Thursday, August 15, 2013

Operative Reports

It is not uncommon for an Administrative Law Judge (“ALJ”) to deny a Social Security Disability (“SSD”) claim on the grounds that a medical condition is not severe enough to be disabling because the claimant did not have surgery.  The case law had made clear that it is not necessary to have surgery to show that medical condition is disabling.  Nonetheless, if you have undergone surgery, then it should be obtained and submitted as evidence.

I had two cases that were approved today without any difficulty.  Both claimants sustained orthopedic injuries from motor vehicle accidents.  The first case involved a 48 year old warehouse manager whose foot was crushed, and the other concerned a 41 year old paralegal whose neck and back were injured.   

Generally, Social Security prefers denying SSD benefits to claimants who are under 50 years old.  I have had many claimants who are under 50 years old with motor vehicle injuries who retained me after their SSD application was denied.  What the two cases I had today in common was that each claimant underwent major surgery.  Each ALJ decision highlighted the surgery.

Treatment reports and functional capacity assessments can suffice to establish entitlement to SSD benefits.  However, operative reports tend to lead to faster claim approvals.  Many ALJs favor what Social Security doctors say over treating doctors because the ALJs think that treating doctors’ reports overstate a claimants’ disability in order to help them get SSD benefits.  It seems that ALJs perceive surgery as evidence that a treating doctor is not exaggerating the extent of a claimant’s inability to work.

No comments: