Will my doctor charge me for a letter or statement to help my disability claim?

This is an interesting topic. Here's the thing: if your social security disability or SSI disability case is due to be presented at a disability hearing, in front of an administrative law judge, a letter or statement (and what we really mean is a medical source statement captured on something equivalent to an RFC or residual functional capacity form) can make all the difference in winning or losing.

Why is this? Simple: because physician's notes typically have very little to say about a claimant's ability to perform work activity or otherwise engage in activities of daily living. In fact, they often have so little to say that it becomes fairly easy for the social security administration, via the RFC rating slapped on a case by a disability examiner and the unit medical consultant with whom he works (i.e. the social security doctor), to deny disability cases.

A Detailed statement from a claimant's physician, however, can neatly put on paper what the physician or psychiatrist's opinion is regarding their patient's level of functionality. In other words, it points the way for a judge to determine A) whether or not the claimant can return to their past work, B) can perform some form of other work or C) if the claimant is unable to engage in what is known as substantial gainful activity and is, therefore, disabled and eligible for disability benefits from the social security administration.

Very few people, if any, would ever argue that a medical source statement shouldn't be obtained for an SSD or SSI case. Such statements can be crucial at disability hearings, though, in all candor, they have the potential for being somewhat useless at the initial claim and reconsideration appeal level simply because the state disability processing agencies--generally known as DDS, or disability determination services--operate in a climate of institutional bias that causes them to turn down tens of thousands of claims that judges later approve (government in action, eh?).

But...will your doctor provide such a statement to assist your disability claim as it heads to the hearing level? Well, not if you don't ask. That's fairly obvious, of course. However, I think it safe to say that 90+ percent of all unrepresented claimants who go to a hearing without a disability attorney or non-attorney disability representative at their side will not know that they should attempt to get a statement from their treating physician.

Now, if your representative, attorney or otherwise, does not make the attempt to get a statement from one or more of your treating physicians, you may have a valid reason to question the quality of the representation you're getting and you may wish to switch. However, what if your doctor is not entirely willing to supply a statement?

Believe it or not, a sizeble percentage of doctors really aren't so eager to help their patients in this way. I can categorize it as follows:

1. Doctors who willingly and expeditiously provide a statement.

2. Doctors who inevitably provide a statement but only after umpteen follow calls have been made to their office (nurse: "it's on his desk, I'm sure he'll get to it this week"). Very often, following up on getting a form completed means having to fax over another one because, for some reason, they've lost--or keep losing--the original.

3. Doctors who tell you that they'll complete a medical source statement or RFC form, but only for an exorbitant fee (sometimes several hundred dollars). I think this can be reasonably interpreted to mean A) they don't really want to take the 15 minutes required to pull and review a chart and then complete a check-off form and B) they don't feel particularly obliged to help out their patients.

4. Doctors who don't provide such statements at all, even if doing so only involves completing a 5-8 page check-off form. Some doctors will flatly say "I don't do that".

Obviously 3 and 4 are the most problematic. Doctors who fall into category 3 are money grubbers and their patients would be wise to leave them. The latter part of that statement holds true for doctors in category 4.

How will you know which category your doctor will fall into? Unfortunately, that would be difficult to know until the time comes.

One thing is for sure, however: you'll have a better chance of obtaining a supportive statement if your doctor is one that you've seen for a protracted length of time, someone that you have a longitudinal history of treatment with. A doctor that you've only recently switched to may not feel this way at all, and that may simply be human nature along with the fact that the doc has a limited history with you.

Routine doctor switching is probably not the best way to go, and also for reasons that nothing to do with disability claims. However, if you want to get a "feel" on how helpful your own doctor may potentially be, you may wish to review your medical records from the doctor's office and possibly discuss your pending claim in the attempt to discern whether or not your treating physician may be of the mindset to supply a statement to assist with your claim...or not.



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