Understanding SSDI evidence requirements is essential for claimants

Many SSDI claims are denied because applicants don’t submit adequate medical evidence or satisfy Social Security’s evidence requirements.

It's not unusual for people seeking Social Security Disability Insurance benefits in Chattanooga to have their claims denied on medical grounds. According to a Social Security report, medical reasons were cited in 688,348 unfavorable SSD claim decisions made in 2010, the last year for which data is reported. Nearly one-quarter of all claims made that year were denied on this basis.

Many people who claim SSDI benefits may legitimately meet the medical criteria to qualify for benefits. Unfortunately, regardless of the severity of a medical condition or disability, inadequate documentation can lead to SSDI claim denial. Therefore, it is essential for people seeking SSDI benefits in Tennessee to understand Social Security's medical evidence standards and requirements.

Mandatory and recommended evidence

According to materials from Social Security, SSDI applicants are responsible for securing and providing medical evidence that is relevant to their claims. Social Security specifically requires a diagnosis from an acceptable medical source, such as a licensed physician, to prove the existence of a disabling condition. Additionally, Social Security requires the following forms of evidence to make a claim decision:

  • Medical records and other evidence from treating sources and facilities
  • Medical reports that describe diagnoses, clinical and laboratory findings, treatment protocols and medical history
  • Opinions and statements from treating medical professionals regarding the disabling condition, its effects and its prognosis
  • Statements from other sources, including employers and caregivers

Applicants can further support their claims with statements from personal sources, such as co-workers, friends or family members. Applicants also may submit direct reports regarding their medical conditions and functional limitations. Social Security will consider this information alongside other medical evidence. However, this subjective evidence carries less weight and cannot take the place of medical evidence.

Reporting adverse medical evidence

Many SSDI applicants suffer from disabling medical conditions that are episodic or not readily apparent. As a result, there may be medical records or professional opinions that suggest these applicants don't qualify as disabled. Prior to April 20, 2015, applicants did not have to submit this unfavorable evidence. Instead, applicants were asked to submit all evidence that could be "helpful" to their claims. However, in March 2015, Social Security issued a new ruling on this matter.

Under this ruling, applicants must submit all known evidence that pertains to their disabling conditions or SSDI claims. The only exceptions are for information that was already furnished and certain communications between applicants and their representatives. People who qualify for SSDI benefits on the basis of incomplete medical information risk losing their benefits later.

Documenting disabling conditions

Given these requirements, it is essential for SSDI claimants to submit full medical documentation and provide additional evidence to justify any adverse medical information. During this process, the assistance of an SSDI attorney may be invaluable. An attorney may be able to offer advice on effectively documenting the medical condition and establishing its debilitating nature.

Keywords: Social Security, disability, benefits, insurance