Will Social Security Award Me Disability if I have not been to the Doctor?

Social Security will award disability benefits if you satisfy the definition of disability, but this cannot happen without a medical determination based upon objective medical evidence. On the other hand, Social Security does not medically deny an individual if they have not seen a doctor. Now you may be wondering, just how does Social Security go about obtaining medical evidence when an individual has not been to a doctor for their disabling impairment or impairments?

Generally, Social Security Disability examiners like to base their medical determinations on medical evidence supplied by the medical treatment sources of the disabled individual.

However, if an individual has no medical evidence, or they have not been to a doctor within the last ninety days, the disability examiner is obligated to obtain current medical information prior to making their disability determination.

Toward this end, disability examiners schedule consultative examinations--physical or mental examinations performed by a physician paid by Social Security--for individuals who have not been to a doctor within the past three months (however, its not uncommon for a CE, or consultative exam, to be scheduled when the last treatment date is only 60 days out).

This may sound good to an individual who has not been able to afford medical care, however this examination is not for the purpose of medical treatment. Remember, Social Security's goal is to obtain medical information in order to ascertain if a claimant is capable of working at a level that is considered to be SGA (substantial gainful work activity).

For practical consideration, SGA is a monthly earnings limit that is increased each year by Social Security. If an individual works and earns over the set monthly amount under regular work conditions, they are considered to be working at an SGA level. If an individual is performing substantial gainful activity (SGA), their disability claim will be denied even if the individual has significant medical problems. This is because the social security administration's definition of disability rests upon the precept that a disabled individual is incapable of working and earning SGA-level wages for at least 12 months.

As you can see, medical records are a very important component of the Social Security Disability process. Consultative examination doctors are hired by Social Security to perform a one-time examination that will determine an individual's eligibility for Social Security benefits. Consequently, if at all possible, individuals who are applying for Social Security should at least try to get some medical treatment (i.e. hospital visits, clinics, or doctors) prior to applying for disability.

On the face of it, it would stand to reason that you might get a more thorough examination from your doctor than a doctor hired by Social Security to perform a one-time examination. However, as a former examiner I can safely state that in most cases the results of consultative exams have little positive effect on the outcome of a case.

In other words, A) few cases are won on the basis of a report provided by a physician who has been contracted to examine or test a disability claimant and B) the best medical record documentation will be provided by a claimant's treating physician who has an established history of treatment with the claimant and is also qualified to provide a medical source statement, or RFC form (detailing the claimant's physical and/or mental limitations),

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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