Can You Get Disability Without a Doctor?

If you're applying for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) but you haven't seen a doctor, Social Security is likely going to be skeptical that you're disabled. Even though you might have legitimate reasons why you haven't had doctor's appointments, the agency won't award you benefits without evidence of a medically determinable impairment.

Missing prescription medications, lack of an official diagnosis, or limited doctor's visits are some areas where your case file may need to be developed before Social Security can make a decision on your claim. Knowing what the agency is looking for in terms of medical records—and how to proceed when you haven't had any doctor's visits —can go a long way towards increasing your chances of getting SSDI or SSI.

Applying for Disability When You Don't Have a Doctor

For some people, regular doctor appointments are a luxury they can't afford. While the Affordable Care Act made generous subsidies available for purchasing health insurance, millions of Americans are still without insurance. And paying out of pocket just isn't financially feasible for most people.

This presents a problem for people who become unable to work and apply for disability benefits, because claims examiners base their decisions first and foremost on the medical records. Without some sort of recent medical evidence—preferably a doctor's visit within the past three months—the examiner has no proof that you have a health problem that's keeping you from working. And if you're not receiving treatment for your condition, Social Security might think you can work if you take the proper medication or engage in another type of therapeutic approach.

That's why it's important for you to get all the treatment you possibly can on your own. Investing even a moderate amount in medical care up front to show how severe your condition is can pay off if you're later approved for disability benefits.

Why Going to the Social Security Doctor Isn't Enough

After you apply for disability, Social Security will often schedule you for a consultative exam (at no cost to you) with a doctor. Consulting doctors aren't employees of Social Security, although they do get paid to conduct the examination. The doctor might ask you to perform a series of physical motions to see how well you can move around or conduct a mental examination of your memory and thought processes. The doctor will then submit a report containing their findings back to Social Security.

Consulting Doctors Don't Have a Treating Relationship With You

Keep in mind that the consultative exam is just a snapshot of how you're feeling and what you can do on that particular day. As such, the consulting doctor is limited in the amount of insight they can provide to Social Security about your ability to work on a regular, full-time basis. They aren't a substitute for a doctor/patient relationship that develops a longitudinal medical history to support a disability claim.

Ideally, you'll establish a relationship with a primary care physician who can supply Social Security with a diagnosis, prognosis (likely outcome of your condition), date of onset, and specific details about your functional limitations. Having your treating physician complete a residual functional capacity form can greatly improve your chances of approval.

The Consultative Exam Probably Won't Help You Win Disability Benefits

Unfortunately, consultative examinations have a well-deserved reputation for being quick and not very thorough. By themselves, they hardly ever form the basis for an approval of benefits. So even after you attend one, you're not likely to get SSDI or SSI without at least some other medical evidence. That's why it's important to get as much medical attention as you can on your own and not rely on the consulting doctor's report.

Good Reasons for Not Seeking Treatment

Many people put off seeing a doctor for understandable reasons, such as prohibitive cost, childcare responsibilities, or work commitments. Social Security is aware that establishing regular medical treatment can be difficult and expensive, and won't normally hold it against you if you haven't been treated as often as you'd like. But you must show that you've at least sought out medical treatment.

Even for people who are underinsured (or uninsured), Social Security wants to see that you've tried to go to a medical provider for treatment more than once. Free or sliding scale medical clinics or urgent care centers are a good place to start. Don't forget to include the dates of any hospital visits when you're filling out the medical history section of your application.

If you've been to the doctor before and your doctor recommended a course of treatment that you weren't able to follow through on, Social Security will consider whether you have an acceptable reason for not complying with "doctor's orders" (SSR 18-3p). For example, if your doctor advises you to take medication that you can't afford—and you can't get it from a free or subsidized provider—the agency will consider cost to be a good reason why you aren't taking the prescribed medication.

Older Medical Records Can Still Help Support Your Case

For your Social Security claim, the more recent your treatment, the better. But even if you were treated years ago for your condition (or a medically related one) and haven't been seen since, Social Security will consider those records as part of your claim.

Be sure to list where and when you received treatment on your application, even if was many years ago. These older medical records can help show, for example, that your condition is longstanding and chronic, or that medical professionals have previously told you that nothing more can be done to help your condition—which might explain your lack of recent treatment.

Frequently Asked Questions (FAQs)

Below, you can find answers to some frequently asked questions (FAQs) about getting disability benefits without a doctor.

Can You Get Disability Without a Diagnosis?

Social Security awards disability benefits based on how severely your medical condition results in functional limitations, not your specific diagnosis. Some disorders are notorious for being difficult to diagnose, so the agency won't penalize you if it took your doctor a while to determine that you have chronic fatigue syndrome (for example). That said, it's almost always better to have a medical diagnosis than to not have one.

Do You Have to Be On Medication to Get Disability?

Generally, being on one or more prescribed medications signals to Social Security that you have a condition severe enough to require ongoing management. You don't have to be on medication to get disability, but the agency will question why you aren't taking anything that might relieve your symptoms (and allow you to work), especially if you've tried a particular kind of medication in the past with good results.

Does a Doctor Have to Sign Off on Disability?

The doctor's role in Social Security disability determinations isn't to write a note saying that you should be excused from work. Ultimately, the decision to award you benefits is a legal one—albeit one that requires input from medical professionals. While a doctor can't unilaterally determine that you're disabled, you can have a doctor write a medical opinion about your limitations that Social Security will consider when deciding your claim.

Do I Have to See a Doctor to Keep SSDI or SSI?

If you're awarded benefits, you'll likely be scheduled for at least one continuing disability review, or CDR. CDRs are Social Security's way of determining whether you still meet the agency's definition of disability or if your condition improved enough to no longer be disabling. You don't need to attend a medical examination to pass a CDR, but the agency will be looking at your updated medical records, so you'll need to keep seeing a doctor on a regular basis.

Getting Legal Help for Your Disability Claim

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, by hiring a medical expert to review your case, or having a specialist examine you. Disability attorneys only charge a fee if you win, so cost shouldn't be a major concern for you when deciding whether to hire an attorney. Many disability lawyers also offer free consultations as well, allowing you to "shop around" until you find a representative who's the best fit for you.