According to the Social Security Administration, medical evidence is the “cornerstone” of every disability determination. Medical evidence is absolutely a requirement for every application, and many acceptances or denials hinge on whether an applicant has the right medical information and enough medical care. In addition, having thorough, accurate, and complete information often speeds up the Social Security Administration’s (SSA) review process. Bruce L. Weider, PC, assists Michigan residents with Social Security disability claims. Learn more by contacting our office at (734) 485-0535.
Medical Evidence Requirements in Social Security Disability Claims
The primary way that social security disability applicants demonstrate that they are totally disabled is through providing extensive documentation of medical evidence. Even if an applicant has submitted all the medical records they have, the SSA will also often reach out to various care providers and other medical professionals for additional records and opinions.
Disability applicants are required to provide comprehensive medical records, to the extent possible. They cannot pick and choose which medical evidence to submit. Instead, the SSA requires that every applicant provide “complete and timely” medical evidence. Ultimately, medical evidence is required for every application to show both the existence of an impairment and the severity of the impairment.
Evidence of an Impairment
SSA requires that the applicant have an impairment for any benefit award under Title II and Title XVI programs. Title II is for those who are “insured” based on the value of their contributions to the Social Security program during their working life. Title XVI provides payments to those who have limited access to resources and income, including those who are under the age of 18.
The impairment must be shown by “objective medical evidence” from an “acceptable medical source.” In most situations, medical records from an impartial care provider will meet the regulatory requirements listed in the Program Operations Manual System.
In addition to demonstrating that they have an impairment, each applicant must also demonstrate that the impairment they have is severe, rendering them unable to engage in substantial gainful activity under SSA guidelines. The SSA assesses severity by reviewing medical records, including medical professionals’ notes and opinions. SSA officials may also consider the level of care received and the amount of time that the applicant has had medical care for the condition.
The SSA will consider medical records in reaching its determination about whether the condition is severe enough to prevent an individual from engaging in any form of gainful activity. These records can bolster other non-medical information, such as information from the applicant, family members, caregivers, or prior employers.
How Does Social Security Conduct a Medical Review?
Each application must go through a series of “checks” before a disability determination is made. Below is a quick overview of this process. Bruce L. Weider, PC, may be able to help disabled individuals in Michigan through the steps of their Social Security disability application from start to finish.
Review by the Local Field Office
The SSA processes most Social Security disability claims through a local field office or state agency. These offices will conduct the first level of review, which includes verification of income and resources, living arrangements, and other eligibility requirements. Once the local office determines that all of the non-medical qualifications have been met, the field office will send the claim to the state-run Disability Determination Services (DDS) office.
Examination by Michigan’s Disability Determination Services
In Michigan, DDS is managed under the auspices of the state’s Department of Health and Human Services. The SSA lists four Disability Determination Services offices for Michigan:
- Traverse City
The Michigan DDS will start its review of the medical records provided by the applicant. If there is not enough information, then the DDS might request a consultative examination from a doctor. This doctor will provide an opinion about the applicant’s disability that DDS will use in conjunction with other medical records and history to make a disability benefits determination. In many circumstances, the consultative examination will be conducted by the applicant’s own doctor, but they might also seek out an independent medical professional to provide an opinion as well.
Medical Source Statement
The medical professional performing the consultative examination might also be requested to fill out a Social Security Administration Form HA 1152 This document helps guide the physician to provide information related to an applicant’s working abilities, such as whether they can understand and remember simple instructions or make judgments and complex work-related decisions. In cases where the applicant’s disability is related to their cognitive function, this document can be very helpful in a final medical review.
Once DDS has gathered the information they expect to need, they will begin a review of the evidence to reach a determination. The ultimate decision is made by a team of people. These people usually include:
- Medical consultant
- Psychological consultant
- Disability examiner
In some cases, this team might go back to a medical source to request additional information if necessary. The DDS team might also refer the case to a state vocational rehabilitation agency if the applicant is eligible for those services.
Return Decision to the Field Office
Once the DDS team makes a decision, they return the case to the field office for further processing. If there is a disability finding, then the field office will calculate benefits and complete any other non-disability-related paperwork to begin benefits. If the applicant is found not to be disabled, then the file will remain with the field office in case the applicant decides to appeal Social Security disability denial.
SSA Determinations Requiring Medical Evidence
The SSA thoroughly reviews the submitted medical evidence to determine whether an applicant meets the requirements for a claim. In particular, the reviewing team is looking for:
- General information regarding the nature of the disability
- Evidence of how the disability has impacted the applicant’s life
- Care and treatment demonstrating the severity of the disability
- How long the applicant has been experiencing the impairment
- Whether the applicant can still do work-related physical or mental activities given the impairments that they have
Regular, long-term medical treatment and care are often critical for a successful Social Security disability claim. Medical evidence is usually the most effective way to show that treatment.
Get Help With Your Michigan Social Security Disability Claim
SSD applications can be confusing and overwhelming, but a Michigan Social Security Disability attorney may be able to help. Lawyers experienced in handling Social Security disability claims are prepared to help you gather and present medical evidence as part of your application, and assist with any appeals as necessary. Contact Bruce L. Weider, PC, for more information about our services. Call (734) 485-0535 to set up your no-cost initial consultation.