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SSA - Condition stabilized do I have to continue to see a doctor?

For many Social Security Disability Insurance (SSDI) applicants the most difficult part of the disability process is getting proper medical care to prove they are disabled. With the increasing cost and inaccessibility of medical care this will continue to be a growing problem. Recently, on our disability forum we had a SSDI claimant ask if they had to constantly see a doctor if their condition stabilized and was not expected to improve. So how often do you need to get medical care if your health condition stabilized and is not expected to improve?


Medical evidence to prove disability


First, let’s talk about what the Social Security Administration expects you to have to prove you are disabled. The most important thing the SSA will be looking for is a medical diagnosis identifying your medically determinable impairment and evidence of the symptoms and conditions which are so severe you cannot work. The SSA will expect you to see a qualifying medical source to get this diagnosis and supporting information. The SSA defines a qualifying medical source as a:

 

  1. Licensed physicians (medical or osteopathic doctors)

  2. Licensed or certified psychologists.

  3. Licensed optometrists

  4. Licensed podiatrists

  5. Qualified speech-language pathologists


Medical evidence for your condition should include appropriate medical reports, 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.

What if my condition stabilized and will not improve?


The continued advancement of medical care does allow for some SSDI applicants to get new treatment and eventually return to work, but there are many SSDI applicants whose condition is not expected to improve. Consider a genetic disorder or a paraplegic whose spinal cord is severed. No one can rule out a medical miracle, but most of these SSDI applicants can expect to continue to receive SSDI benefits indefinitely and a weekly or monthly visit to the doctor may not be necessary.

The good news is the SSA understands medical conditions and the likelihood that you will recover. In fact, some conditions will be so severe and permanent that the SSA performs less frequent continuing disability reviews for them.

If your condition stabilized and  is not expected to improve what you will need is what was described in the previous section. You will need an initial diagnosis and very good medical evidence of your condition. For example, if you are in a severe car accident and you are paralyzed, the SSA would expect that you would have received medical care at the time of the accident which would include x-rays, doctor’s notes, E.R. reports, lab work, etc.

Then my recommendation after all the initial medical care is provided (rehabilitation, physical therapy, etc.) is that you continue to go to the doctor maybe every 6 months to one year. This frequency would allow the SSA to determine that you are getting appropriate medical treatment and they would also have evidence from the last year that your condition has not improved and it continues to prohibit you from performing substantial gainful activity.
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