Physical and mental disability can leave people struggling to make ends meet, making applying for disability benefits a necessity for many Americans. However, without a doctor’s endorsement, obtaining Social Security Administration (SSA) disability benefits can be difficult. Unfortunately, disability leaves many individuals unable to secure work and a paycheck, greatly hindering their ability to afford to see a doctor.
Why does the SSA require doctor endorsement for disability?
Sadly, there is always someone looking to take advantage of the system. In order to ensure that non-disabled individuals don’t “create” a disability or exaggerate the degree of one, information from a medical provider is required. A proper diagnosis eliminates the potential for “fakers” and helps the SSA to understand an individual’s medical conditions, and then judge their need for help.
Regular doctor appointments can be expensive, especially for the uninsured. Problems arise when disabled individuals without medical evidence supporting their situation attempt to file for Social Security Disability (SSD) or Supplemental Security Income (SSI). Disability examiners—those responsible for determining whether an applicant qualifies—require medical records. Without medical evidence of disability documented within at least three months prior to application, they will have no choice but to deny the claim. But not all hope is lost: enter the consultative exam.
What is a Consultative Exam?
Because of the financial or even physical difficulties preventing many with disability from visiting a doctor, Social Security cannot outright deny benefits without offering the option of a consultative exam (CE). A CE involves meeting with a private physician at no cost in order to determine eligibility.
Some disability applicants are wary of a CE, however, believing it to be biased against them. The thought is that the CE physician will be paid to downplay disabilities in order to save the SSA time and money. While physicians do get paid for providing CE services, they are not employees of the SSA and do not stand to benefit by weakening an applicant's case.
What if the CE doesn’t work in my favor?
An empty medical record does not look good when it comes to applying for disability, hence the need for the CE. However, it's possible to avoid the CE process—even if an applicant is unable to afford regular doctor visits—simply by going to a free clinic or an emergency room prior to applying for benefits. This helps establish medical history and offers disability examiners information to go off of when making their determination.
I’ve been to the doctor and have still been denied—why?
This result often comes down to a lack of compliance. The SSA will look at a number of factors when making their benefits determination, and one common mistake applicants make is failing to follow through with their doctor’s orders. If a disability examiner discovers that an applicant ignored a doctor’s advice (not taking medications, failure to use assistive devices, etc), they may conclude that conditions are not as serious or as debilitating as the claimant asserts and deny the claim.
If you have been unable to see a doctor due to disability, or feel you have been denied your claim unfairly, the Disability Experts of Florida can help. We understand that there are times when you cannot work due to disability, and our goal is to make sure Social Security Disability provides the safety net designed it was designed to offer. Don’t worry about costs; we don’t get paid unless you do. Contact a caring disability expert today to discuss your claim.