How does a person get approved for disability benefits?
The decision that is made on your Social Security Disability or SSI disability case will be made on the basis of both vocational and medical information. This means A) the information that is in your medical treatment records and B) your job history, including the the titles of the jobs that you have worked and a detailed description of everything that was done on a particular job. For more information regarding your work history, you may wish to read the following pages:
1. Social Security Disability and the Job that You Worked
2. What does social security mean by past work?
The medical information will, of course, include whatever records are obtained from your doctor or doctors. The social security administration (SSA) has a term for the doctor that has been responsible for treating your specific condition; for example, your family doctor or endocrinologist for diabetes, a psychiatrist or psychologist for depression or bipolar disorder. That term is "treating physician".
Some individuals will have one treating physician and other individuals will have several treating physicians. The treating physician is simply a doctor who has a history of providing treatment to the claimant and is familiar enough with the claimant (with regard to their diagnosis, history of response to treatment, and prognosis) that they can provide a medical opinion as to what the claimant is capable of doing, or not capable of doing, i.e. what their functional limitations are.
However, even though SSA considers that the claimant's treating physician is qualified to provide a medical opinion (either directly through a letter or through what their treatment notes have to say), the outcome of a disability claim cannot necessarily be determined on the basis of a doctor's recommendation.
This works both ways, of course, meaning that a claimant will not necessarily be denied if a doctor states that, in their opinion, their patient IS NOT DISABLED. By the same token, a claimant will not necessarily be approved if their doctor states that their patient IS DISABLED.
How does a person get approved for disability benefits from the social security administration? For a claimant to be approved for disability, the medical evidence must indicate that they have sufficient limitations that make it impossible for them to work (at one of their former jobs or doing some type of other work) and earn a substantial and gainful income. And these limitations are extrapolated from the information contained in A) a claimant's medical records and B) whatever statement a doctor may provide.
However, in cases where statements are offered by a claimant's doctor, the opinion reflected in the physician's statement must be consistent with the medical records. In other words, a statement saying the claimant is disabled will not seem valid to SSA if the doctor's own office notes do not reflect this opinion, or do not indicate that the condition is sufficiently severe enough to rule out work activity.
Note: SSA does not attempt to get statements from treating physicians; these are usually only obtained by disability lawyers at social security hearings.
More at: How to prove you are disabled and win disability.
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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