IDHS/DRS' Bureau of Disability Determination Services Fact Sheet - IDHS 4122

State of Illinois
Department of Human Services

IDHS/DRS' Bureau of Disability Determination Services Fact Sheet

Program Overview

The Social Security Administration (SSA) disability program provides benefits to persons with severe disabilities whose impairments prevent them from performing gainful work.

In Illinois, the evaluation of claims for the federal disability program is administered through the Illinois Department of Human Services, Division of Rehabilitation Services, Bureau of Disability Determination Services (IDHS/DRS' DDS). The Bureau of Disability Determination Services, which is responsible for disability determinations, is 100% federally funded and makes its decisions according to SSA rules and regulations.

This fact sheet is a general introduction to the SSA disability program in Illinois and the role played in its administration by the IDHS/DRS' Bureau of Disability Determination Services.

The SSA?Disability Program

SSA disability benefits fall into two primary categories as established by the Social Security Act: Disability Insurance (Title II) and Supplemental Security Income (Title XVI).

Social Security Disability Insurance (SSDI) provides benefits to eligible persons with disabilities-and their dependents-who have worked under and contributed to the Social Security system. SSDI is funded through Social Security Trust Funds.

Supplemental Security Income (SSI) is intended for eligible persons with severe disabilities who fall below a certain income/resources level. SSI is funded through federal General Revenue funds.

Applying for SSDI, SSI

Application for SSA disability benefits can be completed online, by phone, or at any convenient Social Security office. The local Social Security office makes the initial determination of eligibility based on work earnings for SSDI applicants and income/resources level for SSI applicants. Information is also gathered from the applicant on the nature of the disability and treatment incurred.

Defining "Disability"

For all individuals applying for disability benefits under Title II, and for adults applying under Title XVI, the definition of disability is the same. The law defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical and/or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a period of not less than 12 continuous months.

Disability in Children

 Under Title XVI, a child under age 18 will be considered disabled if he or she has a medically determinable physical or mental impairment or combination of impairments that causes marked and severe functional limitations, and that can be expected to cause death or that has lasted or can be expected to last for a period of not less than 12 continuous months.

Evaluating the Claim

Each claim received by the Bureau of Disability Determination Services is subject to strict SSA requirements for quality control, accuracy measures, confidentiality, and processing time parameters.

Claims must be fully developed and documented by Bureau staff. This development requires extensive correspondence with medical and vocational sources of information. Medical evidence is obtained from the disability customer's doctor and from any clinics, hospitals, or other institutions where the person has received treatment. If additional information is needed, staff will arrange for the purchase of special medical examinations. The final decision on disability is made on the basis of objective evidence by a highly-trained adjudicator in collaboration with a professional medical consultant.

Bureau staff members also consider each claim for vocational rehabilitation potential. Cases with such potential are referred to the Division of Rehabilitation Services or to the Bureau of Blind Services, as appropriate.

Rights of Appeal

Individuals who receive a denial or adverse decision on their benefits may appeal the decision within 60 days through their local Social Security office. The appeals process consists of four steps: reconsideration, administrative law judge hearing, Social Security appeals council, and civil action in federal court.

For those cases involving Continuing Disability Review (CDR) cessations, the reconsideration level of appeal includes the opportunity for a face-to-face hearing. During the hearing individuals can explain, in person and with their attorney or representative present, why they believe they still qualify for benefits. Individuals also have the option to continue receiving benefits through the hearing level of appeals. In order to continue receiving benefits during the appeals process, individuals are required to ask, in writing, within ten days after the date of receipt of the cessation notice.

Case Reviews

Continuing Disability Reviews are required by the Social Security Act to ensure that only those persons entitled to disability benefits continue to receive them. These reviews are conducted periodically on all cases. The frequency of review depends on the category of the cases; cases where improvement is not expected are reviewed less often than cases involving impairments which are expected to improve.

Case Inquiries

The Bureau of Disability Determination Services hotline number is 800-225-3607. DDS staff operate under federal provisions for confidentiality. Persons wishing to obtain information on behalf of a disability customer must submit the inquiry in writing with a release form signed and dated by the customer. (Exception is made for U.S. Senators and Representatives.)

Please note that disability determination is the only Social Security program handled by a state government office. Inquiries concerning other aspects of Social Security programs should be directed to SSA field offices. The Social Security hotline number is 800-772-1213.

Programs, activities and employment opportunities in the Illinois Department of Human Services are open and accessible to any individual or group without regard to age, sex, race, sexual orientation, disability, ethnic origin or religion. The department is an equal opportunity employer and practices affirmative action and reasonable accommodation programs.

DHS 4122 (N-07-15) DRS' Bureau of Disability Determination Fact Sheet Printed by the Authority of the State of Illinois. PO #15-2146 300 copies