Social Security Disability - Why do I need to see my doctor regularly when my doctor can't help me?

I recently communicated with an individual who is pursuing an application for disability. She responded to the comments I left on her blog (about her pending claim) and threw out a very relevant question, one I'm sure has occurred to many disability claimants. The question was basically "Why is it so important to be seen regularly by my doctor when my condition is incurable and does not require regular visits". She elaborated on this by pointing out that a phone call will often suffice when she needs medication prescriptions refilled.

I have to admit, I was glad to hear someone address this issue. Because, honestly, it is a bothersome one. Here's what I mean. Social security likes to see recent medical record documentation when they evaluate a claim for Social Security Disability or SSI. In fact, if you haven't been seen by a doctor in 90 days, they are likely to send you to a social security medical exam so "recent medical evidence" can be obtained.

The logic used by the social security administration is that your condition and limitations cannot be properly evaluated if you have not been seen recently. But let's be honest. This is, in many instances, pure BS.

I'll give you several examples as to why I believe this is the case. First example: I know an individual who has addison's disease, a history of heart attacks, and a prior back fusion. This person is fairly limited with regard to functionality. However, she doesn't go to the doctor but once every four months or so. Why? Because she doesn't need to. Her physicians know her status and month to month monitoring is not necessary.

Second example: I know of an individual with schizophrenia. This is a person who has had several inpatient hospitalizations over the last 40 years for auditory hallucinations. She takes several medications, including one strong anti-psychotic. How often does she see her psychiatrist? About once every 4 months. Why? Because unless her condition degrades or she has a problem with her medication, there's no real need.

In each of these examples, the determination has been made by the patient's doctor that monthly visits or bi-monthly visits are unnecessary. Yet, from the standpoint of SSA, these patient's haven't been seen enough to determine eligibility for disability benefits.

Who's right, who's wrong? Obviously, the treating physicians are right in determining how often they need to see their own patients.

So, to address the question we started with, why does social security want you to see your doctor regularly when your doctor can do little more than prescribe you meds? Here's the answer, and its a two-parter---

A) Because someone in the social security administration, at some point and time, made the arbitrary decision that a claimant couldn't be approved without the most up-to-date medical records being made available, as in not older than two or three months.

B) Because the Social Security Disability system is an adversarial system that is hostile to claimants, i.e. it always looks for ways to unreasonably make the process harder and more disadvantageous to claimants.

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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