The Medical Records and Evidence You Need to Apply for SSDI Benefits
Social Security Disability Insurance (SSDI) is the primary federal disability program administered by the Social Security Administration (SSA). To qualify for SSDI, an applicant must satisfy both the technical requirements and the medical requirements.
With comprehensive, well-organized medical records, you will be in the best position to get access to SSDI benefits. In this article, you will find an overview of the records and evidence that you need to apply for SSDI benefits.
Medical Evidence is Key to an SSDI Claim
Funded through the federal payroll tax contributions of employees and employers, Social Security Disability Insurance (SSDI) exists to provide financial support to people who have a medically determinable disability—either physical or mental—that prevents them from substantial gainful employment. Notably, there are no “partial” SSDI benefits. An applicant is either qualified for benefits or not. To prove eligibility, you will need medical evidence that establishes your disability.
Notably, a significant percentage of SSDI claims are rejected because of issues with medical records/medical evidence. According to official data from the Social Security Office of Retirement and Disability Policy, approximately 1 in 4 Social Security disability claims are denied on medical grounds. WIth a medical denial, the SSA has essentially ruled that the applicant has failed to meet their burden of proving that they have a medically determinable disability.
Every SSDI Claim is Different: Medical Evidence Takes Many Forms
You may be wondering: What medical records do I need to file an SSDI claim? The answer depends on many different factors—most notably, the specific nature of injury, illness, or medical impairment. Some medical examples of evidence that is commonly part of a Social Security disability claim include:
- Notes/statements from doctors;
- Bloodwork results;
- Laboratory tests results;
- Imaging reports (MRIs, cat scans, etc);
- Mental health records; and
- Much more.
There is not one record or piece of medical evidence that is determinative in any given case. The totality of the medical records matter. Ultimately, you are going to need to present comprehensive, well-organized medical records that clearly indicate the presence and severity of a disabling medical condition.
Three Criteria that Your Medical Records and Evidence Must Satisfy
As noted previously, a significant share of SSDI claims are initially denied solely on medical records. If you are preparing to file for Social Security disability benefits—or if you are getting ready to appeal a medical denial—it is crucial that you know what is needed to submit a strong, compelling application for benefits. While every SSDI claim is different, there are some key principles that apply to all Social Security Disability cases. Your medical records and medical evidence should meet the following three criteria:
- Timely: Medical records must be fully up to date. One of the leading reasons for avoidable SSDI denials is untimely medical evidence. Many injuries, illnesses, and other impairments are subject to change. The SSA wants to know the current state of your condition. If medical records and medical evidence is not timely, the SSDI claim could be rejected on those grounds alone. Make sure that you’re submitting updated medical records. In some cases, it may be advisable to get a new statement from a treating physician supporting the nature and severity of your disability.
- Accurate: Inaccurate medical records are a serious red flag for the Social Security Administration. To be considered accurate, medical records and medical evidence should conform to the SSA’s standards. As an example, imagine that you are seeking SSDI benefits for a shoulder injury. If you have never had any x-rays or other imaging scans taken, the SSA may consider your medical records to be inaccurate. That is to say the records might not be viewed as reliable enough to approve your claim.
- Sufficient: Finally, your medical record and medical evidence must be sufficient to establish a disability. In some cases, SSDI applicants submit medical evidence that is suggestive of a disability but, for some reason, is incomplete. In other words, there is nothing wrong with the evidence that they submitted, but they are missing something important. Lack of sufficiency is another common reason why otherwise valid SSDI claims are denied on medical grounds. Make sure your medical records are comprehensive.
Get Help From an SSDI Claims Attorney
Social Security disability claims are complicated. If you have questions or concerns about the medical records and evidence that you need to apply for SSDI benefits, you are not alone. An experienced Social Security disability lawyer will help to navigate the claims process.