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How to file for disability, Filing for SSI
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How Important is the Treating Physician to a Social Security Disability or SSI case?



 
The Social Security Administration considers a treating physician to be a doctor who has an established history of providing treatment to a patient for a specific condition. Because this physician has a history of providing care to a person for whatever their condition is, SSA considers this doctor to be a reliable source of information regarding the individual's A) prognosis, and B) the extent to which--and manner in which--their condition limits their ability to engage in normal daily activities, including work activity.

A treating physician, by definition, is not simply a doctor who has seen a patient once or twice. By the same token, a doctor who is a podiatrist (foot specialist) cannot be considered a treating physician for a disability claimant who is applying for disability on the basis of a mental condition.

How important is the opinion of the treating physician to the decision that is made on a Social Security Disability claim, or SSI disability claim? Fairly important.

At a disability hearing where the decision is made by a federally appointed judge, the opinion of a treating physician that is recorded on either a residual functional capacity form, or on some other type of medical source statement (a statement submitted by a doctor which indicates in detail how a person is physically or mentally limited), can absolutely determine if a claimant will qualify for disability benefits, or not.



The opinion of a treating physician is much more highly valued than the opinion of a doctor who has only seen a claimant once or twice. This, of course, makes sense considering that a treating physician, by definition, should know much more about the claimant's condition, treatment, and response to treatment.

For this reason, most experienced disability representatives (i.e. a disability attorney or a non-attorney representative) will try to obtain a statement from a claimant's treating physician whenever a case is to be heard by an ALJ (administrative law judge) at a hearing. Disability judges simply give credence and weight to such medical opinions.

Will the opinion of a treating physician carry the same weight when the case is being decided at a lower level, such as the disability application level, or the reconsideration appeal level? Unfortunately, this is often not the case. This is because the lower levels of the disability system are tilted against the claimant. This is easily demonstrated by several facts:

1. The social security administration does not make any attempt to obtain the opinion of a claimant's treating physician, or treating physcians (you can have more than one), when the claim is being decided initially. This is despite the fact that disability lawyers routinely obtain them to present to social security judges at hearings.

2. Social Security will instead use the opinion of a medical consultant who is part of disability examiner's case processing unit. This consultant is a medical doctor who assists the examiner in making a determination on a disability case. In so doing, the medical consultant will review the claimant's medical records, just as the disability examiner has done.

However, the fact remains that this doctor has never treated, nor met the claimant. By definition, this doctor is immeasurably unqualified to give an opinion as to the claimant's functional limitations in comparison to the claimant's own doctor.








Essential Questions

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Can you work while getting or applying for Disability?

How Often Does Social Security Approve Disability The First Time You Apply?

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What kind of Mental Problems Qualify for Disability?

Receiving a Disability Award Letter

Conditions Social Security will recognize as a disability

Previously answered questions regarding SSD and SSI

Applying for disability in your state



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Related pages:

When Social Security Disability Sends You To A Doctor, What Kind Is It?
Who is The Doctor for a Social Security Disability Claim or SSI Case?
What should you get from your doctor to file for disability benefits?
Why Will You be Sent to a Social Security Doctor for your disability case?
Will Social Security Grant Disability If I Have Not Been To the Doctor?
If I apply for disability and my doctor says I am disabled, is there a waiting period to receive benefits?
SSA Medical Exam and your own Physician
How Important is the Treating Physician to a Social Security Disability or SSI case?
Will surgery on limbs give you a chance of getting disability?
Will getting retirement affect my application for disability based on COPD?
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Social Security Disability Back Pay in California
Social Security Disability For Mental Illness in California



These pages answer some of the most basic questions for individuals who are considering filing a claim.

Can you get temporary Social Security Disability or SSI benefits?

Permanent Social Security Disability

What is the difference between Social Security Disability and SSI?

Who is eligible for SSI disability?

Can I Be Eligible For SSI And Social Security Disability At The Same Time?

What makes a person eligible to receive disability benefits?

Applying for Disability - How long does it take to get Social Security Disability or SSI benefits?

What happens if I file a disability application and it is denied by a disability examiner or Judge?









For the sake of clarity, SSDRC.com is not the Social Security Administration, nor is it associated or affiliated with SSA. This site is a personal, private website that is published, edited, and maintained by former caseworker and former disability claims examiner, Tim Moore, who was interviewed by the New York Times on the topic of Social Security Disability and SSI benefits in an article entitled "The Disability Mess" and also by the Los Angeles Times on the subject of political attempts to weaken the Social Security Disability system.

The goal of the site is to provide information about how Social Security Disability and SSI work, the idea being that qualified information may help claimants pursue their claims and appeals, potentially avoiding time-consuming mistakes. If you find the information on this site helpful and believe it would be helpful to others, feel free to share links to its homepage or other pages on website resource pages, blogs, or social media. Copying of this material, however, is prohibited.

To learn more about the author, please visit the SSDRC.com homepage and view the "about this site" link near the bottom of the page.