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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.

Return to:  Social Security Disability Resource Center, or read answers to Questions

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?

Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI

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

Filing for disability - How to file for SSD or SSI and the Information that is needed by Social Security
How to Apply for Disability - What medical conditions can you apply and qualify for?
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?
How to Prove you are disabled and qualify to win disability benefits
How do you prove your disability case if you have a mental condition or impairment?
Social Security Disability Back pay and How Long it Takes to Qualify for it and receive it
Social Security Disability SSI - Eligibility Requirements and Qualifications Criteria