Medical Evidence Plays a Key Role in Social Security Disability Approval

August 17, 2012

Although most healthy adults do not plan for a disability, research shows that the average 20-year-old worker has a 33 percent chance of becoming disabled before retirement. Those that find themselves in this difficult position often have not prepared financially. Thankfully, various state and federal programs are available to offer aid. One of the largest federal programs to help the injured is the Social Security Disability program.

When an individual becomes disabled, programs like Social Security Disability can help lessen the financial blow. Although the program has recently been flooded with applications as people with disabilities lose their jobs and fight to find another position in an economy that continues to struggle, benefits are still available to those who can establish they qualify. In fact, over three million people are expected to apply for acceptance to the program in 2012 alone.

Qualifying for the program often hinges on establishing the presence of a disability. Properly making a case is extremely important, as about half of all initial disability applications are denied.

Basics of Disability Determinations

Generally, a disability application is filled out and processed with various Social Security Administration (SSA) field offices and state agencies. The field office will review non-medical requirements like the applicant's age, employment and social security coverage information while the state counterpart researches the medical evidence and provides an initial determination.

The medical evidence provided must be sufficient to meet the SSA's definition of a disability. This program provides benefits to a specific group of people: those suffering from an approved disability that is expected to last at least a year or more. Essentially, this means the individual must be unable to work.

An applicant must not only be unable to continue in their current position, but the medical condition must also make the applicant unable to work another job as well. Furthermore, the SSA's time requirement means that an applicant must prove that the disability lasted or is expected to last at least one year (or will result in the applicant's death).

The application evaluation process includes reviewing medical evidence of the disability supplied by both the applicant and his/her physicians. If insufficient evidence is provided, the applicant will be denied.

Disability Evaluation Under Social Security

Medical evidence supplied with an SSD application can include the applicant's own description of the disability, medical reports from physicians and notes from other professionals that have treated, evaluated or observed the applicant's disability.

The SSA accepts a broad range of medical professional opinions for purposes of evaluating a disability application. "Acceptable medical sources" include licensed physicians, psychologists, optometrists, podiatrists and speech-language pathologists.

The information supplied by these professionals must be in line with their training, though. For example, the SSA will review the evaluations of a certified or licensed psychologist for establishing mental retardation, learning disabilities and borderline intellectual functioning but that same expert could not provide evidence of an applicant's visual disorder.

The SSA has evolved to place special emphasis on the opinions of these treating physicians. In the past, the administration focused on additional, external evaluations to make their decision, but this shift is intended to provide the SSA with a more detailed picture of the applicant's impairment and, ultimately, a more accurate decision based on the individual's needs. However, if the information provided is inadequate, the SSA has the option to require additional information be gathered through a consultative examination conducted by an independent source.

Providing Medical Documentation

Because of the weight placed on the medical information supplied by the applicant, it is important to provide all needed medical records from treating sources in a timely manner.

Applicants should be sure to include the following:
- Medical history
- Clinical findings
- Laboratory findings
- Diagnosis
- Prescribed treatment
- Necessary test results (like X-ray or MRI readings) that will prove the evidence of a disability

It is also important to include evidence of the effects of the symptoms the applicant suffers from. This can include discussions of pain, shortness of breath or fatigue and how these symptoms negatively influence the applicant's ability to work.

Putting together a strong application can increase the likelihood of being awarded benefits in a timely manner, but half of all applications are denied the first time around. The SSA does offer an appeals process where insufficient applications can be remedied and resubmitted for consideration.

Having an experienced social security benefits attorney at your side can greatly increase your chances of having a denied claim overturned on appeal. If you need help at the appellate phase of a disability application, seek the counsel of a lawyer in your area who can help you fight for the benefits you deserve.

Article provided by Richard A. Sly Attorney at Law
Visit us at www.richardsly.com