OPPAGA text logo with graphic of FL historic capitol
OPPAGA text logo with graphic of FL historic capitol

Department of Health

Disability Determinations

What is the purpose of the program?

The Division of Disability Determinations determines medical eligibility for Florida citizens who apply for disability benefits under the Social Security Act disability programs-Social Security Disability (OASDI-Title II) and Supplemental Security Income (SSI-Title XVI)-and the state's Medically Needy program.

How is the program organized?

The Disability Determinations Division has four bureaus and a Quality Assurance Unit.
  • Bureau of Medical Disability Administrative Services provides administrative support functions such as budget, finance and accounting, facilities management, and human resources management.
  • Bureau of Medical Disability Information Services provides administrative oversight and management of all the division's information technology functions such as application development, web publishing, and systems security.
  • Bureau of Medical Disability Program Operations directs and coordinates claims processing in eight area offices to ensure an effective and efficient workflow to meet the federally and state mandated production, cost, and quality goals.
  • Bureau of Medical Disability Program Services coordinates the dissemination of federal and internal policies and procedures. The bureau also processes requests for hearings before administrative law judges in the Social Security Office of Disability Adjudication and Review.
  • Quality Assurance Unit ensures that claims are adjudicated accurately. The unit performs reviews of evaluated claims, reviews federal data reports and conducts specialized studies. These activities support the division and its compliance with federal standards.

How are claims processed?

Persons with a disability may apply for Social Security disability benefits at a local Social Security field office or on-line. Applications for the Medically Needy program are made at a local Department of Children and Families office or on-line. In both cases, the division evaluates the application to determine medical eligibility.  The division then returns the claim to the Social Security Administration or the Department of Children and Families for a final determination of non-medical eligibility.  If the person is eligible, staff initiates benefits.

How is disability determined?

The division determines medical disability according to the federal Social Security Administration's criteria and definition of disability. Federal law defines disability as the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

How many Floridians receive disability insurance benefits?

Florida has one of the largest state disability program in the nation. During Calendar Year 2018, more than 1 million Floridians received federal disability benefits totaling approximately $12.3 billion dollars.
Disability Benefits Awarded by Year
Calendar Year Number of Recipients Amount (in Billions)
2014 1,106,705 $11.7
2015 1,112,835 $12.0
2016 1,105,067 $12.1
2017 1,096,892

$12.2  

20181,082,342$12.3
Source:  Social Security Administration.

How many disability claims were processed accurately?

In Fiscal Year 2018-19, the division processed 285,111 claims for the period, above the approved performance standard of 249,608 claims. In addition, the division accurately processed 97.3% of the claims, exceeding the state performance standard of 95.31%. The total determinations completed have decreased 4.07%, partially due to the lack of federal hiring authority.

How are these activities funded?

Fiscal Year: 2020-21
Fund Dollars Positions
PROGRAM: DISABILITY DETERMINATIONS
DISABILITY BENEFITS DETERMINATION
160,982,829
1,040.00
TOTAL
160,982,829
1,040.00

Where can I find related OPPAGA reports?

A complete list of related OPPAGA reports is available on our website.

Where can I get more information?

Other Reports
Annual Statistical Supplement 2019, Social Security Administration.
Agency Financial Report Fiscal Year 2019, Social Security Administration.
Websites of Interest
Social Security Newsletter
Social Security Disability Benefits
Social Security Disability Insurance Benefits
Performance Information
Performance measures and standards for the department may be found in its Long Range Program Plan.

What are the applicable statutes?

Title 20 Part 404, Code of Federal Regulations,Title 42 Part 442, Code of Federal Regulations, and Ch. 409, and s. 20.43, Florida Statutes.

Whom do I contact for help?

Division of Disability Determinations, 800-499-6590

Website