My doctor wrote a letter and said I am disabled—so why was my claim denied?

By November 6, 2019 Advice
Claim Denied

A physician’s support for an individual’s claim is extremely helpful. However, your physician’s comments are considered to be an opinion, not the final say. The opinion can be given great weight, some weight, or no weight by the Social Security Administration. The adjudicator of a claim relies also on the complete medical record, and a doctor’s opinion must be consistent with the record.

Another point is that we don’t really want a doctor to say “my patient is disabled.” When a physician makes the comment “my patient is disabled,” the Social Security Administration’s answer is that this conclusion is not up to the physician, but is a decision “reserved for the Commissioner of the Social Security Administration.” In other words, the physician doesn’t have the authority to make such a determination. Nor do most physicians understand the rules and regulations involved in the decision- making process.

So…rather than have your physician write a letter saying you are disabled, it is better if a letter is written regarding how your IMPAIRMENTS affect your FUNCTION. For example, if you have mental health issues, do you have difficulty with focus, concentration and memory? If you had a job, would you be off task a significant part of the day? Or, if a claimant has chronic pain due to a back injury, is it the opinion of your physician that your pain would be so distracting so as to make you off task or miss more work than is accepted by an employer? Or prevent you from doing even a sedentary job?

For the most part, think of it this way. It isn’t the name of your impairment—it is how you function with your impairment. There are degrees of most everything. What needs to be established is that your impairment significantly interferes with doing any kind of employment.

That being said, the Social Security Administration welcomes the opinions of health care providers, and their support is of great value.

Kelly Kimball

Author Kelly Kimball

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