Claimants are considered disabled and qualify for Social Security Disability Insurance (SSDI) only if they provide medical evidence to Social Security, which proves they have a medically determinable mental or physical impairment that is expected to last 12 continuous months and does not allow them to engage in substantial gainful activity (SGA).
What does the SSA need to determine if a condition is a medically determinable impairment?
To make a disability determination, the Social Security Administration (SSA) will review a claimant’s recent medical records. Specifically, they will review medical evidence—provided by the claimant’s treating sources—that the claimant’s listed impairments are the "result of an anatomical, physiological, or psychological abnormality, which can be shown by medically acceptable clinical and laboratory diagnostic techniques."
Although statements from the claimant regarding their symptoms and impairments will be evaluated by the SSA, the SSA will also need medical evidence documenting their signs and symptoms.
This evidence can be acquired through medical evaluations from valid medical sources (medical doctors, nurses, therapists, psychiatrists, psychologists, etc.) and through medical testing (i.e. MRIs, CT Scans and X-rays).
Prior to applying for SSDI benefits, claimants should make sure that they have a diagnosis and prognosis, medical history information, clinical findings, laboratory findings and a medical statement from their treating sources identifying work activities (i.e. sitting, standing, walking, lifting, carrying) that they cannot perform given their impairment(s).
SSA Requests a Consultative Examination
The SSA will make their determination about a claimant’s disability based almost entirely on the medical evidence that they collect from the claimant’s treating sources. If a claimant has not seen a doctor or they have seen a doctor but there is insufficient evidence to make a disability determination, the SSA may schedule a consultative examination (medical examination) for the claimant.
The consultative examination can be conducted by the claimant’s own doctor or by an independent source. The information from the consultative examination, as well as any additional medical evidence, is reviewed by a two-person adjudicative team and then a disability determination is made.
Many claimants assume that if they cannot afford to see a doctor, they can simply get a free medical evaluation through the consultative examination and easily win benefits. Unfortunately, many claimants find that the consultative examination is nothing more than a cursory exam, often lasting less than 10 minutes, and generally does not provide enough evidence about their disability to win SSDI benefits.
No doctor… now what?
So what do you do if you cannot see a doctor and you have no medical evidence proving that you are disabled? Unfortunately, given the state of the current healthcare system and the sky-rocketing cost of medical care, even individuals with medical insurance may have difficulty finding a great doctor. If you do not have medical insurance, the situation can be even more precarious.
While there may be several steps you can take to begin to accumulate medical evidence that you are disabled, there are no good solutions. Several options, however, are discussed below.