Recent Medical Records for a Social Security Disability or SSI case

In order for a disability examiner to make a decision on a disability claim, the examiner will need to have recent medical evidence in the file. Recent evidence is defined as medical records that are not older than 90 days.

Why does social security need "recent medical evidence"? SSA actually needs newer AND older medical records. Older records can help establish how far back a person's disability goes, and this can have an immediate effect on the claimant's eligibility for back pay. Older records are also needed to establish that an applicant's disability began while they were still insured for title 2 benefits, which are SSDI, or Social Security Disability insurance benefits (note: SSI benefits, as opposed to SSDI benefits, do not rely on insured status because SSI is based completely on need).

For those who are unaware, one's eligibility to receive Social Security Disability benefits begins with the fact that they are insured for such benefits as a result of work credits that are earned through their years of work activity. Once a person stops working--such as due to a disability--they will eventually get to a point at which they are no longer insured under the SSDI program.

The best way to conceptualize this may be to think of it as being similar to car insurance and the fica taxes that are taken out of a paycheck (which pay for both social security and medicare) as being analogous to the payment of the premiums. Once a person stops working and receiving a paycheck, the "premium" is no longer sent in and the policy only has a certain amount of time before it lapses. Fortunately for individuals filing for SSDI, it can take years for SSDI coverage to lapse.

Newer, or recent, records, however, are needed for an entirely different reason. And that reason is this: for the social security administration to award disability benefits, it must be clear that the individual is disabled now, as of the time that the claim is being decided. And only recent medical record documentation can reliably prove that.

This, of course, is exactly why it is necessary for the social security administration to obtain recent medical records when a person's disability case is being decided. And, likewise, this is why it is important for a person who is filing for disability to keep going to their doctor regularly if they wish to qualify for disability benefits.

Note: If the social security administration cannot obtain recent medical records, the applicant will mostly likely be scheduled to go to a social security medical examination, otherwise known as a CE, or consultative exam.

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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