Are you applying for disability and wondering if you need to find a “disability doctor” near you? It’s important to note that there are generally no “Social Security doctors” who specialize in treatment for the purpose of winning Social Security claims. Unlike other disability systems such as workers’ compensation, where claimants are sent for independent medical evaluations for the purpose of determining work ability, Social Security primarily relies on the medical records from your treating physician. In addition, Social Security will rely on any specialists that your treating physician refers you to, physical therapy appointments, and mental health providers such as treating psychiatrists and psychologists.
The reason the Social Security disability process does not rely on “disability doctors” is that the disability evaluators assume that you will pursue treatment for the medical conditions that are most bothersome. Social Security also assumes that your established treating doctors will only recommend medical treatment that is necessary to cure or improve your medical impairments. Therefore, the medical records from your treating doctors and referrals are credible and reliable. Unlike evaluations from “disability doctors” in workers’ compensation cases or long-term disability (LTD) cases through private insurance companies, the medical records from your doctor are not generated for the purpose of litigation, so they are especially reliable in Social Security disability claims.
This article provides a clear roadmap regarding how Social Security will evaluate the treatment notes from your doctor for your Social Security Disability claim, offering insights into preparing for evaluations, maintaining effective communication, and understanding legal and ethical considerations. By staying informed and organized, claimants can ensure their medical records reflect the severity of their condition, aligning their healthcare provider’s objectives with their ultimate goal: securing the benefits they rightfully deserve.
Understand the Importance of Staying in Treatment with Your Doctor
Because of the way that Social Security rules and regulations are structured, your doctor plays a significant role in the outcome of your case. Doctors play a vital role in providing robust support by crafting detailed statements about your limitations, which strengthens your case.
Here’s what to consider when the Social Security Administration (SSA) evaluates the medical records from your doctor::
- Specialization: A doctor who understands your specific medical condition and can accurately interpret necessary evaluations, who is specialized in the area of disability, is generally viewed as more persuasive.
- Length of treatment: A doctor who has known your condition over a longer period can enhance your chances of a successful claim.
- Thorough recordkeeping: A doctor who keeps detailed medical notes about your medical condition will improve your chances of success.
A supportive and well-prepared medical record not only improves documentation but also ensures your medical condition is clearly communicated to the SSA, improving the likelihood of an accurate disability determination. This highlights the indispensable role health professionals play in navigating the disability claims process.
Navigating the Records Request System
When applying for Social Security Disability Insurance (SSDI), your primary doctor plays a crucial role. The SSA often contacts your physician to verify medical information and request medical records to support your claim. Additionally, they might seek your doctor’s opinion on your ability to work, which is part of the disability evaluation process. Independent medical consultants (called consultative examiners) may also be involved, providing evaluations without advocating for the claimant, which is essential for an unbiased assessment in determining disability benefits.
Securing evaluations and documentation
Medical documentation serves as the backbone of any Social Security disability application. Medical records are the “evidence” in your disability claim, and the Social Security Administration puts the burden of proof on the person applying for disability to “prove” disability. The SSA Social Security does not take people at their word regarding their limitations; the impairments must be documented by accredited sources. Thorough medical records enable evaluators to understand a patient’s diagnoses, treatments, and the daily impact of their conditions, all of which facilitate a fair assessment of the disability claim.
The treating physician plays a key role in this process by providing factual observations and referring to medical evidence within the patient’s records. It’s important for physicians to offer detailed statements that are supported by concrete medical evidence rather than relying on broad generalizations. Although the treating physician provides essential insights, it is the responsibility of the Disability Determination Services (DDS) claims examiner to ultimately determine the disability status based on the medical evaluations and records presented.
Medical evaluations for Social Security disability involve reviewing medical history, records, and conducting necessary physical examinations. These assessments aim to address the key criteria set by the SSA for disability, emphasizing the importance of submitting complete and detailed medical documentation. Carefully securing these evaluations guarantees an accurate and considerate determination process for disability applicants, enhancing the likelihood of receiving deserved benefits
Tips for getting support from your doctor for your disability
Asking your doctor to give an opinion about your disability can be daunting, given the administrative responsibilities they may need to undertake. Doctors sometimes hesitate to write letters or complete forms for Social Security disability claims due to a reasonable concern about getting involved with legal matters. Doctors already deal with onerous requests and paperwork from insurance companies, so requests from attorneys and judges represent additional administrative burdens on busy professionals.
Therefore, securing a physician willing to assist in this task is critical. Obtaining a statement from your physician detailing any limitations that prevent you from working is invaluable and can significantly enhance your case. Typically, the Social Security disability process involves your doctor verifying medical records and offering an opinion on your work capabilities. Providing detailed medical records coupled with a strong statement from your doctor can notably improve your chances of a successful disability claim. Remember, a comprehensive disability examination might include multiple medical professionals, such as specialists, not just your primary care physician, to ensure thorough documentation of your condition.
Alternatives if your current doctor is reluctant
As mentioned, some doctors may be reluctant to participate in the disability claims process. This reluctance can arise from various factors, such as workload concerns or skepticism about the validity of claims.
Understanding the specific reasons behind your current doctor’s hesitation can help you decide on the next steps, including whether to seek a second opinion or consult different medical evaluators. Exploring online resources or consulting advocacy groups may help identify experienced practitioners who are more than willing to support disability claims. Transitioning to a new doctor may become necessary, and having comprehensive and accurate medical documentation will ease this process and ensure continued support for your disability application.
