Medical Evidence Is the Key Factor when Determining Disability

by | Published on May 20, 2020 | Medical Review Services

Medical evidence is paramount in a social security disability claim, and for this you need to request for the disability applicant’s medical records that may be with different healthcare providers. Disability lawyers typically utilize medical records services to retrieve these documents. To speed up the claim processing and to ensure a faster determination on a disability claim, timely, accurate, complete and sufficient medical evidence is vital.

Importance of The Blue Book

The Social Security Administration (SSA) uses the Blue Book, their medical guide, to determine eligibility for disability benefits. The Blue Book is an online resource that lists hundreds of conditions and their symptoms as well as the test results needed for claim approval. The medical criteria required to qualify for a particular condition may vary based on an applicant’s diagnosis. There are serious conditions that qualify automatically such as ALS (amyotrophic lateral sclerosis) or esophageal cancer. However, even if the applicant has a listed condition, relevant medical records must be submitted to show that he/she meets the level of severity necessary for automatic approval.

To qualify for disability, the applicant must meet the SSA’s definition of disability. Partial or temporary disability may not meet their definition. The claimant must be able to prove that:

  • He/she cannot do the work they did before becoming disabled.
  • He/she cannot do other work because of the disability.
  • The disability will last at least a year or is expected to result in death.

Why Disability Claims Are Denied

Disability claims are most commonly denied because the applicant didn’t submit sufficient medical evidence to prove the disability. In fact, the SSA may want to see medical records dating back to the time when the applicant first became disabled. Identifying the disability onset date could prove difficult, particularly if the disability is mental rather than physical. For mental health disability claims, it is vital to verify with family, friends, and employers when the applicant’s condition started affecting his/her work.

  • Another important factor to consider is the timeliness of the medical records. These records must be recent enough to prove the claimant’s present medical condition – a rapidly changing condition would require more up-to-date information compared to a condition that progresses slowly. The SSA prefers records no older than 6 months. However, older records / past medical history is also important to obtain an overall picture of the claimant’s health condition.
  • Next, the medical records submitted must be accurate and correctly describe the claimant’s condition according to the acceptable medical sources’ standards. A medical opinion that is objected to, quoting objective evidence will not be considered accurate. Only if the medical records are complete and contain sufficient information from acceptable medical sources, can the SSA make an independent medical evaluation regarding the nature and severity of the claimant’s medical condition.
  • Ideally, the medical records must be typed, mention all the complaints of the plaintiff, show all exam/test results, as well as the treatments given. They must also include the patient’s response to the treatment, future treatment plans and a prognosis. However, medical records are often incomplete and insufficient and lead to claim denial. For instance, for a patient with arthritis, the medical record must contain description of the affected joints, range of motion test results, X-rays and other tests. Apart from these, the SSA also requires information such as whether the claimant cooperates in taking medication.

Medical Source Statements from the Treating Physician

Medical source statements from the claimant’s treating physician carry the most weight with the SSA. The treating physician who frequently interacts with the claimant is the best person to explain how the claimant’s disability interferes with his/her ability to perform full-time work activity. The treating physician can provide a clear evaluation of the claimant’s physical as well as mental condition.

Non-medical Evidence Could Be Important

Non-medical evidence is also important when it comes to evaluating a disability claim. For example, documenting the disability applicant’s daily activities and how the impairment affects these is important. If the claim goes to court, the claimant may be required to describe his/her ability to sit, stand, walk, carry objects, and do other specific tasks. A vocational expert could be consulted and his/her written opinion obtained detailing how the claimant’s condition affects his/her ability to work. Friends, colleagues, family members and other acquaintances can also attest to the claimant’s disability and how it has impacted the claimant. Importantly, it is not enough to just have symptoms of a disability, these symptoms must affect the claimant’s ability to perform work.

Social security disability applicants who work with a good disability lawyer have a better chance to get their claim approved. Disability lawyers employ medical records services to get all the medical evidence needed to support the claim – this is easier for them because they have a clear understanding regarding the medical records the SSA needs to approve the claim. They know what medical tests and expert opinions can help strengthen the claim, and guide the claimant through the entire process. The SSA has a checklist for online adult disability applications. Though the checklist isn’t exclusive, you can provide any extra information that is necessary to strengthen your claim.

Discover our medical record review solutions and partner with us for your next case.

Related Posts