Does a Statement from A Family Doctor Writing “Disabled” Guarantee A Finding of Disability?

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Often, a person will begin the disability process by going to a local Indianapolis Social Security office and apply for disability benefits.  Many times, the reason that the person is applying for benefits is because the family doctor said that the person can no longer work.  Sometimes the doctor writes  a note saying “patient is disabled.”  Armed with the note and the opinion from the his/her doctor that he/she can on longer work, the person expects to be placed on Social Security disability within weeks of applying.

The person is surprised to learn that after three to four months, Social Security has denied the initial application for disability benefits.  When that person comes to see me about the initial denial, we have a conversation about the effect of the family doctor’s statement and its impact on the decision making process at Social Security.  The fact is, a simple note from a treating physician has little influence on whether Social Security will award disability benefits.

Social Security regulations 20 CFR 404.1527 (d)(1) and (2) and 416.927 (d)(1) and (2) deal specifically with short physician notes.  (d)(1) states that “a statement by a medical source that you are ‘disabled’ or ‘unable to work’ does not mean that we will determine that you are unable to work.”  (d)(2) reminds the reader that the final responsibility for deciding whether a person is disabled is a matter reserved for the Commissioner of Social Security.  This means that just because a treating physician writes that a person qualifies for disability under the rules and regulations for Social Security disability, there is no guarantee that the person will be found disabled.  The policy consideration underlying these regulations is that Social Security does not want private physicians and psychologists controling the federal disability system.

In addition to the regulations discussed above, for claims filed after March 27, 2017, the “treating doctor rule” has been changed.  The “treating doctor rule” requires that the Commissioner give the opinions of treating doctor “controlling weight” if the opinions are supported by medically acceptable diagnostic techniques and are otherwise not inconsistent with the other evidence in the record (see 20 CFR 404.1527 (c)(2) and 416.927 (c)(2)).  For cases filed after March 27, 2017, regulations 20 CFR 404.1520c and 416.920c apply.  These new regulations do not allow the opinions of treating physicians to have “controlling weight.”  Instead, the opinions of treating physicians are viewed at the same evidentiary level as non treating source physicians (whether those non-treating source physicians are examining or non-examining physicians).  The new regulations allow the Commissioner to give each opinion different weight depending on the supportability of the opinion, whether the opinion is consistent, the relationship with the person (including the frequency of the examinations, the purpose of the treatment, the extent of the treatment, the examining relationship) and the specialization of the physician or psychologist.  It is interesting to note that new regulations find it important to draw a distinction between a physician who examines a person or just review the evidence in the folder.

The new regulations emphasize the need for a well reasoned medical report.  In the Commissioner’s view, a well reasoned medical report must contain important details, clinical findings and medical reasoning from which the Commissioner can reach a conclusion about functional limitations that result of the illness.  It is uncommon for physicians and psychologist to write reports.  It is rare for those physicians and psychologists who are willing to write reports to include in the reports the data which the Commissioner now demands.  The more detailed the reports, with inclusion of medical reasoning and clinical findings, the more impact those reports will have on the ultimate outcome of the case.

Indiana Trial Lawyers Association