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SSDI- Do I have to see any more doctors?

Doctors and SSDI


Many disability applicants have a good medical doctor and specialists who they see on a regular basis and are wondering if through the SSA disability approval process they will be required to go see another “SSA doctor” to be approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Recently on our disability forum we had a user ask, “Will I have to see another doctor to be approved for SSDI?” This blog will address this question.

How does the SSA make their disability determination?


Most disability applicants think that the SSA sends them to one of the SSA “approved” doctors who reviews their case and determines whether they are disabled or not. This is not quite how the process works.

Instead of sending each SSDI or SSI applicant to a doctor, the SSA actually relies on your current medical records to determine if you are disabled. So the SSA, assuming you meet the nonmedical requirements for SSDI or SSI, will request all of the relevant medical records from your treating sources (doctors, hospitals, therapists, etc.) and review the records. The goal of the record review is to determine if you have a diagnosis, evidence to support the diagnosis, information about the severity of your conditions and information about whether or not you can work for at least 12 continuous months.

Medical information is generally pulled from the last three years or specific time frames that are relevant for your case.

Doctor


When will the SSA send me to more doctors?


If you do not have enough medical information in your medical records to prove you are disabled, your doctor fails to send your medical records or you did not see the appropriate specialist then the SSA may decide they need more information for your case and will ask you see a consultative examiner (C.E).

Many claimants who do not have insurance or who do not have the funds to pay for medical care get really excited that they get to see a consultative examiner, but they need to temper their enthusiasm. Unfortunately, although the C.E. is not officially a governmental employee and does not really work for the SSA, they are known for their cursory examinations which may not really help your case.

For instance, I have heard of claimants complaining that a C.E. spent five minutes with them and then determined they were not disabled. Let’s suppose the C.E. spent up to an hour with you, would this really be enough time to determine you are disabled? What if you are having a good day? Consultative examinations can be especially problematic for mental health patients whose condition may ebb and flow over weeks or months of treatment.

What if you have great medical information?


Assuming you have great medical information and a doctor who is really involved and supportive of your claim and is willing to provide the necessary evidence for your case, this is ideal. Under these conditions it is unlikely you will NOT have to see a consultative examiner.

If you don’t have a doctor and you are relying on the consultative examination for approval of SSDI, you are likely making a big mistake.
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