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Will Social Security Administration Award Me Disability if I Have Not Been to The Doctor?

The Social Security Administration will not grant Social Security Disability Insurance (SSDI) benefits or Supplemental Security Income SSI) without objective medical evidence which substantiates a claimant is mentally or physically disabled and unable to work. In fact, the Social Security Administration would like to have at least 12 months of medical records and specifically, medical information for the last three months.

Does this mean claimants who do not have recent medical records should not apply for SSDI or SSI disability benefits? No, if a claimant is unable to work due to a mental or physical health condition, their condition is expected to last at least 12 months (or result in death) and they can not work, a claimant should apply for Social Security Disability benefits as soon as possible. The Social Security Administration will be required to send the claimant to consultative examinations to get physical or mental medical information to make their disability determination.

The purpose of the consultative examination is not to provide medical treatment but rather to gather enough information for the Social Security Administration to determine if the claimant is able to work or perform “substantial gainful activity”. Unfortunately, a one time visit to a doctor who may not specialize in treating the claimant’s disabling health condition will not be able to provide the same level of detail about the claimant’s physical and mental limitations as a doctor who has spent years treating their condition. It is important to note, the consultative examination is supposed to be objective and performed by a doctor who does not work for the Social Security Administration.

Is it possible to receive Social Security Disability benefits from information gathered solely from a consultative examination? Yes, it is possible, if the doctor who examines the claimant states in their examination report that they are disabled, but historically, few Social Security Disability claimants win Social Security Disability benefits based solely on the consultative examinations.

Gathering data at a Consultative Examination

Consultative examinations may begin before the claimant realizes they have started. The medical examiner may take notes of what they see and hear before the claimant thinks the “examination” has begun. How does the claimant get into the building? How do they behave in the waiting room? The medical examiner may note any discrepancies in a claimant’s behavior. Claimants should never lie or exaggerate their mental or physical health conditions, but it is also important not to minimize symptoms. Unfortunately, for many cases the consultative examination does not positively affect the decision for a Social Security Disability claim.

How do most claimants win Social Security Disability Benefits? The best way to be awarded Social Security Disability benefits is to seek medical care from an objective medical provider prior to applying for Social Security Disability benefits. Some of the best medical documentation a claimant can have is a Residual Functional Capacity Form (RFC) completed by a treating physician who has a history of providing medical care for the claimant. The Residual Functional Capacity Form (RFC) will detail the mental and physical limitations of the claimant and can be evidence to establish the claimant is unable to work.

Claimants who are unable to pay for ongoing medical care should at the very least try to visit a clinic, hospital, doctor or free mental health clinic to document their mental or physical conditions prior to applying for Social Security Disability benefits. The bottom line is…few cases are won from the medical information provided exclusively from a consultative examination.