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Evidence in a social security disability, SSI or DIB Claim: Non-treating non-examining physician opinions are not good

Non-treating non-examining physician opinions are not good evidence in a social security disability claim. Social Security Disability Specialist — Susan O’Malley In most Social Security disability cases, the Social Security Administration uses medical consultants to review the record and issue opinions about a claimant’s functioning at the initial and reconsideration levels of review. These physicians typically do not examine or treat the claimants, and base their opinions upon a review of medical records only. Social Security Disability application is stronger with a good letter from your doctor Federal Courts have ruled that “the opinion of a non-treating, non-examining physician based upon only a review of the record cannot constitute substantial evidence to support a finding of non-disability.” Smith v. Schweiker, 795 F.2d 343, 348 (4th Cir. 1986).  A determination by a state agency non-treating non-examining physician can be substantial evidence, but only when it is “consistent with the record.” Smith, 795 F.2d at 345 (citing, Kyle v. Cohen, 449 F.2d 489, 492 (4th Cir. 1971)).  More recently, the Eastern District of North Carolina affirmed those rules of law in Mathis by Mathis v. Shalala, 800 F.Supp. 461, 463 (E.D.N.C. 1995).  In general, greater weight is accorded to the opinion of an examining physician than a non-examining physician. Jamerson v. Chater, 112 F.3d 1064, 1066 (9th Cir. 1997); Ortega v. Chater, 933 F.Supp. 1071, 1074 (S.D. Fla. 1996)(citing Lamb v. Bowen, 847 F.2d 698 (11th Cir. 1998)); see also, SSR 96-6p. These laws can be important to your disability case because a non-examining non-treating physician will not know as much about your condition as your doctors. You do not get to discuss your condition with these doctors and they do not get to see how credible your pain or disability is for themselves.  In almost every disability case, these medical consultants review your records and issue opinions. Often, these opinions are the only items of opinion evidence available in a case, and they frequently underestimate the functional effects of a claimant’s impairments and symptoms. The Federal Court opinions regarding how much weight a non-treating non-examining physician should be given reaffirm the value of a treating physician opinion to your disability case. When you have applied or are thinking about applying for disability, it is very helpful to talk to your treating doctors, psychiatrists, and other providers about whether they will support your disability application. By getting your treating physician to detail why you are disabled, you provide the judge with opinion evidence that is often contrary to the opinions of the medical consultants. As explained in the law cited above, when there is an opinion that is contrary to the medical consultants opinion, the medical consultants opinion cannot be used as substantial evidence to support a finding of non-disability. If you have any questions about treating source opinions, medical consultant opinions, or anything else regarding Social Security disability, please contact us.

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