Selecting Your Doctor and Following Treatment Plans Can Win Your SSDI Case

by April L. Roberts | Jun 8, 2022

Summary: If you are trying to win your SSDI case and want all the help you can get, we have some tips that may get you closer to your goal. The doctor you choose can have a big impact on getting your claim approved, and following your treatment plan exactly also makes a difference when it comes to the final decision.

The process to apply for Social Security Disability Insurance (SSDI) is fraught with challenges. Because the government is so focused on avoiding fraud, they have made the process extremely complicated. While it is easy to understand why it is important to spot fraudulent claims, it is even more important that delays are avoided for those who deserve and need their benefits.

One of the things that can help keep your claim on track is selecting the right doctor who will provide the best treatment plan. Staying compliant with your physicians’ treatment plan(s) demonstrates your desire to get better, which has a positive impact on your case. Here we look at the importance of selecting your doctor and how to win your SSDI case by sticking to a treatment plan.

A Doctor’s Influence

Doctors have a major impact on your SSDI case and the application process. They help establish your eligibility while also providing valuable medical evidence to confirm their diagnoses. Rarely if ever will a claimant’s treating source be called into a hearing or asked by SSA to testify as to their findings or opinions regarding their patient’s conditions. However, reporting conditions and difficulty functioning to the treating source is not only important to the outcome of treatment, but to the case file, in general. Detailed medical records are key to a positive outcome)

How Does the SSA Define Disability?

The SSA defines disability as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than 12 months.” Social security disability benefits are used for those who have worked and paid into the insurance program. It can be paid for up to 24 months, at which point patients receive Medicare benefits. SSDI benefits are very different from Social Security Income (SSI) which is designed for those without a recent work history.

How Does the SSA Determine Disability?

The SSA uses special criteria to determine disability status when reviewing SSDI applications:

You cannot earn more than $1350 per month ($2260 if you are blind) a month in wages.
Your condition must be considered severe and interfere with your ability to perform “basic work-related activities.”
You must have a medical condition considered so severe that it is specifically listed in the SSA disability manual or be of equal severity to one of those conditions.
If you don’t meet the third requirement, you must be unable to perform the type of work you did in the past and also be unable to retrain or perform a different kind of work.

If your condition is on the SSA list of impairments, you automatically qualify. Each condition then lists specific criteria that must be met based on the measures taken by your doctor. As mentioned in point #4, if you don’t fall under one of the listed conditions, but your ailment keeps you from performing work based on past skills or acquiring new ones, the SSA will look at your work history to determine if there are in fact other jobs you can perform.

To make a determination in these cases, they must look at your work experience, age, education, and transferable job skills to decide if you are in fact able to work in some capacity. They consider the impact of the economy and look for opportunities that might provide work such as changing from an auto mechanic to a factory worker.

What is My Doctor’s Role in Determining Disabilities?

When you choose your doctor, they must provide medical reports with as much objective evidence as possible. This information would include:

All medical records
Clinical and laboratory findings, imaging such as MRIs, CT scans, and X rays
Diagnosis
Treatments
Response to treatments
Referrals to specialists

Your doctor is the “treating physician” and their input is key to establishing your eligibility. However, there are also physicians on the other side. SSA-employed physicians are required to examine your chart. They consider your treating physician’s assessment based on your examination. Sometimes, the SSA finds they need additional information to make their determination.

In the case of a decline, the SSA can refer you to another physician to perform a “consultative examination.” Physicians can also be involved if your claim is denied, and you choose to go through the appeals process.

Ensuring You Have the Right Medical Evidence

Unfortunately, because you aren’t medically trained, you have no way of knowing if the records and information provided by your doctor are strong enough to establish eligibility. This can lead to rejection because you fail to present a strong, convincing case to the SSA. As mentioned, their strict guidelines are based on medical facts and criteria.

If you don’t meet their criteria, or the information provided by your doctor is either irrelevant, conflicting, or inconsistent, it could ruin your chances of approval. The only way to avoid this issue is to work with a social security disability advocate to handle your case and ensure you have the evidence supporting your claim. As your dedicated SSDI advocate, we ask for documented medical reports describing your conditions, symptoms, test results, and treatments you have undergone to ensure your case is approved.

Following Treatment Plans

You also have an important role in the decision. You have a duty to listen to your doctor and follow through with any treatment they recommend. If you decide not to seek treatment, this will negatively impact the determination. Providing a “paper trail” of all recommendations, the appointments you attended, and receipts for the medication you took, all provide proof you followed your treatment plan.

You also need your doctor’s documentation regarding your progress to show treatment failed or helped. Even something as simple as using a cane still needs to be documented. If the doctor you see fails to provide proper treatment, this can impact the outcome of your case. Therefore, you want to ensure when selecting your doctor, they will provide proper care, treatment plans and documentation to support your case. Without a doctor, the SSA has a right to send you to their own doctor which means your case is based on a far less objective diagnosis.

At Princeton Disability, our SSDI advocates offer disability assistance. We work on your behalf to ensure you have all the documentation required showing you have a doctor, that you followed their treatment plan, and that your condition prevents you from working. We help avoid denied SSDI and the drawn-out process of SSDI appeals so that you receive the maximum payout. Speak to our team today.