What Counts as Medical Evidence for Disability Benefits?

When you apply for SSDI, one of the most important parts of your claim is supporting medical evidence. The Social Security Administration relies on detailed, objective documentation to determine whether your condition qualifies as a disability under its rules.

One common reason disability claims are denied is a lack of sufficient medical evidence. Understanding what counts as valid medical documentation and how it gets used in the evaluation process can improve your chances of approval. 

In this article, we’ll walk you through what medical evidence is, how the Social Security Administration evaluates it, what types of records are accepted, and how to gather the documentation you need to support your claim.

What is medical evidence for disability?

Medical evidence for disability claims includes documentation of your disability establishing that it prevents you from working or significantly limits your ability to work. It’s a critical part of your Social Security Disability Insurance (SSDI) application because it:

• Provides an official record of your diagnosis
• Demonstrates the severity of your condition or impairment
• Explains how your disability limits your ability to work
• Supports that your condition meets or is equivalent to a listed impairment in the Social Security Administration’s (SSA) Blue Book, which outlines conditions that qualify for SSDI benefits based on objective medical criteria

A common reason the SSA denies disability claims is insufficient medical evidence. You can strengthen your application by submitting thorough medical records that clearly describe your condition and how it impacts your daily functioning.

What kind of medical evidence is accepted?

Medical evidence is the cornerstone of an SSDI benefits claim. 

When you file a disability claim, you’re generally responsible for providing medical evidence that shows the existence and severity of your condition. Supplying this information upfront can help the SSA to process your claim more quickly. 

If you don’t have access to your records or can’t get them yourself, the SSA can request them directly from your physicians, psychologists, and other healthcare professionals. However, this may slow down the review process. 

Acceptable medical evidence includes:

• Medical history reports
• Clinical findings (such as the results of physical or mental status exams)
• Lab results or test results
• Imaging (such as CT scans, x-rays, and MRIs)
• Emergency room visit summaries
• Diagnosis
• Treatment prescribed with response and prognosis
• A statement from a medical professional on what work activities they believe you are capable of doing despite your condition
• Any treatment information
• Info about your daily activities and capabilities 

Medical evidence typically comes from professionals who have treated or evaluated you for your impairments. This includes licensed physicians, psychologists, and other qualified healthcare providers.

How do I find my medical records?

Under the Health Information Portability and Accountability Act (HIPAA), you have the right to view and acquire your medical records from any healthcare provider you’ve seen. If the SSA requests additional information about your condition, you can follow these steps:

1. Make a list of your healthcare providers. Include all doctors, specialists, clinics, or hospitals that have diagnosed or treated your condition.
2. Contact each provider. Reach out by phone, email, or their patient portal to request that your medical records be sent to the SSA through an authorization to disclose information.
3. Complete any required forms. Some providers may need you to fill out a release form or submit a written request. Be prepared to mail or fax your own documents when necessary.

Keep in mind that the process for obtaining medical records can vary by state. Some states require special authorization forms or have specific deadlines for releasing records. Make sure you understand the requirements that apply in your state to avoid delays.

How does the Social Security Administration use medical evidence for disability claims?

The SSA follows a five-step process to determine whether a person is disabled, with medical evidence playing a key role in steps 2 through 5.

After you apply, a claims examiner reviews your medical records to decide whether you have a severe physical or mental impairment, or a combination, that significantly limits your ability to work and is expected to last at least 12 months or result in death.

The SSA then checks whether your condition matches a listing in its Blue Book, which includes impairments considered severe enough to qualify automatically. If it does, you’ll be found disabled at this step.

If your condition doesn’t meet a listing, the SSA will proceed to assess your ability to work despite your limitations, referred to as your residual functional capacity by the SSA. This assessment, too, relies heavily on your medical evidence and other supporting evidence.

How Woods & Woods can help

Having a disability shouldn’t mean losing your peace of mind. At Woods & Woods, we help individuals with disabilities connect with legal help. If you’re seeking SSDI benefits, call us today for a free case evaluation.

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