Can you be denied disability in California even if your doctor says you are disabled?

Yes, and, unfortunately, this happens all the time. Ideally, the process of evaluating a Social Security Disability or SSI disability claim is supposed to work like this:

1. Your claim is assigned to a disability examiner (after the claim is transmitted, of course, from the social security office where you filed your application for disability).

2. The disability examiner requests MER, or medical evidence of record, from all of your doctors.

3. Once the medical evidence comes in (this can take weeks or even months), the disability examiner will evaluate the claim.

4. If the medical evidence, including the opinions of your treating physician (or treating physicians) points to a an approval, the disability case will be approved.

However, in actuality, things work less than ideally, particularly at the disability application level and at the reconsideration level (first appeal). At these levels, disability examiners often give little weight to the opinions of treating physicians and sometimes ignore them completely.

Why is this? There may be more than two reasons that comprise the answer, but I'll cite just these two. One, decisions on Social Security Disability and SSI that are made at the lower levels are administrative decisions, not legal decisions. Meaning that such decisions are not bound or guided by this or that legal circuit, but, more often, by the predilections of DDS unit supervisors (i.e. the supervisors of disability examiners).

In fact, I've not only seen DDS supervisors completely ignore the opinions of treating physicians, I've seen them argue with the opinions of their own unit medical consultants (the doctors who actually work at DDS and assist disability examiners in their decision making) and be successful in getting those opinions (RFCs) altered. Which is crazy if you think about it. After all, who's the doctor? The doctor or the state employee who works as a disability unit supervisor?

Two, treating physicians, unless they are prompted to deliver an opinion regarding a claimant's residual functional capacity (what you are still able to do despite having physical or mental problems), seldom do so in their records. Typically, doctors record only their observations and measurements in their treatment notes. And very often, this makes the task of "discerning" their opinion regarding a claimant's outlook nearly impossible. In other words, you can't give much weight to a treating physician's opinion if you can't find one to begin with.

A lot of this problem could be solved, of course, if disability examiners in California were simply required to ask doctors to complete residual functional capacity assessment forms. However, this is not likely to happen for a number of reasons. For starters, doctors would, in the vast majority of cases, demand substantial payment for this because it would consume time from their daily routine. Second, and this is just my opinion, the social security administration would not likely be in favor of this because the potential exists for greater numbers of approvals.

So, to address the question we began with, "Can you be denied for disability even if your doctor says you are disabled?", the answer is yes.

However, if your doctor firmly supports your case and makes it evident in his/her medical records that you are no longer able to work and will supply a detailed statement on your behalf to this effect, then your case will be much stronger than it otherwise would have been and your chances of being approved will rise considerably.

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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