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HOW SOCIAL SECURITY WEIGHS PHYSICIANS' OPINIONS

WHAT TO DO WHEN THE PHYSICIAN IS UNSURE IF THE PERSON IS DISABLED

Medical evidence is the most important component in a claim for Social Security Disability benefits. However, the patient, physician, and third-party reviewers alike may misinterpret what will help a disabled patient get approved. A statement announcing that a patient is "totally disabled" will not get a claim approved, even when it is true. A statement of medical opinion can be a very valuable tool, but should include documentation of symptoms, diagnosis, prognosis, the physical and/or mental residual functional capacity, and should define the restrictions of the claimant.

Social Security will generally give more weight to examining physicians' opinions than those of non-examining physicians. Treating physicians are accorded controlling weight when supported by the comprehensive medical record. The opinion of any physician must be supported by objective medical or clinical findings. Basing conclusions on the patient's subjective complaints without objective support will not provide Social Security or a claimant's representative with the tools needed to get the case approved.

Individuals assisting with claims or physicians themselves should provide the basic medical information (office notes, laboratory tests, etc.) and leave the decision of disability to Social Security.

Keep in mind that, depending on the age of the patient, a combination of factors may be considered when assessing whether or not an individual is disabled. Take Joe Smith for example:

Joe Smith is 58 years old, and has worked for 25 years in construction. He now has a back impairment which prevents him from doing any strenuous lifting or standing for too long.

His doctor says he is limited to sedentary work, or work requiring sitting for the majority of the day and lifting no more than 10 pounds. Is he disabled?

From all work, no, Mr. Smith is not disabled. However, by application of their "grid rules," (SSA Reg. No. 4), Social Security has found Mr. Smith to be ‘disabled’, even though he can do a sit-down job. Social Security will take into consideration whether or not Mr. Smith has learned skills in the past which would be useful for sedentary work. Given his work experience in construction, he does not have skills that would transfer to sedentary work. Therefore, he is ‘disabled’ by their rules.

   
   

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Revised: March 12, 2010.