What You Need to Know about Medical Records and Disability Benefits

February 21, 2018
Dayes Law Firm

Medical records provide the foundation for a claim for Social Security Disability benefits, as one of the main requirements for obtaining benefits is that the claimant meet certain medical criteria.

The Social Security Disability lawyers in Phoenix at Dayes Law Firm PC understand the critical nature of medical records. We can help identify and gather important medical evidence to support your claim. Contact us today for a free consultation to learn more about how we can help you.

Why Is Medical Evidence Important?

Claims for disability benefits are won or lost on medical evidence. This is because qualifying for benefits requires that you meet the Social Security Administration’s (SSA) definition of disabled, which requires that your condition prevents you from working and has lasted for one year or will result in your death. The only way to do this is with medical documentation of your condition.

Medical records establish the types of impairments you have been diagnosed with and provide clinical findings, lab results and important medical opinions from medical providers who are most familiar with your condition. It is important to provide all relevant medical records to ensure a complete and accurate picture of your condition.

You should also make sure your records are submitted to the SSA in a timely manner. If you do not submit your medical records in a timely manner and the Social Security Disability examiner could not otherwise obtain your records, SSA may make a decision on your application without reviewing your records.

This could lead to your claim being denied because there is not enough evidence showing that you meet the SSA’s requirements. This may require you to submit additional information or appeal the decision, which can delay the process of obtaining benefits.

What Types of Medical Evidence is Important?

The records you should provide depend on your condition. If your condition is listed in the SSA’s Blue Book of impairment listings, you may need to submit specific information that is required by the listing. If your impairment is not listed in the Blue Book, you can still receive benefits, but the information you need to submit may be slightly different.

The Code of Federal Regulations outlines the types of medical evidence that can be evaluated with your claim:

  • Objective medical evidence – This includes laboratory finds and test results, such as blood tests, MRIs and x-rays.
  • Medical opinion – This is a statement from a medical provider that details what you are able to do despite your disability. This can include your ability to walk, stand, lift and carry objects, perform mental activities, use your senses, and adapt to environmental changes.
  • Other medical evidence – This includes judgments about the severity of your condition, medical history, diagnosis, treatment and prognosis.
  • Evidence from nonmedical sources – This includes information and statements form nonmedical sources, such as you, family members or coworkers, about anything related to your claim.

Are Certain Doctors Better for My Claim Than Others?

Typically, objective medical evidence and medical opinions will carry the most weight in the decision about your claim. Opinions from licensed medical doctors and psychologists are generally more persuasive and carry more weight than opinions from other medical providers, such as:

  • Nurse practitioners
  • Nurses
  • Chiropractors
  • Social workers

Additionally, administrative law judges usually give more weight to treating doctors than examining doctors or a reviewing doctor who has only reviewed the patient’s medical records and not actually observed him or her in person. A treating doctor is given more weight because he or she has an established history with the patient. However, a treating doctor’s opinion can be rejected if his or her opinion is not consistent with the patient’s medical records.

The opinion of a doctor who specializes in your condition can also be persuasive and may be given significant weight in determining whether your condition prevents you from being able to work.

If the SSA determines that your medical records are not complete, you may be sent to a consultative examination. This appointment is not intended to provide you with any treatment. Instead, a doctor hired by the SSA will evaluate you for the sole purpose of determining qualification for Social Security Disability benefits.

How Do I Request My Medical Records?

You do not necessarily have to submit all of your medical records. However, you should submit all records that are relevant to your condition. Patients can receive copies of their records by requesting this information from doctors, hospitals and other treatment providers. You may be required to pay copy fees and to sign a release form.

Due to patient privacy laws, you and your personal representative, with your written content, are the only people who have the right to access your medical records. If you are having trouble obtaining the records you need to support your claim, your attorney may be able to help.

How Can a Lawyer Help Me Collect My Records?

Our disability lawyers have years of experience helping people through the disability claims process. We are familiar with the information the SSA needs to approve your claim, and we know how to obtain that information from your health care providers.

We can not only request your records, but can also sort through your records to determine what should and should not be included with your claim. Most disability claimants will have significant medical records, which can be overwhelming to sort though.

Get Legal Help with Building Your Claim

If your claim has been denied due to inadequate medical records or information, our attorneys can help you gather the necessary information to appeal the decision. We are experienced in helping disability claimants and can help guide you through the process.

Contact us today to schedule your complimentary consultation to learn more about how a lawyer can help with your claim.

Call 1-800-503-2000 or complete a Free Case Evaluation.