I Was Denied Disability Benefits for Lack of Medical Evidence – Now What?

If you received a letter that your social security disability application was denied, know that you’re not alone – an estimated 70% of are rejected during the initial evaluation stage.

Some of these rejections are technical denials. This means your application for social security disability benefits was rejected based on something other than your disability status. For example, your monthly income exceeds what the Social Security Administration considers substantial gainful activity or you haven’t accumulated enough work credits.

The majority of SSD denials, however, are for lack of medical evidence. The SSA considers medical evidence “the cornerstone of the disability determination.” Medical denials happen for two reasons:

  • You submitted insufficient medical evidence to support your claim of disability, or;
  • You submitted inadequate documentation of the disability’s impact on your ability to work.

If your social security disability application was denied for lack of medical evidence, don’t panic! There are steps you can take to improve your chances of approval.

 

Should I appeal or file a new application?

When you receive a denial for lack of medical evidence, you’ll need to decide whether to appeal the denial or file a new application. There are three levels of appeal in the SSD process – reconsideration, administrative hearing, and the appeals council.

Reconsideration is the first appeal level, and the appeal must be filed within 60 days of receiving the denial letter. A reconsideration review is essentially the same as the initial review. Your file is assigned to a different disability examiner at the same SSA field office. Though you may submit updated medical information to the disability examiner, only 10- 15% of claims are approved at the reconsideration level.

If your application is denied at the reconsideration level, the next stage is to request an administrative hearing before an administrative law judge. Depending on the court’s caseload it can take up to two years to get a hearing scheduled, though the average wait time in Chicago is 14.9 months.

Why then would you file an appeal and potentially wait two years or more before receiving disability benefits (assuming your application is ultimately approved) rather than file a new application? For one, approval rates at the administrative level are higher than at the SSA review level – nationally, 62% of SSD applications are approved following the administrative hearing.

More importantly, if your social security disability benefits application is approved on appeal, you will be entitled to receive benefits dating back to at least the date of your application. Simply reapplying could mean losing out on months of benefits.

An experienced social security disability attorney can help you decide whether you should appeal a medical denial or file a new application.

 

What medical evidence is required?

Whether you decide to appeal a denial or file a new application, you need to make sure you provide sufficient evidence to support your claim of disability and its impact on your ability to work. The exact documentation you’ll need to submit depends in part on your disability.

Medical evidence is more than a doctor’s note stating your medical diagnosis and that it interferes with your ability to work. Depending on your medical condition, there are specific criteria that must be met to qualify for SSD benefits. The SSA includes these requirements in its blue book, which contains more than 100 disabling conditions that qualify applications for SSD benefits. In general, however, appropriate medical evidence includes the following:

  • Hospital, physician, and therapist records, including all notes;
  • Results of lab tests;
  • X-rays, CAT scans, MRIs, and other diagnostic imaging;
  • Treatment plans, including the reasons why any course of treatment was abandoned, and;
  • Medications taken, both past and present

Though it’s not required a medical source statement can be extremely helpful in supporting your disability claim. Medical files and doctor’s notes contain information that verifies the existence of your medical condition. A medical source statement, on the other hand, captures information that is not typically included in those records, such as residual functional capacity – what tasks you can and cannot perform due to the disability. Such information is vital to help paint a clear picture of how your condition limits your ability to perform activities of daily living or job-related functions.

Without this information, the disability examiner will determine your residual functional capacity himself or send you for a consultative exam with a doctor contracted through the SSA. Neither of these scenarios is likely to work in your favor.

 

What are appropriate medical sources?

Just as important as providing the appropriate medical information is ensuring it comes from appropriate medical sources. This can be any licensed physician or therapist who has actually treated you, and who practices in the field of your illness. For example, if your benefits application is for kidney failure, you wouldn’t submit medical documentation of back pain. Appropriate medical sources may include:

  • General practitioners;
  • Psychiatrist or psychologist (for mental health conditions);
  • Specialists, such as orthopedic surgeons or neurologists;
  • Therapists, including physical or occupational;
  • Optometrists, or;
  • Speech-language pathologists.

Medical evidence should be current. While medical records more than 90 days before your application or administrative hearing date are helpful to show that your condition has not improved over time, they only show how your disability impacted your ability to work in the past. A finding of disability is based on what you cannot do when you applied for benefits, so it’s important to have your file reflect that your medical condition continues to negatively impact your ability to work.

Regular visits to your physician or specialist are also important. In the SSA’s eyes, if your medical condition is so debilitating that you cannot work, you should be seeking treatment to, if not get better, at least do what you can to alleviate the pain associated with your condition. Failure to maintain regular visits or lack of participation in a treatment plan can lead the SSA to believe your condition is exaggerated, and ultimately cause them to deny your claim.

In any level of the SSD application and approval process, legal representation is helpful and crucial. Consider the Good Law Group for your representation – call (847) 577-4476.

 

By |2020-07-27T21:44:30+00:00July 27th, 2020|Appeals, Application process, Blog, Eligibility, SSD|0 Comments