Articles

Social Security Must Pay the Cost of Incomplete Medical Records

Where the decision regarding disability benefits lies in the evidence set forth in medical records, these records are vital to the claimant's case. But what happens when the claimant's doctors do not provide complete or clear records. In the real world, medical practitioners are extremely busy and rarely have time to create perfect files for their clients. With their increasing patient load, doctors sometimes jot down several new notes on boiler-plate forms. These records are then a jumbled and confused mess, with little pertinent information, by the time they get into the hands of a Social Security Disability decision maker. Some medical records are simply a cut and paste job of the patient's prior visits with an additional note scribbled in differentiating one visit from the next.

What about claimant's who can only afford some sort of doctor visit, but not any x-rays or treatment programs? The truth of the matter is, such a claimant's records are not “complete” in any sense of the word. A decision maker cannot tell by looking at these records whether the claimant is truly disabled, or if the person's disability is easily treatable with the right services.

So…the question is, who should pay the price for inadequate medical records? The answer is, “not the claimant.” It is unfair for a claimant to bear the cost for his doctor's inadequate documentation of the illness. In Webb v. Barnhart, decided last year in the 9 th Circuit, it is clearly stated that an administrate law judge cannot deny the claim based on incomplete medical records. Instead, where the medical evidence seems ambiguous or unclear, the judge's duty is triggered to supplement these records. After that, the case gets a complete sequential evaluation for determination of benefits. Thus, a claimant's case cannot be denied because his medical records are not complete.