Why Your Doctor's Opinion Counts & How to Obtain It
By Carolyn J. Shulman, Esq.
In a claim for Social Security disability benefits, it may seem like the Social Security Administration is getting the opinion of every doctor but your own. Social Security will often obtain the opinions of their own consultative doctors, who only examine you once. They may also ask doctors who have never examined you to describe your work-related limitations based only on the paper medical records in your file.
So, where does YOUR doctor's opinion fit into all of this? Does Social Security even have to consider what your own doctor says?
The answer is yes! Social Security's own regulations and rulings provide that if your treating doctor offers an opinion about what you can and cannot do in the workplace, the person deciding your case must consider what your doctor says. In fact, Social Security's rules state that usually, your doctor's opinion should be given greater weight than the opinion of a doctor who has not treated you. Also, the longer that doctor has treated you, the more weight it will generally be given. This means your doctor's opinion about your limitations can make a big impact on your case.
What is the best way to get your doctor's opinion? At Morgan & Weisbrod, we will usually create customized forms, called Interrogatories or Medical Source Statements, for your doctor to complete. These forms are basically questionnaires aimed at getting the most essential information about your limitations from your doctor. For example, if you have severe back pain, we might ask your doctor how long you can stand, walk and sit, and whether it's medically necessary for you to lie down several hours a day to alleviate pain. Or, for instance, if you struggle with mental impairments like depression or anxiety, we will ask your psychiatrist or psychologist how often you experience difficulty concentrating, whether you can follow complex versus simple instructions, and whether you can be expected to interact appropriately with co-workers, supervisors, and the public. Usually, we will mail these forms to you and ask that you take them to your doctor to be completed.
Often, the challenging part is ensuring that your doctor completes the forms. We cannot force your doctor to do this. Sometimes, treating doctors are hesitant to complete forms for various reasons. However, there are some points you can make to your doctor if he or she is reluctant to help. If you encounter this problem, keep the following talking points in mind:
- *Explain that your doctor's opinion can make a big difference in your Social Security disability case. It might even make the difference between winning and losing your claim.
- *If your doctor tells you that your lawyer already has his/her treatment notes and that should be enough information, politely disagree. Explain that their treatment notes do not necessarily discuss all of the functional limitations addressed in the forms. For example, do their notes indicate how much weight you can lift or how long you can sit, stand, or walk? Often, they do not address those details.
*If your doctor says you need to see a "disability doctor" or have a functional capacity evaluation ("FCE") performed, tell them that under Social Security's rules, this is not required. In fact, it's much more helpful to get your doctor's opinion, based on multiple office visits, than to go to a doctor who will only evaluate you once.
*Explain that your doctor need not perform any additional examinations; his or her answers can be based on his or her knowledge of your conditions and treatment history.
*Tell your doctor that if you win your disability case, you will start receiving either Medicaid or Medicare. Many doctors are unaware of this fact. However, once they learn this, they sometimes see the "big picture" and realize that winning this claim is not just about the monthly dollar benefits, but also about obtaining regular (and often better) medical attention through the Medicaid or Medicare program.
If your doctor agrees that you cannot work, the best thing he/she can do to help you win your case is answer a few simple questions about your limitations. Making this small effort will help the judge understand exactly how your conditions keep you from working.