December 2011 Archives

1. The information from a claimant's medical records should allow the disability examiner or administrative law judge (depending on the level of the claim) to discern that the claimant has functional limitations that are great enough to rule out the ability to work at a substantial and gainful level at--

A) at job that is part of their relevant work history and

B) at any other type of job for which they might otherwise be qualified.

2. The information should go far back enough to precede their DLI, or date last insured (think of it as the expiration point for insurance coverage), if their claim is for title II social security disability only, and should also go far back enough to hopefully support their AOD, or alleged onset date (when they believe that their condition became disabling).

3. The information in the medical records should contain recent information that supports a finding of "disabled". Social Security, for this reason, needs to see medical evidence that has been generated within the last ninety days. What happens if recent information is not in the file? It can make it more difficult to get a case approved. For SSA to make the determination that a person is disabled, they need to be able to determine that the person is disabled now. Without recent medical record information, a disability examiner will certainly be faced with having to schedule a claimant for a social security medical exam, or CE (consultative exam).

Consults are performed by independent physicians and when they are physical exams, they tend to be fairly brief. They are not for the purpose of providing treatment, and the examining physician may know next to nothing about the claimant or their medical history. Typically, a social security medical exam is ordered simply so the examiner can get the case closed. Will a CE get a disability case approved? Usually not on its own. However, if the remainder of the medical evidence is strong enough, it can allow an approval to be made since it will supply recent medical records which the examiner needs to close the case.







Additional Information on:
Social Security Disability







Social Security Disability Questions



Homepage for the: Social Security Disability Resource Center




















I recently received an email from a reporter at the Wall Street Journal, whose specialty seems to be economic affairs. He said that he had seen something I wrote, presumably long ago, about medical consultants and doctor shopping. I couldn't recall ever writing about doctor shopping, but I could tell his article would not involve any topic that I could realistically contribute well to, so I declined. However, this is main part of what I wrote back to him:

If by consultants, you're referring to the private physicians who conduct consultative medical exams for the social security administration, those exams tend to be largely useless aside from satisfying a requirement that an adjudicator have some amount of medical documentation that has come into existence within the last 90 days (so that SSA can state that their decision is legitimately based on current evidence).

If you're referring to the unit consultants who work with disability examiners, that system is astoundingly flawed. In that system, an M.D. who works in the examiner's unit will give a residual functional capacity rating to a claimant after reviewing the medical evidence. I.E. a doctor who has never treated or seen a patient will assess the patient's condition and resulting limitations. The consultant is hardly objective since he works for a state disability agency that is a component of the federal system. Yet, at the same time, if a claimant presents a detailed supporting statement from their treating physician (a doctor who, by virtue of his history of providing treatment to the patient, is actually deemed qualified to issue a medical source statement), that statement will likely be ignored.

The question should be "Why doesn't social security make the attempt to obtain a statement from the claimant's own doctor?" The system would make a lot more sense that way. They don't. And maybe cost is considered a prohibitive issue. But they still send people to these useless, unproductive exams and those have a cost. Like sending a claimant to a gynecologist for a consultative exam when the individual has degenerative disc disease.

Sorry I couldn't help.







Additional Information on:
Social Security Disability







Social Security Disability Questions



Homepage for the: Social Security Disability Resource Center




















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