A Doctor’s Opinion Could Be the Difference Between Approval and Denial on an SSDI Application

If you’re sending in an application for Social Security disability insurance (SSDI) benefits, you’re probably wondering what evidence the Social Security Administration (SSA) will use to determine if you are disabled. While there are many different components that affect your eligibility, one of the biggest factors in your case will be a medical opinion on your condition. Simply put, if a doctor strongly believes that you are not sufficiently disabled, your application may be denied.

The good news is that the SSA could weigh the opinions of several medical professionals before making a decision. The medical portion of the decision, known as the disability determination process, can involve a variety of doctors and their views regarding your prognosis.

Here are some examples of health care providers who may be asked to evaluate your SSDI application:

Treating Sources

Any of your own doctors, nurses, psychiatric evaluators, or other healthcare professionals who have provided you with ongoing medical treatment is considered a “treating source.” Whether you were treated at Saint Elizabeth Regional Medical Center in Lincoln, the University of Nebraska Medical Center in Omaha, or somewhere else, your treating sources may not be asked to determine whether you are disabled. Instead, they may be asked for a statement about your ability to perform work given your physical or mental limitations. The SSA will strongly consider the opinion of your doctor or psychologist, as these are the professionals who have the closest relationship with you as a patient and can attest to the severity and daily challenges of your condition.

Consultative Examiners

If your own doctor does not provide clear or sufficient medical evidence of your condition, the SSA may contact a doctor or psychologist to assist with the disability determination process. The State of Nebraska disability determination services (DDS) may request that you undergo an examination with a licensed physician or psychologist. These providers work within the SSA guidelines to perform examinations or evaluations .

Program Medical Professionals

Physicians or psychologists at the state DDS review claims for disability benefits. These doctors or psychologists review cases without ever meeting with the applicant. They are employed by the state agency to provide opinions. They make the residual functional capacity determination that affects whether you win or lose your case at the initial or reconsideration level.

Medical Experts

If your application is denied and you appeal your case to the hearing level, the administrative law judge may request expert medical testimony to clarify the finer details of your condition. The medical expert is pulled from a roster of physicians who provide testimony for hearings. The expert will be asked wheter you meet or equal a listing and if not  to give their opinion of your residual functional capacity.

Do you want to know which errors are guaranteed to get your claim denied? Read through a free copy of our guide, 5 Deadly Mistakes That Can Destroy Your Social Security Disability Case, or email us at [email protected].

Sean D. Cuddigan
SSA and VA Disability Attorney in Omaha, Nebraska