The Role of Your Doctor in a SSDI Claim

One of the first things a person does at the onset of a serious and disabling condition is to consult a doctor. The initial days and weeks of assessing and learning about a debilitating impairment are scary and stressful for those afflicted. Doctors are the first and primary source for dealing with disabling conditions, and will play a key role in claims for Social Security Disability Insurance (SSDI) benefits. Proving disability rests largely on the medical evidence submitted to the Social Security Administration (SSA) that shows the existence of conditions that severely limit an individual’s physical and/or cognitive function. While it is common for those suffering from a disabling condition to see a bevy of specialists as they try to cope with their new reality, most people have one doctor they see for the majority of treatment. This doctor could be a family physician, but for those with a disability, more often the doctor is a specialist in the area most closely related to treating the disabling condition. These doctors are usually in the best position to give accurate and medically-supported opinions on a person’s functionality and pain levels. Recent numbers reveal that fewer disability claims are being approved by the SSA compared to the past, so gathering as much quality medical evidence as possible is even more important to being approved. Further, recent SSA rule changes will affect the impact of the treating physician’s opinion, so understanding what medical information the SSA focuses on when evaluating SSDI claims is essential.

Crucial Medical Information in the Disability Application

Applications for SSDI benefits are long and detailed, requiring a lot of information to complete, especially as it relates to work history and medical treatment. It can easily require several hours to complete these applications, which is a strong argument in favor of working with a disability attorney to ensure it includes all the key points. However, an attorney is limited by the amount of information provided by the applicant, so it is incumbent upon the person seeking disability benefits to provide as much as possible. In particular, many applicants fail to list all relevant medical providers, accurately list the earliest dates a condition was diagnosed, or correctly identify when treatment began with specific doctors or hospitals. The SSA uses the earliest treatment date to establish when the onset of a disability began, which is in turn used to determine when potential disability benefits start to accrue. In addition, examiners will base medical records requests on the dates and providers listed by an applicant, and if an applicant does not record this information accurately, crucial information may be left out of the applicant’s file.

Treating Physician

Previously, and still applicable to applications filed before March 27, 2017, the opinion issued by a treating physician was given a significant amount of weight in the disability determination. A treating physician is a doctor who has a history of treatment with the disability claimant, and is considered to have the most accurate information concerning a claimant’s prognosis and limitations. As noted above, this rule still applies to applications filed before March 27, 2017, but for new applicants, the focus will be on the supportability and consistency of medical evidence. However, this new rule does not necessarily mean it is a good idea to bounce from specialist to specialist. The more doctors that become involved in an individual’s treatment, the more likely opinions about prognosis and treatment will start to conflict, which weakens the overall case for a disability finding. Rather, it may be better to obtain treatment from a few related specialists that complement one another and concur about the existence of a condition that would have severe debilitating effects on the sufferer.

Get Help

Dealing with a disability is an overwhelming task all by itself. Protect yourself from additional stress by working with an experienced disability attorney on your disability benefits claim. An attorney will know exactly what information to include and the types of medical records to obtain to build you the strongest case possible. Farrell Disability Law represents clients in Jacksonville, Orange Park, Fernandina Beach and the surrounding areas in disability insurance matters, and can help you get the benefits you deserve. Contact the office for a free consultation.

Resource:

ssa.gov/oact/STATS/dibStat.html