Being denied for disability in Indiana and the Medical Evidence

The basic reason any get a disability claim approved, a disability examiner (examiners make decisions on initial claims and reconsideration appeals) or a federal administrative law judge must have documentation available to them that allows them to do the following:

1. Determine if the claimant's impairment (or various impairments, as is usually the case) is severe or non-severe.

2. Determine what the claimant's functional limitations are. Functional limitations can be either mental or physical. Many claims do, in fact, involve both mental and physical impairments and this requires that the decision-maker on the claim consult with both a medical consultant as well as a psychological consultant (both consultants are part of the disability examiner's case processing unit).

There are instances, of course, in which a claimant has no history of medical treatment, or very little history of recent treatment. In those cases, the claimant will be scheduled to go to a consultative examination. This examination can be a physical examination, an IQ test, a mental status exam, or a full fledged psychiatric examination.

Consultative exams, often referred to as Social security medical examinations, are performed by independent physicians and psychologists, not by individuals who are actually employed by the social security administration.

Are disability claims in Indiana ever won based on the results of a consultative exam? It does happen occasionally. And it tends to happen more often when the exam is mental (such as for memory scale testing, or intelligence testing) versus a physical consultative exam (usually, physical exams last little more than ten minutes and the report provided by the examining physician provides very little useful information for either a disability examiner or a judge).

However, in the great majority of cases, consultative exams do not provide the basis for an approval of a social security claim.

Because cases that lack substantial evidence stand a poor chance of being approved by social security, individuals who are considering filing for disability benefits should do the following:

1. If they are not being seen by a doctor, they should begin to get regular treatment. This is the only way that medical records will be generated for the social security administation to obtain and review.

2. If they have a condition that has not been formally diagnosed (such as depression, or anxiety disorder), they should be seen by the appropriate source of treatment (for example, fibromyalgia should be diagnosed by a rheumatologist or a pain treatment specialist, whereas depression should be diagnosed by a mental health professional, ideally a psychiatrist).

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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