Your treating doctor’s opinion of your medical condition and the limitations caused by your illness or injury is very important to winning your social security disability case. Social security law recognizes this fact in requiring social security to thoroughly analyze a treating doctor’s opinion. But this is not the same as requiring social security to simply agree with what the treating doctors have to say about a patient who is seeking disability.
I often talk to Texas social security claimants who have gone through the social security disability process without an attorney and have failed to secure social security disability benefits. I usually ask them why they did not get a lawyer. They typically do not say that they were trying to save money in representing themselves, but often say that, because their doctor “disabled” them, they did not think that they needed an attorney. Doctors also often assume that their opinion will be adopted by social security, and often write their patients a short letter stating that, in their opinion, their patient is “permanently and totally disabled”, and are surprised when such letters do not result in a favorable disability decision. This common and dangerous myth – that a treating doctor’s “disability decision” will be readily accepted by social security – is shared by Texas social security disability claimants and medical professionals alike.
The ultimate decision in a social security disability case – that the claimant is “disabled” under the Social Security Act – is specifically “reserved” to social security. It is not for the doctor to make. The doctor’s opinion on her patient’s medical condition, and the specific functional impairments that those conditions cause, is in most cases deemed to have “controlling weight”. But the determination of whether those functional limitations entitle the claimant to disability benefits under the Social Security Act is for social security alone.
Experienced social security disability representation presents the opinions of medical professional with reference to those areas that social security law deemed the medical to be “expert”, and effectively argues that those limitations render the claimant entitled to disability benefits under the Social Security Act.
The Dallas County indigent health care facility, Parkland Memorial Hospital, has been plagued by problems in treatment and supervision of health care providers in recent days. The sad reality is that it is virtually impossible to secure social security disability benefits if you are not getting regular medical treatment. The Parkland PLUS program provides medical treatment to Dallas County residents on a sliding scale – virtually free if you are without income or resources. So if you live in Dallas county Texas and are without medical insurance, Parkland is the only game in town.
But these recent horror stories coming out of Parkland Hospital are disconcerting. Many of my clients now going to Parkland ask me “if they can stop” going to Parkland. Obviously I cannot give that kind of advise. But regardless of the bad press Parkland is getting, it remains true that if you are seeking social security disability benefits, and have no medical insurance, most Administrative Law Judges deciding Dallas cases will find the recent Parkland scandals to be a sufficient excuse for not seeking medical treatment. A couple of thoughts:
- Medical treatment is inherently risky. Mistakes, misdiagnosis, and poor medical treatment can happen anywhere. Conversely I have seen many clients receiving excellent care at Parkland.
- Medical treatment “horror stories” (like amputating the wrong leg) get a lot of attention, understandably. But they are still very rare, and the sheer tragedy of such mishaps often causes us to overestimate the risk we run in medical treatment.
- Parkland is under such intense scrutiny right now that I would expect the care provided there is the best it has ever been.
- The risks of not treating a medical condition vastly outweigh the risks of medical malpractice.
I have written before about how important regular medical treatment is in winning a social security disability claim. Loss of a job due to a disability, however, often leads to loss of medical coverage, Parkland Hospital is available to low income Dallas county residents who do not have health insurance available. My experience, however, is that my disabled clients often have medical insurance “available” (for example, medical coverage is possible through a spouse’s job) but there is simply not enough money without a job to pay for medical insurance.
Project Access is collaboration of Dallas county doctors and healthcare providers to bring free medical care to those not poor enough to qualify for Parkland Hospital treatment. For more information visit www.projectaccess.info.