Why is Medical Evidence Important to Your SSD Claim?

In order for a person to be eligible for Social Security Disability (SSD) benefits, he or she must be unable to engage in a substantial gainful activity (SGA). Essentially, this means that the individual, because of some long-term disability, injury, or illness, is unable to work at any job or in any capacity. In order to prove that you are eligible for SSD benefits, you must present the necessary medical documentation. In other words, a healthcare provider must be able to state, to a reasonable degree of medical certainty, that your long-term disability or illness prevents you from working in any capacity. If that documentation is not included as part of your claim, the chances are great that your claim will be denied – at least initially.

A knowledgeable California SSD lawyer can review your circumstances with you and determine if you are eligible for benefits. If so, your lawyer can assist you with filing a claim for those benefits and pursuing them. Additionally, if you are denied SSD benefits by the Social Security Administration (SSA), your attorney could assist you with appealing that denial and working to get you the long-term benefits that you deserve.

Necessary Medical Documentation in an SSD Benefits Claim

In order for a person to be eligible to recover SSD benefits, there must be medical documentation present in the file which states that the person is unable to take part in any substantial gainful activity. In fact, lack of the necessary medical documentation is one of the most common reasons why a claim for SSD benefits is denied.

If your insurance company denies your claim for Social Security disability benefits, the insurance company must send you a letter stating why the claim was denied. If the claim was denied for lack of medical documentation, you could file an internal appeal of the claim denial and include the necessary documentation with your appeal. In a claim for SSD benefits, it is essential that you have a doctor on board in your case who is willing to state, to a reasonable degree of medical probability, that your injury or illness prevents you from being able to work in any capacity.

Appealing a Claim Denial  

It is not unusual for SSD benefit claims to be denied for lack of medical documentation and/or for failing to follow the necessary protocols. Insurance companies must allow at least one opportunity for an internal appeal of a claim denial. If your claim is denied and you have exhausted all of the administrative remedies provided by your insurance company, you might be able to file a federal lawsuit against the insurance company in the court system. However, if your claim gets to federal court, you will no longer be able to introduce additional medical documentation in support of your claim. All of that documentation must be introduced at the administrative level. Therefore, it is essential that you introduce the relevant documentation at that time.

A knowledgeable California SSD benefits attorney will be able to explain all of your legal options to you and can help you pursue the disability benefits that you deserve. If your claim is denied or if you need to file an appeal in federal court, your attorney will be able to assist you throughout that process and represent you at any court hearings.