If you haven't seen a doctor for your medical condition, and you aren't receiving any kind of treatment for it, it will be hard to convince Social Security that it is serious. In addition, if you aren't taking medication or receiving medical treatment for your condition, Social Security won't know whether your condition could quickly improve with medical treatment, allowing you to go back to work.
But for some individuals, regular doctor appointments are a luxury they cannot afford. The cost of medical insurance for an individual or family is not financially feasible for many of today's working class or middle-class citizens, unless one member of the family works for an employer who offers some sort of insurance benefit.
This presents a problem for those who become disabled and file for Social Security Disability (SSD) or SSI, because disability examiners base their decisions on information contained in an applicant's medical records. Without some sort of recent medical evidence (specifically, a doctor's visit within the past three months), a disability examiner has no proof that the patient is currently not able to work (or even has an impairment, for that matter).
However, it is possible to collect disability benefits even if you have never seen a doctor or had any sort of medical treatment for your condition. Social Security cannot deny disability applicants benefits just because they haven't been to a doctor. There are several acceptable reasons for not seeking medical treatment.
If there is a lack of medical evidence in your file, a disability examiner will schedule a consultative exam (CE) with a private physician. However, the Social Security exams are brief and are seldom used as a basis of approval of any claim. Disability examiners send applicants to consultative exams because without some sort of medical opinion from a doctor or other approved medical treatment source, disability examiners cannot issue a denial on a claim.
Are CEs biased against disability applicants? Some people think so. The physicians who perform consultative exams are not employees of Social Security, although they do get paid to perform examinations for disability claims. At a minimum, keep in mind that physicians who perform CEs have contracted with Social Security to provide an opinion on a claimant's ability to work. This is different than the doctor/patient relationship that forms between a treating physician and his or her patient. A treating physician will try to safeguard his patient's health and act as his or her advocate; a physician who performs a CE is merely providing a service to Social Security so that the disability examiner can close a case.
Because not having sought medical care for your condition hurts your credibility, even if you go to a CE, you are not likely to win benefits without at least some other medical evidence. So you should try to get some sort of medical attention prior to filing for disability, even if it means you need to visit a free clinic or an emergency room, so that you have something in your medical record. The ideal of course, is to establish a relationship with a primary care physician who can supply Social Security with a diagnosis, a prognosis, a date of onset of disability, and a detailed list of your physical and/or or mental limitations. Having a residual functional capacity (RFC) form from a treating physician can greatly improve your chances of approval (particularly at the appeal level).
If you haven't been able to see a doctor, or have only seen a doctor once or twice, a disability lawyer can develop medical evidence through testimony or by hiring a medical specialist to review your case. For more information, see our article on developing evidence of disability when you haven't seen a doctor.
By: Tim Moore, former Social Security disability claims examiner