Social Security Disability Doctor, Supportive Statements

Most applicants who file for Social Security Disability (SSD) or SSI do so as a last resort they simply are unable to earn a living due to their physical or mental condition. In many cases their treating physician, the one who is in the best position to evaluate their functional limitations and to give a prognosis (how the impairment will progress over time) agrees that the medical condition is both severe and disabling. Yet, how much weight does one's treating physician carry in the disability determination process? Sadly, at least at the first two levels of consideration, not enough.

Decisions on initial disability applications and first appeals (requests for reconsideration) are decided by disability examiners who work for the state Disability Determination Services (DDS) agency. These examiners are under an enormous amount of pressure to keep their total number of approvals down; they give little consideration to reports from treating physicians because the reports typically support the case for disability.

DDS examiners are subject to quality control reviews, and if they hand out too many approvals they will probably find themselves out of a job.

However, supportive statements from treating physicians can be very important to claimants who file a second appeal. The second appeal is decided at a disability hearing by a federal administrative law judge (ALJ), who is not employed by DDS, and thus is not subject to the same pressure to deny disability claims. Perhaps because they do not feel the same pressure to deny claims, disability judges tend to give great weight to the opinions of claimants' treating physicians, and are statistically far more likely to approve SSD/SSI claims than disability examiners: about half of all disability claims denied by DDS are later approved by an ALJ at the hearing level.

So, having a supportive opinion from a doctor can make or break a disability case if it has reached the hearing level, though the exact same opinion will have little if any impact on the decision of a disability examiner.

This is no accident: the entire disability determination process is designed to frustrate and discourage applicants, and the strategy works. Most individuals who are denied disability benefits do not appeal, or at least do not appeal to the hearing level, at which they stand their best chance of winning.

Claimants with severe mental or physical medical conditions who have the support of their treating physicians are in a good position to win Social Security Disability benefits'if they have the stamina to see their claims through to the second level of appeal, a disability hearing before a judge.


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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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