Medical Evidence and Your Social Security Claim

During tough economic times, our practice usually sees an increase in clients attempting to obtain Social Security Disability or Supplemental Security Income. Many times, an applicant, although suffering from debilitating medical conditions, has continued to work out of necessity. However, when the economy takes a downward turn, lay-offs are all too common and that worker loses his or her job. Now the employee is faced with the daunting prospect of finding new work while still suffering from physical problems. This can be a very difficult situation that leads to the application for disability benefits.

As a general rule, you must be out of work for 12 months, or have a disabling condition that is expected to last 12 months or more. Those applicants who have worked recently can almost always expect a denial, at least at the initial level. However, as you proceed through the system, if required to go all the way to a hearing, it will likely have been 24 months or more since you applied for benefits (assuming you have not engaged in substantial gainful employment during the interim). Therefore, you will have satisfied the general requirement of being out of work for at least 12 months.

Regardless of whether you have recently worked or not, there is one factor that is an absolute must in order to improve your chances of obtaining social security benefits....medical evidence. Medical evidence is necessary in order to prove entitlement to social security benefits. Good medical records that establish treatment for the disabling medical conditions are of immeasurable benefit in obtaining social security disability or supplemental security income. The reason it is so important to have your own treating doctors who have documented your condition and treatment, is that Social Security Judges give more weight to treating physicians than those appointed by Social Security to perform a one time evaluation. Therefore, establishing a physician/patient relationship prior to going before a Judge is very important.

Many times I hear that an individual has not had regular medical care because they have no insurance or a lack of financial resources to obtain care. Although unfortunate, the Judge will likely not be swayed by that predicament. Individuals, who do not have resources for regular medical treatment, should nevertheless make every effort to see a doctor. Many counties offer medical services for those with limited resources such as County Health Departments. Also, some hospitals have "patient assistance" programs to provide treatment for medical conditions. The Social Security Administration will likely set up medical examinations with their own doctors to assist in determining whether an individual is disabled. On rare occasions, these Social Security doctors find that a person has significant medical conditions and physical limitations that the Judge could find sufficient to award disability. However, these instances are extremely rare. More often than not, the Social Security doctors find that individuals have the physical capacity to perform gainful employment. If this is the only medical evidence before the Judge, then it is very likely the Judge will find the individual is not disabled and thus deny benefits.

As such, it cannot be emphasized enough the importance of having good medical evidence from a "treating" doctor prior to going before a Judge.