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Why Doctors are Crucial when Applying for Social Security Disability Benefits

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Applying for Social Security Disability Insurance (SSDI) can be a complex and confusing process. Extensive documentation is required, and there are multiple steps that must be taken.  In Alabama, approximately 70% of SSDI applications are denied at the initial stage of the application process. An even higher percentage are denied at the first stage of appeals. The reality is that the majority of SSDI claimants are not approved until their case is brought before an Administrative Law Judge (ALJ). And this can mean waiting several months or longer to receive the benefits you are entitled to.

Though the odds are not in your favor, there are claimants that are able to get approved during the initial stage after applying. One of the major factors in the success of an SSDI application is having a treating physician to help validate the claim. The Social Security Administration (SSA) relies heavily on medical documentation when determining if an SSDI claimant has a qualified disability, and doctors are crucial in providing the documentation the SSA is looking for.

There are several ways a treating physician can help you become approved for SSDI benefits, some of the most important include:

They Can Compare Your Condition to the SSDI Blue Book Listing

The Social Security Administration maintains a master listing of debilitating conditions (commonly known as the “Blue Book”) that automatically qualify a claimant for SSDI benefits. If your condition is an exact match to one that is listed, you should have an easier time getting approved. The conditions listed in the Blue Book are very specific, and most applicants do not have an exact match. This, however, does not mean you cannot qualify for benefits.

A claimant can become approved for benefits if they can show that their condition is medically equivalent in severity to at least one listed in the Blue Book. For example, your condition may be listed in the Blue Book, but it may not meet the specific criteria of the listing. In such cases, you can still get approved if you can show that you have other medical impairments (in addition to your main debilitating condition) that make your overall condition medically equivalent. Another example would be if you have multiple impairments, but none are listed in the Blue Book. However, the combined effects of these impairments make them medically equivalent in severity to at least one that is listed.

This is where your doctor can be crucial in showing how your condition compares to at least one that is listed in the Blue Book. Your treating physician can compare your condition to those the Blue Book to find out if there is an exact match of a listed condition. If there is no match, the totality of your impairments can be examined to determine if your overall condition meets the “medically equivalent” standard.

They Can Help Ensure that you Take the Right Tests

Medical tests play a major role in substantiating the claim that you have a listed condition or one (or multiple) impairments that are medically equivalent. The SSA is very picky about which tests are admissible (and which are not) when applying for benefits. Your doctor can help determine which tests you should take (or retake) to help provide the documentation needed to fulfill the Blue Book requirements. Your doctor can also help ensure that any other necessary documentation (such as hospitalization history, list of prescription you are taking, general physician notes, etc.) is included in your application.

They Can Provide Written Testimony and a Recommendation for Approval

When you apply for SSDI benefits, it is best to include as much evidence as possible regarding your condition. This may include written testimony from those who can attest to your condition; such as family members, friends, those you used to work with, and your treating physician. The written recommendation of your doctor is the most important, because they are qualified medical experts.

The written recommendation of a treating physician may not carry as much weight at the initial application stage as at the Administrative Law Judge (ALJ) level. This is because at the initial stage, the SSA’s disability examiner relies more on the opinion of the medical consultant who is part of the examiner’s case processing unit. This makes no sense, of course, because the medical consultant has never met the claimant and knows very little about them. But unfortunately, this is the system we have to work with. If the case is heard by an Administrative Law Judge, however, the opinion of a treating physician is given much more weight and credence.

Trouble Getting Approved for SSDI Benefits? Speak with an Experienced Attorney

Doctors are crucial when applying for disability benefits, but they are not the only factor in the success of an application. It is also very helpful to work with a skilled Social Security Disability lawyer who understands the complexities of the process, and what it takes to get your application approved in a timely manner.

At The Dansby Law Firm, P.C., we have extensive experience and a successful track record helping claimants in Alabama become approved for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) benefits. Our founder, attorney Kay Dansby, is a former Social Security Staff Attorney, and she knows the ins and outs of the system. She works closely with clients to help ensure they are able to receive the important benefits they need and deserve.

For a free consultation with our office, call us today at 334-834-7001. You may also send a secure and confidential message through our online contact form.

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