The majority of social security disability applications are denied for insufficient medical information. That means medical records are vital when it comes to applying for disability.
To qualify for SSD benefits, your medical records must support the claim that your medical condition lasts or is expected to last at least 12 months, or is expected to result in your death. They must also support a finding that it negatively interferes with your ability to participate in substantial gainful activity, which the Social Security Administration (SSA) considers the ability to earn more than $1,260 per month. A simple doctor’s note submitted with your disability application stating that you were diagnosed with X condition, with nothing more, isn’t enough to meet that threshold.
Although the SSA disability examiner assigned to your case can request medical records, it is in your best interest to submit them when you apply for disability. Not only will this help your application get reviewed sooner, but it will also ensure that the examiner reviews the appropriate information.
Getting your medical records isn’t difficult, but there are some things to know ahead of time to make the process easier.
HIPAA and medical records
The Health Information Portability and Accountability Act (HIPAA) is a federal law that protects disclosure of your medical records without your permission. It also grants patients rights to view and obtain copies of those records.
Under HIPAA, your doctor’s office is legally required to let you view all of your records at the office (note that your doctor’s office may require an appointment to do this, so best to check ahead of time). HIPAA also lets you obtain physical copies of your records, either for your personal use or to send to other providers or an attorney. In these cases, depending on the size of your file, the doctor’s office may charge a fee to make copies.
If you want the office to release those records directly to another individual or agency, such as your disability attorney or the SSA, you will most likely be required to a sign a release of information.
Obtaining copies of your medical records is usually as simple as submitting a request to your physician’s office. In some cases, it takes only a phone call. In others, you may have to submit a signed release or make the request in person. This is done for your protection, to ensure the records are being released to the correct person. Federal law requires that the doctor’s office release your records within 30 days of receiving your request. If they cannot, they must notify you of the reason for the delay.
If you have hired a disability attorney or disability advocate to help you apply for disability, they can obtain medical records on your behalf. In these instances, either your attorney or the doctor’s office (and sometimes both) will have you sign a form authorizing the release of the records to the attorney or advocate.
What records to obtain
When you apply for disability it may be tempting to submit all of your medical files. After all, the more medical issues you have, the greater your chance of being approved for disability benefits, right? Wrong. Not only is this a waste of time, it can also backfire.
To qualify for social security disability benefits, you must be able to prove that you have a medical condition or disability included in the Social Security Administration’s Blue Book. The Blue Book a listing of more than 100 disabling conditions that can qualify an applicant for disability benefits, provided they meet the specific criteria for each listing. Providing irrelevant medical information will not improve the chance of approval; it can, however, give the disability examiner a bad impression of you, which can decrease your chance of approval at the initial stage.
So, what records should you submit? Those that directly support the disability or disabilities you have included on your disability application. For example, if you are applying for disability due to crippling back pain that leaves you unable to sit or stand for long periods or to bend and lift objects, you would not want to submit records about occasional migraines or a broken arm (unless they were related to the back pain, of course).
The following are the types of records you should submit with your disability application. Depending on your diagnosis, you may have some or all of these documenting your disability or medical condition. Records from the six months prior to submission of your application are the most important, though records extending back further help paint a picture of the duration and progression of your disability, which helps support a finding that it is not expected to improve:
- Treatment history
- Physician’s notes
- Emergency room visit logs
- Medications prescribed
- Therapy notes, such as from a physical or occupational therapist
- Medical tests and results
- X-rays, MRIs, CAT scans, or other relevant imaging
- Other relevant records
It may also be beneficial to ask your physician(s) to complete a medical source statement to submit with your disability application. Medical records are good at painting a picture of the medical condition or disability that led you to apply for disability benefits. Emergency room logs confirm your admission for a heart attack, surgical notes show that you underwent a quadruple bypass, and physician’s notes show the medications prescribed to control your condition.
What these records are not good at showing, however, is how your condition affects your ability to work. Having a qualified disability isn’t enough to qualify for social security disability benefits. The disability must negatively impact your ability to work. Most medical records don’t include detailed descriptions of how the patient’s disability impacts their ability to perform daily activities; if they do, they are usually included only in a cursory manner, such as “Patient says she experiences pain when walking.”
Such descriptions are insufficient to paint a true picture of how your disability interferes with your ability to work. Medical source statements elicit that information from your provider, which increases the chance that your disability application is approved. Your disability attorney can provide such a form to your physicians on your behalf. Consider the Good Law Group for your representation – call (847) 577-4476.