Preparing for a Doctor's Appointment
When preparing for a doctor’s appointment, it is vital to provide detailed and specific information about your symptoms and limitations, including how your impairments impact your ability to perform basic activities of daily living. You may find it useful to keep a list of your primary impairments, and take these notes with you to your appointment with your doctor. This level of detail is crucial because it supports your disability claim with solid medical evidence that accurately documents your day-to-day functioning. Further, your doctor may want to send you for further evaluations such as X-rays or MRIs, or for additional specialty appointments to address your main concerns.
Inclusion of your doctor’s statement in your disability file is essential, as the Social Security Administration places significant value on opinions consistent with the overall medical records. If your current medical documentation isn’t comprehensive enough to support your claim, the SSA may arrange a consultative examination with an independent evaluator. Remember, these consultative exams are not for medical treatment but serve to objectively assess your condition’s impact on your ability to perform work-related tasks. They are particularly useful in cases where information from your treating medical sources is lacking and additional clarity is necessary for an accurate disability determination.
Importance of Good Communication with Your Doctor
Effective communication with your doctor is crucial when applying for Social Security disability. It’s critical for your doctor to understand not just your diagnosis, but precisely how your condition limits your ability to perform work-related activities and daily tasks. Also, you must clearly convey all limitations you experience due to your medical condition to ensure your doctor’s reports align with the information provided to the SSA. If you are in medical treatment for other conditions, or have a history of medical treatment for certain conditions, you should discuss this with your doctor so that they have a comprehensive understanding of your condition.
By openly discussing your functional limitations and the daily struggles you face, and refraining from exaggerating or downplaying your condition, you equip your doctor with the necessary information to provide compelling medical evidence. This detailed perspective helps the SSA accurately assess the severity of your disability and its impact on your life.
Also, keep in mind that engaging your doctor in this process involves more than providing information; it requires ongoing dialogue and ensuring that they complete necessary Social Security disability forms accurately.
Legal and Ethical Considerations
A pivotal element of applying for Social Security disability is the submission of a doctor’s statement that outlines the applicant’s limitations. This opinion is called an RFC (residual functional capacity) statement, in which your doctor provides an opinion about the impact of your conditions on work abilities, such as limitations on standing, walking, lifting, carrying, the ability to concentrate in spite of your pain, or any unscheduled absences you may experience due to a medical condition.
Social Security regulations require you to submit “all evidence” regarding your disability, including statements from your doctor that are not supportive of your disability. Therefore, you cannot submit any forged RFC opinions from your doctors to the SSA without the risk of being prosecuted for Social Security fraud. Disability attorneys who practice Social Security law take this ethical obligation seriously, as they are “officers of the court” and have an affirmative duty to comply with all SSA rules and regulations, including preventing Social Security fraud. If you have questions about the legal and ethical requirements of submitting Social Security RFC opinions, you should contact a trained Social Security attorney.
Keeping Records and Documentation Organized
Keeping your medical records and related documents meticulously organized is paramount when applying for Social Security disability benefits. The SSA relies heavily on a comprehensive and well-structured presentation of your health history to evaluate your claim. Having your doctors’ notes, test results, prescription lists, and hospital records readily accessible demonstrates the severity and duration of your condition, significantly strengthening your application. Disorganization can lead to delays or even denials, as the SSA may not receive a complete picture of your disability.
Therefore, investing time in organizing these vital documents streamlines the review process and significantly increases your chances of a successful outcome. You should also make sure to provide the SSA with the precise dates and locations of your medical treatments to help avoid misunderstandings that can lead to a denial of benefits.
Additional Notes About Medical Evaluations in Disability Claims
Medical evaluations are a cornerstone of any Social Security disability claim, and these additional notes will provide crucial insights into the process.
Neuropsychological examinations
QME and AME: Not part of the SSDI process
If you’ve had experience with California Workers’ Compensation, you might be familiar with terms like qualified medical evaluator (QME) or agreed medical evaluator (AME). These roles are part of the workers’ compensation system, not Social Security. The SSA does recognize workers’ compensation terms such as “permanent and stationary” or use percentages when evaluating how certain body parts would be limited due to a disability.
However, the SSA does use QME or AME doctors’ exams as part of the overall disability evaluation process. If you have a QME or an AME, you should be sure to submit these reports to the SSA. .
IMEs for long-term disability
Independent medical examinations (IMEs) are often required by private long-term disability insurance companies, not the SSA. If you are pursuing both an LTD claim and an SSDI claim, it’s important to know that each process operates independently. The SSA typically does not accept or require IMEs. Instead, it conducts consultative examinations with doctors it hires directly when it needs more medical evidence.
However, as with QMEs and AMEs, you should submit the IME report to the SSA in order to prove disability under Social Security regulations. The IME doctor often performs an in-person examination and summary of your disability, which can be helpful for a DDS reviewer who is examining your condition.
If you’re seeking Social Security disability benefits, you likely have many questions about eligibility and procedures. The legal team at LaPorte Law Firm offers clear explanations and strong advocacy to help you secure the compensation you deserve. Call us now to discuss your claim.
FAQs
Yes. Depending on your condition, you may need specialists in neurology, orthopedics, or mental health. Larger cities and rehab centers often have these experts. Telehealth can also connect you to specialists outside your area. Ask your doctor or local support groups for referrals.
No. In general, doctors are not “disability doctors” who only treat patients for the purpose of Social Security disability. Your own primary care physician is the best source of medical evidence for the purposes of your Social Security claim. Most attorneys do not recommend obtaining medical treatment merely for the purposes of proving disability. Most people who are approved by the SSA are already under the care of a physician for long-standing conditions.
