How to file for disability, Filing for SSI
Disability Requirements, Disability Status
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The Social Security List of Impairments
Qualifying for Disability, Mental Disability
Disability Lawyer Info, Disability Back Pay
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),
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For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.
The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.
To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.