Monday, December 17, 2007



Social Security Disability - Does it take the right doctor to win?

Someone said this in a forum:"All it takes is having the right doctor to win disability benefits. If you know someone who will say the right things for you, you're in".

How true is this statement, or is there any truth in it at all? well, let me answer by saying that at a social security disability hearing, the written opinion of a treating physician can carry substantial weight, and can certainly make the difference between winning a disability case or losing one. And it is exactly for this reason that a disability representative will attempt to obtain a medical source statement (also known as an RFC, or residual functional capacity, form) from your treating physician or physicians.

In fact, if your hearing date is approaching and your disability representative is making no attempt to gather such a statement for presentation to the administrative law judge...then you might need to consider asking for a postponement of your hearing for the purpose of finding new representation (amazingly, I've actually come across some representatives who did not include this very simple and very effective case development tool as part of their arsenal, and these individuals should probably be enouraged to go into another line of work).

Without a doubt, and I mean any at all, statements from treating physicians are a definite advantage at disability hearings. However, at the first two levels of the disability claim process, things are a bit different.

At the initial claim (the application level) and reconsideration levels, decisions are not made by federal judges, but, instead, by disability examiners. Examiners gather medical evidence. However, unlike disability attorneys who usually attempt to get detailed statements from treating physicians in preparation for a hearing, disability examiners make no such attempt.

Why? There probably isn't an answer that anyone could find in writing as to why this practice (or "lack of a practice" exists). But one thing is clear: by not obtaining such statements, the social security administration approves far fewer claims at the initial claim and reconsideration levels. True, claimants who have been denied disability may request a disability hearing where a judge is more likely to consider a statement from a doctor. But, the reality is that many claimants will simply give up before they get that far. Which means fewer approvals and less money spent by the federal government.

Disability examiners do not gather statements from treating physicians and this poses a clear disadvantage to individuals who are filing for disability. What does social security do instead? A couple of things.

1. A claimant's medical records will be reviewed by a medical doctor who is assigned to the disability examiner's unit. But this doctor works for social security and is hardly impartial. Even worse, this doctor has never seen nor treated any of the cases he or she provides input for.

2. Social Security will often send a claimant to a a social security medical examination. This is an examination that is conducted by an independent physician, someone who does not work for social security. However, once again, this is a doctor who does not have a treatment history with the claimants he briefly sees (consultative exams tend to last 10-15 minutes and are essentially useless in evaluating a disability claim).

Making matters worse, on top of the fact that social security that does not gather statements from doctors is the fact that, even when such statements are gathered by the claimant's themselves, they are often ignored by the disability examiner.


So, regarding the question "Does it take the right doctor to win?", the answer is:

1. A physician's statement can help to win a case, but, in most instances, this will occur at the hearing level.

2. Getting a physician to submit a statement on behalf of a case that is pending at the initial claim or reconsideration level is often a waste of time, though in somes it may provide a positive benefit and help win a claim (the fact that such letters are not as effective at the lower levels of the system is really a fault of the system.




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