What does Social Security need from your medical records?
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.
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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