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How a Disability Determination is Made

Find out what happens at the Disability Determination Bureau (DDB) after you apply for any of the following benefits:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)
  • Medicaid
  • Medicaid Purchase Plan (MAPP)

Full process

Here are the steps to getting a disability determination:

  1. You apply for benefits with your local county or tribal agency. They will review your claim. This involves looking at your income, resources, and assets to see if you meet non-medical requirements.
  2. Then, your application is sent to the Disability Determination Bureau. We will make a medical determination of disability. To make this decision:
    1. We collect medical evidence from your doctors, clinics, and hospitals, along with other information about your condition.
    2. We may ask you to provide information about your daily activities and work history.
    3. We may ask you to have a medical exam, free of charge, if your medical records do not provide enough information for our evaluation.
    4. Our disability examiners and medical professionals evaluate the evidence to decide if you meet the definition of disabled.

The definition of disability

Social Security and the State of Wisconsin use the Social Security Act’s definition of disability.

  • For adults, an individual must have a severe disability (or combination of disabilities) that has lasted, or is expected to last, at least 12 months or results in death, and which prevents working at a “substantial gainful activity” level.
  • For children, the child must have a physical or mental condition(s) that very seriously limits their activities; and the condition(s) must have lasted, or be expected to last, at least 12 months or result in death.

You cannot get benefit payments if your condition will not last 12 months in a row.

How you can help

You can help us keep the process moving smoothly.

  • Give complete information on the application—Provide complete names, addresses, and dates of treatment for the doctors, clinics, hospitals, and other health providers who have treated your medical conditions.
  • Let us know of any changes—Call 800-423-1938 to report any change that occurs after you file your application. This includes if:
    • You have a new address or phone number.
    • You see a new health care provider. o You are hospitalized.
  • Complete and return any forms as soon as possible—We may need these forms to make a decision.
  • Attend all medical exams we schedule for you—These exams help us determine the full extent of your condition and how it affects you.

Learn more

Find more information on the Frequently Asked Questions page.

Last revised December 6, 2022