The role of health professionals in a disability claim is crucial. It can be the difference between winning and losing a claim. If Social Security is going to find someone disabled and award disability benefits, the medical evidence has to be thorough and show that impairments a claimant has prevent them from working at a Substantial Gainful Activity (SGA) level. Evidence of this sort can be obtained from a claimant’s medical provider, but additional evidence will be considered from a doctor Social Security schedules an appointment with for a claimant when the agency finds that not enough medical evidence exists. Below is specific medical information Social Security looks at when evaluating a claim.
The Role of the Health Professional
Health professionals play a vital role in the disability determination process and participate in the process in a variety of ways:
- As medical sources who provide medical evidence on behalf of their patients;
- As CE sources who perform, for a fee, examinations or tests that are needed;
- As full-time or part-time medical or psychological consultants reviewing claims in a DDS, in one of SSA’s regional offices, or in SSA’s central office; or
- As medical experts who testify at ALJ hearings or respond to written interrogatories from the ALJ.
Claimant’s Own Medical Sources
A medical source who has evaluated, examined, or treated a claimant is usually the best source of medical evidence about the nature and severity of a claimant’s impairment(s).
If an additional examination or testing is needed, SSA usually considers a claimant’s own medical source to be the preferred source for performing a CE.
Consultative Examiners for the DDS
In the absence of sufficient medical evidence from a claimant’s own medical sources, SSA, through the State DDS, may request an additional CE(s) to be performed by licensed medical sources (such as physicians and psychologists). All CE sources must be currently licensed in the State and have the training and experience to perform the type of examination or test SSA requests.
Each State establishes the set fee for CEs, and fees may vary from State to State. Each State agency is responsible for comprehensive oversight of its CE program.
Medical professionals who perform CEs must have a good understanding of SSA’s disability programs and their evidentiary requirements. In addition, these medical professionals are made fully aware of their responsibilities and obligations regarding confidentiality and:
- CE scheduling intervals;
- CE report content;
- Elements of a complete CE;
- When a complete CE is not required; and
- Signature requirements.
