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Social Security Disability Blog

Gap In Medical Treatment And Effects On Social Security Disability Benefits

Thursday, June 30, 2016

Medical records are the focus of every social security disability case. The Social Security Administration (SSA) will thoroughly comb through your medical records to assess the extent of your treatment in order to determine the severity of your disability.

In many instances in a social security disability case, a claimant will stop treating with a doctor. The reasons for the gap in treatment are important. If the medical records are devoid of the reason that treatment stopped, SSA may assume that the symptoms have improved and that you are no longer disabled. It is imperative that, whatever the reason, you have discussed the reason with your doctor so that it appears in your records.

Maximum Medical Improvement

If you stop treatment because you have exhausted the many different treatments recommended by your treating physician and there is no improvement in your symptoms, it can be argued that you have reached medical maximum improvement and there is nothing else your doctor can do for you. In this instance, SSA will use all of the relevant medical records to access your eligibility for benefits.

Financial Problems

Another reason for ceasing treatment is a claimant may not be able to afford treatment. This is true for many claimants and SSA understands that you are not working and your financial situation may not allow for you to treat. Thus, SSA cannot make a negative inference from your lack of treatment due to inability to access low-cost medical care or not having sufficient health insurance.

Reluctance to Have Surgery

You may have been recommended for surgery by a doctor but you refuse to go through with the surgery. Your refusal to treat in this situation, can be seen as a refusal to comply with medical treatment. However, your medical history and treatment can support your refusal to comply with treatment. For instance, if you have already had 3 surgeries without improvement it may be reasonable to decide not to have a 4th surgery.

Mental Impairments

For individuals with a mental disability it is understood by SSA that there may be periods of failing to seek treatment. This could be a symptom of your mental disability so failing to seek treatment in this scenario would not, in and of itself, be a deciding factor as to your eligibility for benefits.

Any claimant who has a situation where they have or intend to stop treatment must ensure their reasoning is a valid reason for which SSA will accept and not hold against you. After all, your medical records are the source of accessing your credibility, as well as the nature and extent of your disability. Without this information SSA can infer that your symptoms are not severe enough to warrant you seeking medical help, thus it is not severe enough to prevent you from working.

By Patricia Zeleznik

3 Suggestions To Increase Your Chances Of Winning A Claim For Social Security Disability Benefits

Monday, August 04, 2014

The Social Security Administration (SSA) denies a whopping 72% of the initial disability benefit applications and denies about 90% of reconsiderations (the first level of appeal). (Annual Statistical Report, 2011). Though these numbers might make you think poorly of SSA, in most of these cases the evidence in SSA’s record just does not support a claim for disability. You may, in fact, be disabled but theevidence in SSA’s possessiondoes not support disability. If you are applying for disability benefits or at an appeal stage, below are three suggestions to increase your chance of success.

1. Make sure medical provider information is accurate and current

Your application for disability benefits requests the dates, names and addresses of your medical providers. This is because SSA will contact the providers and request your medical records. This is a blessing and a curse. It’s great that SSA takes on the headache of getting copies of your medical records and even pays the medical records copy fees. But it’s a curse because SSA may not have all of the medical records to support your claim for disability in the record.

An incomplete medical record at SSA is typically because of one of two reasons. First, the medical provider may not have responded to the record request. Unfortunately, this is fairly common. SSA does not have the personnel to pester medical providers who fail to respond to medical records requests. Second, you may have failed to provide accurate and/or current medical provider information. If you do not provide the SSA with accurate addresses or current information about your treatment, they obviously will not be able to obtain those medical records.

So my advice is to be diligent about providing the correct names and address of all of your medical providers to SSA. And for those truly motivated individuals, you might request a complete set of your own medical records and provide copies to SSA. In this way you can be the one to pester your doctors for not providing copies of medical records.

2. Obtain specific work restrictions from your treating doctor

Even if SSA does get all of your doctor’s reports, the reports they receive may not be enough to prove you are disabled. The doctor’s diagnosis of failed back syndrome, bipolar disorder, or muscular dystrophy is often not enough to prove that you are unable to work. Standard medical records contain four basic sections: complaints, examination findings, diagnosis, and treatment. There is no section of a standard medical report for the doctor to provide information regarding your ability to work. Thus, try to get your treating physician to indicate in writing your restrictions as a result of your medical condition and submit this information to the SSA. By restrictions I mean how much you can lift, how long you can sit or stand, etc. A doctor’s note that simply states you are unable to work is rarely persuasive to the SSA.

3. Hire an attorney

I know it sounds self-serving, but consider hiring an attorney. A competent attorney who practices before SSA can be an invaluable resource in making sure the evidence that SSA uses to make its decision is sufficient and complete. An attorney is also a good idea if you are heading to a hearing before a federal administrative law judge.

The numbers seem to support the idea that hiring an attorney might be a good idea. The Social Security Advisory Board found that people who had an attorney at the initial application stage were more likely to be awarded benefits. (SSAB, 2012). And the Government Accounting Office found that people who had an attorney at their hearing were more likely to win their case. (GAO, 2003).

By David Galinis

3 Reasons Your Claim Was Denied

Monday, November 08, 2010

1. You Are Still Working

The most basic eligibility requirement to receive Social Security Disability Benefits is an inability to engage in substantial gainful activity that has lasted or is expected to last for 12 months. In other words you cannot be working. When the disability examiners evaluate your claim, they will look at your earnings record. Remember how Social Security taxes are taken out of each paycheck? Social Security knows how much you have earned during each month of your working life. If the examiner finds ongoing wages, it’s pretty easy to deny the claim.

2. Lack of Medical Evidence

When you apply for disability benefits, the Social Security Administration (SSA) requires that you provide the names and addresses of any doctors or hospitals that have provided treatment. SSA also requests that you sign medical authorizations. SSA will then request your medical records from all the providers that you identify. When the examiners review your file to determine your eligibility for benefits, the medical records received are the most significant evidence considered.

In many cases, when the examiner finally gets around to your case the medical records contained in your file are thoroughly incomplete. This is for a variety of reasons. First, you may not have identified all the providers – thus SSA would have never requested those medical records. This could be a hospital visit you forgot or the diagnostic imaging center that performed your MRI. Second, obtaining medical records requires persistence. Many times the first request to a medical provider gets no response and a follow up request is required. Other times no records are received because the identity or address of the provider is wrong. SSA employees simply do not have the time to follow up on requests that don’t get a response. In these situations, the examiner often denies the case because there are no medical records to support your allegations of disability.


3. The Wrong Kind of Medical Evidence

Even if SSA has received the medical evidence – it is probably the wrong kind of evidence. To understand my point here, you need to understand medical records. When doctors create a record from your visit, they generally write it in the SOAP (subjective, objective, assessment, plan) format. The medical record typically contains these four categories of information: history (subjective), examination (objective), diagnosis (assessment), and treatment recommendations (plan). There is no category called “Disability” or “Work Restrictions.” Hence, most medical records will typically not contain any information about how the condition affects your ability to work.

The medical evidence that will support your claim for disability is information about restrictions. How much weight you can lift? How long can you stand or walk? How often will you be absent from work due to your condition? When the examiner looks in the medical records he or she may see that you have lumbar disk disease. The examiner needs to know how that condition prevents you from doing work activities. What restrictions does that condition impose upon you? The examiner, because the medical record is usually silent as to restrictions, is allowed to formulate his or her own opinions as to how your lumbar disk disease may impair your ability to work.

By David Galinis


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