Does Social Security Disability prefer Current Medical Records for SSDI and SSI claims?
All SSDI (Social Security Disability insurance) and SSI (Supplemental Security Income) disability claims go through the same medical determination process. Both current and non-current information can be helpful to an individual's disability determination. In fact, Social Security Disability examiners prefer to have at least a twelve-month medical treatment history when making their medical disability determinations.
There are a couple of reasons older non-current medical records are potentially valuable to an individual's disability claim.
Firstly, individuals who have an "expired" date last insured (a DLI, or date last insured, is the last point at which a person was covered, or insured, to receive Social Security Disability benefits) need older medical records to help them establish their onset of disability prior to losing their Social Security Disability insured status.
Note: insured status is earned through work credits that result from an individual's work activity prior to their becoming disabled.
Once an individual loses their insured status, they will only be eligible to file for Supplemental Security Income disability program (a.k.a. SSI), which is need-based, and whose monthly disability benefit may not be as high as their receive back payment for months that they may not have been entitled to they only had current medical records. For example if an individual has not worked at a level that is considered to be substantial gainful work activity for seventeen months prior to filing for disability, they may be entitled to twelve months of retroactive benefits.
However the individual must have a medical treatment history that indicates that the individual was indeed disabled seventeen months ago, meaning "older medical records".
Past medical records can be helpful but are they necessary for a Social Security Disability medical determination? Unfortunately, the answer to this question is no. Social Security Disability examiners only need current medical records to make their Social Security determinations. It's logical, considering that Social Security Disability is based upon how an individual is currently functioning rather than how they were functioning.
Social Security Disability examiners can even make a medical determination based solely upon a one-time consultative examination with a physician, who may not even practice in a medical specialty that addresses the disability applicant's alleged disabling condition.
Additionally, these physicians are only paid to give a quick status of the limitations caused by the applicant's disabling condition rather than an in-depth evaluation of the disability claimant's condition, or conditions, and they rarely lead to an approval.
For this reason, it is better for an individual's disability claim to have current medical records from their treating physician or physicians. There is no way around the fact that an individual's own doctor is more familiar with their conditions and how their condition, or conditions, limit their ability to function, versus a consultative examination physician who has been paid by Social Security and who has never personally met them prior to the consultative examination.
Social Security likes current medical records because it helps them save on the expense of developing medical evidence; it also allows them to make quicker decisions. Although it is good for Social Security for a disability applicant to have their own current medical treatment information, it is also very good for a disability claimant's chances of winning their disability benefits.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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