Perhaps the most important thing you need when applying for disability benefits is medical records that support your claim. According to the Social Security Administration, these documents can help prove you are too disabled to work for a year. You can work with your doctor or healthcare provider to prepare supporting medical documents while you apply. Or you can start gathering them yourself before notifying the SSA you plan to file a Social Security disability claim. SSA regulations require “objective medical evidence” from an “acceptable medical source” proving you meet their definition of “disabled.”
Why Do I Need Medical Records to Apply for Disability Benefits?
Giving the SSA timely, accurate, and complete information helps them review your claim much faster. According to the SSA, each person who applies is responsible for providing medical evidence that shows:
- Your impairment(s)
- Impairment severity — i.e., limits your ability to work
Submitting a claim without recent medical records makes it very hard to get approved.
Can’t the SSA Pull My Medical Records After I Apply?
If you give the SSA permission, they can collect medical records and other evidence from your healthcare providers. However, letting the SSA do this takes much longer. It can take months for hospitals, clinics or different doctors to respond. Then, each healthcare provider must transfer those records back to the SSA. Gathering the records you need yourself goes much faster.
What Medical Records Work Best to Prove My Case?
If you’re applying with a physical impairment, these documents with your doctor’s signature can help support your claim:
- Physical Residual Functional Capacity (RFC) form (naturopaths can sign this, too)
- Doctor’s letter with your official diagnosis, onset date and how symptoms limit your ability to function at work
- Complete medical records with treatment notes from a physical therapist, occupational medicine doctor, physical rehab specialist or primary doctor
- If you use a wheelchair, walker, cane, crutches, mobility scooter or other medical equipment, include those assessment records
- Your doctor’s treatment notes listing drug side effects or clinical observations
If your claim involves a mental impairment (like PTSD), get your doctor to sign these medical records:
- Mental Residual Functional Capacity (RFC) form — your psychologist, psychiatrist, therapist or counselor can sign it
- Files from your state’s vocational rehab program
- Assessments showing how well you function from your caseworker or social worker
- Letters of support from any caregiver, disability program or nonprofit agency that helps you (Meals on Wheels, paratransit, etc.)
- School records showing you need disability accommodations
- Psychiatric evaluations or neuropsychological tests
- IQ test results from before and after your disability began
How Much Will These Medical Records Cost Me?
You probably have some documents at home, like bills, receipts or lab results. These free documents are not complete medical records that your doctor signed, and will not help prove your disability claim! You usually must pay for complete medical records. That’s because they include your treatment notes and clinical assessments.
Most people don’t know this, but the cost for your complete medical records can vary widely. Healthcare providers are permitted to charge reasonable fees for copies (including supplies and labor) of your HIPAA-protected treatment records. They cannot, however, charge you to search for or retrieve records — only how much it costs to print out copies.
Step one is to call your doctor’s office and ask how much they will charge to copy your treatment notes. If you can afford it, pay to have those medical records mailed to you or pick them up in person. Vocational rehab files are usually free, so you won’t have to pay for those. Other free records you may submit that support your disability case include:
- Blood test results
- X-rays, CT scans, MRIs, etc.
- Printed prescription drug records (you can get these from your pharmacist)
- SOAR reports (for either homeless or at-risk applicants only)
Can’t afford to copy these medical records? Time for step two! Ask a Social Security lawyer to request those copies for you. A lawyer can add the cost for making copies into your legal fees, which you’ll pay much later.
My Doctor Won’t Release Records “For My Own Protection” — What Does That Mean?
If you have a psychiatric condition, your therapist or doctor may refuse to supply your records. Sometimes, your therapist will say no “for your own protection.” (Your doctor may not want you reading treatment notes on a psych evaluation, for example.) There’s a specific HIPAA rule that says your doctor can deny you access to your medical records. However, that rule only applies in rare circumstances. If that happens, try this method and see if it works:
- Type up a letter that states “I am requesting full medical records, psychiatric test results and treatment notes for ______” (your condition).
- Next, type “Under HIPAA regulation 45 CFR 164.524, please list the extremely rare circumstances that allow you to deny me access to my full and complete medical records.”
- Then, type “I plan to have your decision to deny me access to my own full medical records reviewed by a licensed health professional not involved in the original decision. If you can provide documents that are not denied specifically for my own protection, please mail those copies to: ________” (your address)
- Last, you’ll type “Please respond to this letter with written directions explaining how I may submit a complaint to the HHS Office for Civil Rights.”
When it’s complete, send your letter via certified mail only.
I Haven’t Seen A Doctor Lately/Cannot Afford Treatment. What Now?
If you haven’t seen a doctor recently because you can’t afford it or don’t have transportation, don’t give up! You may qualify for a good cause appeal. If you don’t have medical records for a very good reason, you may still get disability benefits. And if the SSA already denied your claim, you may still win during reconsideration or at your appeals hearing. Some reasons why you might get benefits for “good cause” include:
- If you’re born blind, then doctor’s visits likely won’t make any difference.
- If you have no health insurance and cannot pay a doctor, prove it when you appeal. Submit price quotes from local clinics and hospitals. Include financial statements showing you cannot afford prescriptions or doctors’ visits. If your employer’s health insurance ran out, copy the letter with the date your coverage expired.
- If you don’t have recent medical records, submit older copies and ask for a consultative exam. That way, your local DDS office can assign a doctor to review those documents as evidence.
Other “good cause” reasons the SSA may accept for missing medical records include:
- Fire or other accidental cause either destroyed or damaged all your records
- A serious illness or injury kept you from submitting records in a timely manner before the SSA’s deadline passed
- You were unable to contact the SSA due to death or serious illness in your immediate family
You May Qualify for Legal Assistance
Filing your disability claim through a Social Security attorney makes you almost 3x more likely to get SSD benefits. Those who apply with legal assistance through our website typically get $10,000 in lump-sum backpay, plus monthly benefits. Think you can’t afford a lawyer? All disability attorneys work on contingency. That means if the SSA won’t approve your claim, then you owe the lawyer $0 for legal assistance. And if you do win benefits, then you’ll only pay a small, one-time fee.
Sign up for your free, no-obligation phone call with a local disability attorney today. You can get confidential answers to all your claim questions by phone without ever leaving your home! It’s the fastest, easiest way to get professional claim help at no cost. Those why apply on their own without legal assistance typically wait 18-24 months for their first SSD payment.
Ready to see if you may qualify? Click the button below to start your free disability benefits evaluation now!
Laura Schaefer is the author of The Teashop Girls, The Secret Ingredient, and Littler Women: A Modern Retelling. She is also an active co-author or ghostwriter of several nonfiction books on personal and business development. Laura currently lives in Windermere, Florida with her husband and daughter and works with clients all over the world. Visit her online at lauraschaeferwriter.com and linkedin.com.