Relevance of Old and New Medical Records When Determining SSD Eligibility

Relevance of Old and New Medical Records When Determining SSD Eligibility New medical records are vital to determine SSD eligibility, but older records also have particular use. Here we discuss when and why both types of records are needed.

An applicant’s eligibility for social security disability insurance (SSDI) and supplemental security income (SSI) is determined on the basis of current and non-current medical and work information. A 12-month medical treatment history is usually considered when evaluating the SSD claim.

Current Medical Records – Prime Consideration SSD examiners mainly take into account how a person is functioning now rather than how he/she was functioning earlier. Therefore current medical records are most important. Of course earlier records are needed, but for a different purpose as we shall see in the latter half of this blog.

Given the importance of current medical history, treatment records from the applicant’s treating physicians are needed for evaluation. This will give a clear idea of the individual’s condition, and how that condition (s) affects his/her ability to function.

In the absence of comprehensive treatment records from the individual’s own physician, Social Security may appoint a consultative examination physician to provide a quick evaluation of the person’s medical condition. This is not good and may even lead to denial of benefits if the consultative examination physician is not able to diagnose the applicant’s condition within the limited time. On the other hand, accurate medical records from the treating physician are more welcome to SS because they can avoid the expense of developing medical evidence and also take speedy decisions. Such records are also important from the point of view of a social security disability claimant fighting for disability benefits.

The Relevance of Old Treatment Records Take the case of a person who has an “expired” date last insured (DLI) or the last point at which he/she was insured to receive SSD benefits. Such a person needs older medical records to prove

the onset of disability before losing the SSD insured status. A person earns an insured status via work credits obtained from their work activity before becoming disabled. If the insured status is lost, one is eligible only to apply for SSI or supplemental security income disability program that is need-based. This benefit may not be as high as the SSD benefit one may be eligible for.

Older medical records are also needed when a person has to receive back payment for many months. For instance, a person who has not worked at a level considered to be “substantial gainful work activity� for a period of 17 months before filing for disability benefits may possibly receive 12 months of retroactive benefits. In such a case, the individual must necessarily have a medical treatment history indicating that he/she was disabled 17 months ago for which older medical records are needed.