The Social Security Administration (SSA) will make a disability determination by reviewing a claimant’s medical records from qualifying medical sources. Qualifying medical sources include:
• Licensed physicians (medical or osteopathic doctors)
• Licensed or certified psychologists.
• Licensed optometrists
• Licensed podiatrists
• Qualified speech-language pathologists
• Medical Reports
Medical reports can include the medical history of a claimant, clinical findings (such as the results of physical or mental status examinations), laboratory findings (such as blood pressure, x-rays), diagnosis (statement of disease or injury based on its signs and symptoms), treatment prescribed with response, and prognosis and statements about what the claimant can still do despite their impairment.
What if you do not have any medical records to evaluate? Obviously, the SSA will have a difficult time making a disability determination. Assuming you meet the nonmedical criteria for Supplemental Security Income (low income and resources) and Social Security Disability Insurance (sufficient work credits to be considered insured), the Social Security Administration will send you to a consultative examiner (C.E.).
Can I win benefits just with a C.E. Examination?
First, it is important to understand that a consultative examination is not necessarily a good thing. Yes, it could be the only option many claimants have, especially if they do not medical insurance or money to see a doctor, but the bottom line is, if you have been asked to see a C.E., it means the Social Security Administration does not have enough information to make a disability determination for your case.
Is it possible to win SSDI or SSI benefits without consistently seeing a primary care doctor and simply relying on the consultative examination?
Yes, it is possible. Consultative examiners are independent contractors, although they are hired by the SSA to review a claimant’s health condition, they are not paid government employees. They are simply tasked with providing “objective” information about the residual functional capacity a claimant has to continue to perform substantial gainful activity (SGA).
If the consultative examiner is able to readily identify a claimant’s condition or their examination, in conjunction with reviewing the claimant’s medical records, convinces them that the claimant has no residual capacity to work (and the DDS examiner agrees) a claimant can win benefits after a consultative examination.
Unfortunately, more oftne than not the C.E. will determine that the claimant has the residual capacity to work. The bottom line is, the consultative examiner is not a good substitute for an on-going doctor/patient relationship.
Hiring a Disability Lawyer
Will a disability lawyer take an SSDI or SSI case if the claimant is not under the care of a doctor? Maybe, but they will want the claimant to get medical care as soon as possible.
Remember, disability lawyers work on a contingency fee basis, and they will not take cases they do not think they have any chance of winning.
What do you do if you cannot get medical care?
This is a tough question without a good answer. Some individuals may qualify for Medicaid; others may have to rely on free clinics or minor emergency centers. The important thing is not to wait for the SSA to “send you to a doctor.”