A Treating Physician is an SSD/SSI Claimant’s Best Ally
The Importance of Medical Records
There is no doubt that the most important aspect of a claimant’s Social Security Disability/Supplemental Security Income claim (SSD/SSI) lies in the content of his/her medical records. In fact, the Social Security Administration (SSA) defines disability as the inability to engage in any substantial gainful activity due to any medically determinable physical or mental impairment which can result in death or which has lasted or can last for a continuous period not less than 1 year.
The only way that one can prove a medically determinable impairment is by way of medical records. Of course, treating physicians and other medical providers are in charge of drafting these records. So, plainly stated, doctors hold the most important key in their patients’ SSD/SSI claims. However, it is not simply medical records what wins a disability claim but the content of those records.
Confirming a Patient’s Limitations?
Different from what many people think, in order to determine whether someone is disabled, the SSA does not focus on medical conditions and diagnoses as much as they look for limitations caused by those conditions. It is in this respect that treating physicians can be their patients’ best allies.
When treating doctors not only describe a patient’s medical condition or diagnosis but also their specific physical or mental restrictions, they can give their patients powerful evidence of disability. This is essential in light of the fact that SSA often hires their own physicians and medical examiners that will comment on a claimant’s condition. For the most part, these doctors will only review records or examine a claimant once, and then render opinions (that in the overwhelming majority of the time) will be unfavorable to claimants.
Established Relationships are Key
Another reason why a treating physician’s opinion is such a powerful tool for a claimant in a disability case is found in the SSA’s own rules. Generally, the SSA will give more credence to the opinion of medical providers who have examined claimants than to the opinion of someone who has not. Further, the SSA will also give more weight to opinions from the claimant’s treating doctors since they have the best picture of his/her overall medical impairments and how they affect them (after all, they have been the ones monitoring the claimant’s medical state for a longer period of time). This means that if an individual’s doctor(s), based on the medical treatment he/she has provided them, finds that the claimant has limitations that are consistent with their medical history, tests and treatment, the doctor’s opinion will most likely have controlling weight. That’s why an established relationship with a doctor is of such high importance.
However, beware! Just going to a doctor a few times and getting a favorable opinion from him/her will probably not be given a lot of credit by the SSA. Also, if a doctor gives an opinion that their patient is disabled, but such opinion lacks specific limitations or medical support to back that opinion, it will likewise be given little or no weight. As a result, it is important for disability claimants to talk to their doctors about their limitations and make sure that any limitations or favorable opinions given by their doctors make it to the medical records.
In light of all this, remember that medical records, followed by a medical provider’s opinion stating that a claimant has limitations causing their disability, can win an SSD/SSI case regardless of what SSA’s hired “doctors” say or write. It is up to a patient-claimant to make sure that the records of his/her physician address those areas to improve their chances of success (confirming they have mental/physical limitations). In the end, no one will have more of an impact on an SSD/SSI claim than a claimant’s doctor.
If you would like more information about the Social Security Disability claims process, you can view the website of Rue & Ziffra or call for a free consultation. We employ Social Security attorneys that are knowledgeable in many aspects of disability claims and other types of personal injury cases.
The above entry is NOT LEGAL ADVICE and should not be intended or construed as such. It is intended only as general information. No individual reading it should act upon it. Reading this entry does not create any relationship between Rue & Ziffra and individuals reading it. If you have questions or concerns, please seek professional legal counsel.