	Per-impairment evidence-sufficiency scoring with CE-order recommendation
SSA case file integration	Manual case-file updates in the eDIB / SSA system	Direct via documented SSA case-file integration
Audit log per finding	Adjudicator notes, no per-Listing / per-RFC lineage	Source medical evidence + Listing / RFC citation + confidence per element

How It Works

From SSDI / SSI Application to Determination Memo

Five steps. Every one logged. Every one reversible if your confidence threshold isn't met.

Submission Lands

SSDI / SSI application from the SSA case-file system, plus medical records (treating sources, hospitals), work history (SSA-3369), function report (SSA-3373), ADL statements, consultative examination (CE) reports where ordered, and prior SSA case file (re-applications).

Extraction & Classification

SSA Listings match (Blue Book) by impairment. Severity assessment per durational requirement (12-month rule). Residual Functional Capacity (RFC) drafting. Past Relevant Work (PRW) and step-4 / step-5 analysis. Vocational adjustment under medical-vocational guidelines. Insured-status verification (SSDI) / SSI income / resource check.

Validation Against SSA Bar

Findings validated against current SSA Blue Book Listings, POMS, HALLEX, and the DDS office's adjudication playbook. Anything below your confidence threshold per finding is routed to the adjudicator review queue — final disability determination remains with the federally-required state-employee adjudicator.

Push to SSA Case File

Determination memo into the SSA case-file system via the documented integration. Listings-match basis or RFC assessment with citations. Vocational analysis where applicable. CE-order recommendation if evidence insufficient. Case file ready for adjudicator review and sign-off.

Audit Log Persisted

Every Listings match, RFC element, vocational finding, and evidence citation logged with the source medical record, model version, prompt, and confidence score. SSA-appeal-defense-ready and yours.

Compliance & Defensibility

Built to Meet the Quality Bar SSA DDS Already Runs On

SSA Blue Book Listings conformance

SSA Blue Book Listings of Impairments tracked per impairment category. Listing updates flow into the validation engine within days of effective dates. Per-Listing severity, durational, and laboratory criteria applied consistently.

POMS / HALLEX / regulation fidelity

SSA Program Operations Manual System (POMS), Hearings, Appeals and Litigation Law Manual (HALLEX), and 20 CFR Part 404 / Part 416 disability rules respected per case. Per-rule version preserved in the audit log for ALJ-hearing and Appeals Council review.

Adjudicator role respected

We don't make the disability determination. Final determination is the federally-required state-employee adjudicator role. We assemble the medical evidence, apply Listings / RFC analysis, and draft the determination memo; the adjudicator reviews, edits, and signs off. The adjudicator is in the review-and-approve loop on every case.

PHI / HIPAA / SSA-confidentiality posture

DDS case files contain PHI under HIPAA plus SSA-confidential applicant data. Deployable in your VPC or our SOC 2 / HIPAA-aware environment with FedRAMP-aligned deployment options for federal-contractor work. Encryption in transit and at rest; retention policies tied to SSA recordkeeping rules.

Common Questions

What State DDS Offices and Federal Contractors Ask About Disability Determination

The eDIB system and adjacent SSA workflow tools are the case-management infrastructure. The competitor on this page is the adjudicator labor that does the actual Listings-match, RFC assessment, and determination-memo drafting — typically state-employee adjudicators at $45–$85 per hour fully loaded plus federal-contractor support during backlog spikes. We undercut that labor cost, integrate with your DDS / federal-contractor system, and deliver determination memos for adjudicator review and sign-off.

We don't make the disability determination. Final determination is the federally-required state-employee adjudicator role under the Social Security Act and 20 CFR Part 404 / Part 416. We assemble the medical evidence, apply Listings / RFC analysis, and draft the determination memo; the adjudicator reviews, edits, and signs off. The adjudicator is in the review-and-approve loop on every case.

Our pilot success threshold is Listings-match, RFC-element, and vocational-analysis accuracy at parity with or above your incumbent adjudicator process, measured on the same shadow-data sample of historical cases. Anything below your defined confidence threshold per finding is routed to the adjudicator review queue — your call which queue, ours or yours.

SSA Blue Book Listings are encoded per impairment category. Per-Listing severity, durational, and laboratory criteria applied with the source medical record cited per finding. Listing updates flow into the validation engine within days of effective dates so DDS adjudicators work from the current criteria.

Residual Functional Capacity (RFC) drafting incorporates exertional, postural, manipulative, visual, communicative, and environmental limitations with the medical-evidence basis cited per element. Past Relevant Work (PRW) and step-4 / step-5 analysis runs against the SSA medical-vocational guidelines. We don't make the senior adjudicator call on borderline cases; we surface the basis.

Yes — through the documented integration surface SSA / DDS systems support (eDIB, EDCS, MIDAS, etc.) and federal-contractor case-management platforms. FedRAMP-aligned deployment options available for federal-contractor engagements. Your IT, compliance, and contracting officers review and approve service accounts. We do not require platform-side custom development.

DDS pilots typically run 6–8 weeks: 1–2 weeks of integration and per-state / per-program rule mapping with DDS leadership and adjudicator-team representatives, 4 weeks of shadow-mode running on real cases with no SSA-side determination submissions, 1–2 weeks of supervised cutover on a constrained scope (one impairment category, one office). Production rollout is staged after the pilot meets your accuracy and adjudicator-management sign-off.

We benchmark against your current per-case fully-loaded cost — typically derived from $45–$85 per hour adjudicator rates translated into per-case economics. Our target is 25–45% of that per-case cost at higher accuracy and faster cycle time. Pricing structures around volume tiers and outcome SLAs (backlog reduction), not hourly billable rates.

Two Ways to Start

Take the AI assessment for a structured read on disability-determination feasibility. Or talk to us if you already know multi-month backlogs are the constraint on applicant experience.

Self-serve · 8 minutes

Take the AI Assessment

A short structured assessment that maps your monthly case volume, DDS / federal-contractor system, and adjudicator staffing model to AI feasibility and ROI.

Talk to a specialist

Get a Per-Case ROI Model

Send us your monthly case volume, your DDS / federal-contractor system, and your adjudicator staffing model. We'll come back with a per-case unit-cost comparison and a 6–8 week pilot plan in 5 business days.

Other Workflows

More Healthcare Admin Workflows We Replace

The same approach, applied to the other document-heavy labor lines on your healthcare-admin budget.

Workers' Comp Medical Review

Injury reports, treating-provider notes, IME reports → causation analysis, treatment-plan compliance vs ODG / ACOEM.

Clinical Denial Appeal

Denial letters and medical records → payer-policy-cited appeal letters with evidence chronology.

HCC Coding Review

Progress notes, discharge summaries → HCC capture per MEAT criteria. Submission to CMS RAPS/EDS.

HEDIS / Stars Chart Abstraction

EMR access + measure specs → A1c, BP, screening dates abstracted per HEDIS technical specs.