When Your Medical Condition Is Questioned By The Social Security Administration

At the center of every Social Security Disability Insurance (SSDI) claim is medical evidence. It's not enough to be afflicted with a condition, applicants must also prove their medical condition to the Social Security Administration (SSA). For some help in knowing what the SSA is looking for in terms of medical proof, read on.

The Primary Proof: Your Medical Records

When you apply for SSDI, you must complete an application. In most cases, you can explain your medical issues on the application without the need for sending in medical records. In some cases, the SSA may need to see your records. As a reminder, you should do these things when you apply:

  1. Gather your medical records, doctor's names, and previous employment information.
  2. Continue to see your medical doctors. The SSA needs to see that you have been in treatment for your condition, have followed the treatment suggestions, have had certain diagnostic tests performed, etc.
  3. Be prepared to send in your medical records or any other documents requested by the SSA in a timely manner. In some cases, you might be asked to have your doctor fill out certain forms.

The Consultative Medical Exam

If you have not been seen recently by a doctor for any reason, you may be asked to undergo a special type of medical exam called a consultative medical exam (CME). Applicants that may need to undergo this exam include not just those who have not had recent treatment but also when the SSA needs more information about an applicant's condition.

What Applicants Should Know About the Exam

  1. This exam is not performed by your own doctor but by a doctor who works under contract with the SSA.
  2. You will not be charged for this exam.
  3. No medical treatment or prescriptions will result from this exam. It's more for the SSA to gather information than it is for the applicant to get treatment.
  4. Some exams will also call for diagnostic tests and these are also free of charge.
  5. If you fail to agree to the exam, your benefits are automatically denied.
  6. Be prepared to explain your symptoms to the doctor using factual information and medical terms when possible.
  7. Also, be ready to explain why and how your condition made it impossible to work at your most recent job.
  8. This is not a complete exam – only the body parts affected by your condition will be examined.
  9. Being asked to undergo this exam may be a red flag that your benefits are about to be denied. If and when you do get turned down, be prepared to file for an appeal.

Speak to a Social Security attorney about representing you at your appeal hearing. They can help you argue for your benefits using their knowledge of the hearing officer and what they need to know. Talk to a lawyer about taking this next, important step as soon as you are turned down.