What if the evidence is questioned in a disability claim?

On Behalf of | Jun 27, 2024 | Social Security Disability

Californians who are injured, ill or suffer from a condition rendering them unable to work are wise to apply for Social Security Disability benefits. Unfortunately, in many instances, people encounter obstacles when they move forward with the application process. Knowing how to address these issues and successfully pursue benefits is important.

Evidence is perhaps the most fundamental part of a disability application. The Social Security Administration and its Disability Determination Services look at the evidence the applicant presents and use it to make a decision.

Claims can be denied for many reasons. One of the most common is if there is a problem with the evidence. Knowing the rules for how evidence is considered is a key aspect of a case. Recognizing when there are concerns about the evidence is vital to having a good chance at receiving benefits.

Understanding how evidence is assessed

The evaluation will look at the evidence and assess if it is complete and consistent. That includes the medical opinions and what the doctors say about the person’s issues. If they have an injury, the evidence must show that it is severe enough to prevent the person from performing substantial gainful activity and benefits are warranted.

In some cases, the evidence is said to be incomplete or inconsistent. That does not necessarily mean that the claim will automatically be denied. It just means that a decision cannot be made based on the evidence that has been presented. There could be a disparity in what one medical report says when compared to another.

The reports need to be in line and have all the relevant information about the case. Conflicts, ambiguity or medical evidence that does not come from acceptable sources are all reasons why it could be categorized as incomplete or inconsistent.

When there is inconsistent evidence, a determination could still be made and the person could be found to be disabled based on the available evidence. Despite that, it is wise to make sure the evidence is consistent and proves the person’s impairment is severe enough that they should receive benefits.

Evidence could be deemed consistent but insufficient for a decision to be made. It is also possible that the DDS is unable to decide based on that evidence even if it is consistent. There are several ways this can be resolved. The medical source could be asked to clarify their report or more evidence could be requested. The applicant could be asked to take part in a consultative examination that the SSA will pay for. More information might need to be provided.

Even if the person provides all the evidence necessary, it might not be valuable or persuasive enough for a decision. This could be problematic for the application as the crux of the determination is based on the evidence. If the evidence does not provide sufficient proof, there is a significant chance the claim will be denied.

When applying for disability, pay attention to the evidence

Since evidence is so fundamental to a Social Security Disability case, it is vital to make sure the evidence stands up to scrutiny and meets all the criteria to get approved. Even if there are problems with the evidence, that does not automatically mean the case will be denied. There are always options.

No matter the circumstances, it is useful to understand the nuance of the entire process from start to finish. That includes being aware of the rules of evidence and more. Being fully prepared from the outset is important and can help with a successful claim either on the initial application or through the appeals process.