Adjudication is the application of the law to the facts and an authoritative declaration
of the result (i.e. a signed determination or decision). Consider a claim adjudicated
when an employee with adjudicative authority delegated from the Commissioner of the
Social Security Administration completes
the appropriate electronic adjudicative decision screen,
the equivalent direct input screen, or,
signs a paper adjudicative form.
Once processed, initial determinations are subject to appeal (e.g., reconsideration,
administrative law judge (ALJ), appeals council (AC), or U.S. Court). If the appeal
results in a fully or partially favorable determination or decision, the ALJ or AC
routes the claim to the FO or PC for development, verification of any remaining entitlement
factors, and subsequent adjudication as defined above. Thus, the initial determination and each level of appeal require
a separate adjudication.
Adjudication is part of the effectuation process and occurs automatically and simultaneously
when processing the claim completely via an electronic claims system (e.g., Modernized
Claims System (MCS) or Modernized Supplemental Security Income Claims System (MSSICS).
However, in advance filing situations effectuation does not occur until the Treasury
Department processes payment certification.
Note: The disability determination or decision made by the Disability Determination Service
(DDS), ALJ, AC or U.S. Court constitutes only a part of the adjudicative process for