The Social Security Administration’s (SSA) rules require approved disability claims to be supported by evidence obtained by the SSA and provided by you, the claimant. Medical opinions are a common form of evidence and often form the basis of an approval or denial of a claim. Although the SSA might be able to determine whether you are disabled by your medical records alone, it can be very advantageous for your regular doctor to provide a medical opinion regarding your condition.
Medical opinions provided by your regular medical provider, known as a “treating source,” are typically given more weight than the “consultative examiners” used by the SSA. Treating sources include doctors or other professionals you have seen in the past, including family doctors, specialists, psychologists and therapists. Per 20 C.F.R. 404.1527(d)(2), opinions regarding your conditions provided by a treating source that are well-supported and are not inconsistent with the rest of the available records are given what is called “controlling weight” – that means the SSA must treat the opinion is true, particularly in cases where the opinion states that you are unable to do certain tasks.
Even if the treating source’s opinion is not found to be well-supported or is inconsistent with the available evidence, the opinion can be given more weight than other doctors or consultative examiners used by the SSA. Treating sources with whom you have an established and long-term treatment relationship are given more weight under 404.1527(d)(2)(i) and (d)(2)(ii). Also, the SSA considers how much an opinion by any source (not just a treating source) is supported by the medical evidence, how consistent the opinion is with the available record, whether the opinion is written by a specialist in the appropriate field (such as a psychiatrist, rheumatologist, etcetera), and any other factors raised by you, the claimant.
This means opinions by doctors who see you frequently for illnesses or conditions in which they specialize are usually considered “better” than opinions by consultative examiners that have only seen you for an hour during a single examination. Sometimes an opinion from a claimant’s regular family doctor can mean the difference between getting approved for benefits on an initial application and having to wait over a year and a half for an Administrative Law Judge to finally approve your claim. Attorneys and case managers at Greeman Toomey regularly encourage our clients to speak with their regular doctors about providing medical opinions and we work with those doctors to ensure opinions from treating sources get to the SSA as soon as possible.
