Situations When Social Security May Not Consider Your Doctor's Opinion

Posted on: 29 January 2015

Although the Social Security Administration generally gives a treating doctor's opinion significant weight when considering a disability claim, that's not always the case. Your doctor must provide evidence that your medical impairment will prevent you from performing any substantial gainful activity continuously for 12 months or more. If your treating doctor doesn't provide adequate information relating to your impairments and how they limit what you can do, your claim may be denied even if your physician feels you are disabled.

Your doctor's medical opinion may not matter to Social Security if:

  1. You haven't been the doctor's patient for long. In that case, you haven't established a relationship, so the doctor likely knows little about how your medical condition has affected your life.

    It can help your case for disability benefits if you have a family doctor who can provide detailed records describing your symptoms and functional limitations -- the inability to complete tasks. The more records you doctor can provide, the better. A history of treatment between disability applicants and their primary care physicians is critical. Treating doctors who know their patients and the medical conditions they suffer are in a good position to offer a future prognosis.

  2. If you file a disability claim but haven't seen a doctor in more than 60 days, the Social Security Administration will send you to an independent physician for a general physical exam or mental health evaluation. The doctor will then provide Social Security with a report of the exam.

    Although you may provide records that date back to previous years, Social Security likes to see medical records that span the most recent six months, especially if your condition is deteriorating.

  3. Information the doctor provided didn't explain how your medical condition limits your ability to work and earn substantial income. Although your disability may affect your life in multiple areas, Social Security looks at your work-related abilities and how your condition limits those. If you can provide medical evidence that confirms those limitations, then you may be eligible to receive disability benefits.

  4. The doctor doesn't have much expertise in that area of medicine, or your medical records contain evidence that refutes your doctor's opinion. For instance, your doctor can't state that severe asthma prevents you from working when spirometry and other lung function tests show your asthma is moderate persistent.

  5. Your medical records lack medical documentation that back up your claims stating you suffer a physically or mentally disabling impairment that limits your ability to work. It isn't enough for doctors to write letters to Social Security stating their medical opinions. Social Security needs documented proof that you are disabled and can't work.

    The claims examiner assigned to your case will examine your file for objective medical evidence to support your disability claim. For example, if your doctor states that you are unable to stand on your feet for long, your file must show medical evidence of why you can't stand on your feet for extended periods.

    Doctors must substantiate their opinions about an applicant's condition with objective medical evidence such as clinic notes describing your condition, biopsy results, lab test reports, and the results of x-rays, MRI, CAT scan imaging, cardiac tests, and range of motion tests.

    If your file doesn't include these or other diagnostic test information, the claims examiner may not count your doctor's opinion in determining whether your condition affects your ability to work.

For more information about what can be done, check out lawyers such as Mckown Jim Attorney At Law.