Despite the best efforts of your disability attorney, you may be denied Social Security Disability Insurance benefits (SSDI or “disability benefits”). It can be frustrating to learn that the disability officer or Administrative Law Judge (ALJ) who works for the Social Security Administration (“SSA”) and decided your case, is not required to rely solely on a treating physician’s records and notes. In fact, the ALJ can actually disregard your treating physician’s opinion or give it very little weight. The ALJ must explain why this decision was made to you and your disability attorney.
Here are 3 reasons why an ALJ might give your treating physician’s medical opinion little or no weight at all.
YOUR LAST VISIT TO THE DOCTOR WAS OVER SIX MONTHS AGO
To qualify for SSDI benefits, you must document your current medical condition. You do that through the medical records of your treating physician and/or any specialists you see.
When it comes to SSDI benefits, you must seek regular medical treatment for your condition. That means that if you went to a doctor once or twice, or even for a period of time, but then stopped, (absent good reasons) it is likely that your application for benefits will be denied.
Past medical records are important for establishing the long-term existence of your conditions (and for purposes of back pay if you are awarded disability benefits). However, Social Security disability examiners and ALJs only need current medical records to make their disability determinations. This is because a determination of disability is based on a person’s current ability to function or work on a consistent or full-time basis, not on his or her past ability to do so.
THE DOCTOR PROVIDED LITTLE OBJECTIVE EVIDENCE OF YOUR IMPAIRMENT
In making disability determinations, disability examiners or ALJs must rely on objective medical evidence of your disability or impairment. That means that your application for disability benefits needs to be supported by clinical or laboratory tests that are generally accepted in the medical community. If it is not, then it is likely you will be denied benefits.
Medical test results from MRIs, CAT scans, X-rays, lab tests, or any mental exams performed by a psychiatrist or psychologist, and the like, need to be included in your file. Generally, for physical impairments, it is this lack of objective medical evidence (x-rays etc.) that make them more difficult for your disability attorney to prove.
YOUR DOCTOR DIDN’T PROVIDE A GOOD EXPLANATION FOR WHY YOU HAVE CERTAIN LIMITATIONS
In addition to current and objective medical evidence of your impairment(s), if your doctor did not provide a good explanation of why you have certain limitations (for example, you cannot bend because of severe arthritis) then it is likely that a disability examiner or ALJ will accord his or her opinion of your condition very little weight.
For example, if you have a letter from your doctor that simply states that you are “disabled” or “cannot work,” it is very likely that this opinion will be given little to no weight at all. Why? Because in the arena of Social Security disability benefits, the determination of whether or not someone is “disabled” is a legal conclusion, not a medical one.
Also, when it comes to disability determinations, ALJs and disability officers are looking for evaluations of your condition that can help them decide if your impairment is severe and long-lasting enough to prevent you from performing any type of work at which you might earn a living. So, if you submit a Residual Functional Capacity (“RFC”) form from your doctor which only has boxes checked off and no detailed explanations, it is likely that you will not win the benefits you seek.
Applying for SSDI benefits can be a long and difficult road. A disability attorney can help you gather the information that you will need to prove that you are totally disabled under the SSA’s guidelines.
A DISABILITY ATTORNEY CAN HELP YOU WITH YOUR CLAIM
As experienced disability lawyers, we have helped many people get benefits and we can help you, too. We have offices throughout Missouri. We also have offices in Overland Park, Salina, Topeka, and Wichita Kansas, several cities in Illinois, and in Tulsa and Oklahoma City, Oklahoma. We offer free consultations and we do not get paid unless you win your case. Connect with us on Facebook or LinkedIn or contact us here to set up your free appointment or contact us online.