How Important is My Doctor’s Opinion to the SSA?

Your doctor said that you’re unable to work.  Is that good enough for the Social Security Administration?  Disability Group Inc helps you ensure that your doctor’s medical opinion will matter to the SSA when your disability status is determined.

If getting your disability claim awarded was as easy as getting a doctor to state that you can’t work, many more people would be receiving benefits right now.  Unfortunately, your doctor’s medical decision is just one thing the SSA considers when evaluating your disability claim.  Here are the important facts to know about your doctor’s medical opinion and your disability claim.

1. The SSA has to find that you are disabled!

The SSA needs to determine that you have either a physical or mental condition that is expected to either last for at least 12 months, or result in death.  Your condition has to have prevented you from working at the last job you had, and prevent you from performing any other type of work available in the economy based on your health, education and work experience.

2. The opinion of the SSA doctor that you saw probably won’t matter more than your own doctor’s opinion.

Usually, the one time medical evaluation done by a SSA doctor will not be given more weight than your treating doctor’s opinion.

3. The longer your own doctor has been treating you, the more importance the SSA will give his or her medical decision.

The SSA has guidelines, which dictate how much weight can be given to your doctor’s medical opinion. The SSA will give more importance to your doctor’s opinion if your doctor has been treating you over a long period of time. In addition, your doctor’s opinion will be given controlling weight (most important medical opinion in the record) if:

  • Your doctor has been treating you over a long period of time,
  • Your doctor’s opinion is supported by clinical and laboratory tests, and
  • Your doctor’s opinion is consistent with the other substantial evidence in the record.

4. The more supported and consistent your doctor’s opinion is with the other medical evidence in your record, the more weight it will be given by the SSA.

If what your doctor concludes is not consistent with the other medical evidence in the record, SSA can decide not to automatically give controlling weight to your doctor’s opinion.  The SSA will evaluate each medical opinion in the record and use the following factors to determine the weight given to each opinion:

The length of time the doctor has been treating you and how often this doctor saw you. The longer and more frequent that a doctor has treated you increases the weight the doctor’s opinion receives from SSA.

The nature and extent of the treatment relationship. The more the doctor knows about your condition increases the weight of this doctor’s opinion.

Supportability. Opinions supported by medical signs and laboratory findings, are assigned more weight by the SSA.  The SSA is more likely to consider a doctor’s opinion if there is a well written explanation for the opinion.

Consistency. The more consistent the doctor’s opinion is with the rest of the medical evidence record, the more weight the SSA will assign to the opinion.

Specialization. The SSA will assign more weight to the opinion of a specialist provided the opinion given is within the doctor’s area of specialization.

Other factors. The SSA will give increased weight to a doctor’s opinion, if that doctor is familiar with the SSA’s disability programs and requirements.  Additional weight is given to a doctor’s opinion if that doctor has extensive knowledge of your case record.

5. A disability attorney can really help you out here!

A disability attorney can request medical records so your file is complete. The SSA can only base their decision on the medical evidence provided. An attorney can also provide medical source statements (questionnaires) for you to take to your doctor so your disability limitations are documented.