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SSI and SSDI Disability - Do I have to see a doctor?

One of the most common questions on our disability forum is, “Do I have to see a doctor before I apply for Social Security Disability Insurance or Supplemental Security Income benefits?” And the second question is, “If I do not see a doctor can I be approved for disability benefits?”

To answer this question we will speak in generalizations. It is almost impossible to get SSDI or SSI without seeing a doctor and getting medical care for your mental or physical health condition. In addition, you should not only see a doctor you should also have been following their prescribed treatment plan for some time to ensure that the SSA believes that you have done everything you can to treat your condition and make attempts to work.

Who does the SSA expect you to see?

The SSA expects that claimants will seek medical treatment from what they call “qualifying medical sources.” Qualifying medical sources include:

Not only will the SSA expect that you will have a diagnosis or a medically determinable impairment. They expect this diagnosis to be substantiated with the 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 you have not seen a doctor before you apply for SSI or SSDI benefits?

The bottom line is, if you do not have the proper medical records the SSA will not have anything to evaluate. Their only option is to send you to a consultative medical examiner (C.E.) for a consultative examination.

Many claimants make the false assumption that they will be sent to some type of “evaluation” to determine if they are disabled. This is not quite how the Social Security Disability determination process works. The SSA will only send you to a consultative exam if they do not have sufficient evidence to make a disability determination, your doctor did not send your medical records to them or you did not see the appropriate specialist.

Additionally, the consultative examination does not determine whether or not you are disabled; it simply provides more information to the SSA so the SSA can make a better disability determination.

Concerns for claimants who do not get medical care before applying for benefits

The main issue for claimants who are relying on the consultative examination is the brevity of this exam. There are complaints from many claimants that these exams can last for as little as five minutes. Unless a claimant has a severe disorder which is readily apparent at first glance five minutes is simply not enough time to adequately evaluation a claimant and provide solid evidence for their disability status.

If you have applied for SSI or SSDI it is critical that you not rely on the consultative examination. You must seek good medical care prior to applying for SSDI or SSI benefits and make sure your medical records clearly state why you cannot work. Consider, if you have been asked to see a consultative examiner this is not a good sign; it simply means you lack sufficient medical evidence to prove your SSI or SSDI case.


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