What If A Medical Provider Does Not Provide Your Medical Records For SSDI Benefits?

by Jul 31, 2018General

Home » Blog » Frequently Asked Questions (FAQs) » What If A Medical Provider Does Not Provide Your Medical Records For SSDI Benefits?

If a medical provider does not provide your medical records for Social Security Disability Insurance (SSDI) benefits, it may cause delays in getting your claim approved. In worst-case scenarios, a provider’s failure to release your medical records can result in an SSDI denial. Unfortunately, many hospitals and doctors’ offices are understaffed, and medical records requests do not always appear at the top of their priority list.

A Social Security disability attorney can help move the process along by serving as a liaison between you, the provider, and the Social Security Administration (SSA). A lawyer can often spur the provider into action with a phone call or letter. If that does not work, your attorney can take additional steps so that your provider’s failure does not undermine your claim.

The Importance of Medical Records to Your SSDI Claim

Without current medical records, your chances of approval for SSDI may drastically decrease. Social Security has strict rules about who qualifies for disability and who does not. In order to qualify, you have to meet the SSA’s definition of fully disabled. The SSA defines fully disabled as unable to secure and maintain substantially gainful employment.

How are your medical records relevant to the SSA and its eligibility rules? Your medical records offer evidence that your condition indeed keeps you from gainful employment and is thus sufficiently disabling. They provide the proof that everything you state on your application about your health and functionality is true.

When a Medical Provider Does Not Release Your Medical Records

If you or the SSA have requested your medical records from a medical provider, and the provider has not released them, it is rarely a conscious decision by the provider to ruin your claim. More likely, the provider and their support staff are simply overwhelmed with work, and your request for your records is pushed to the side.

This happens a lot with larger hospitals and medical facilities, where layers of red tape and administrative staff often separate patients from their records. Whereas you can call a small, hometown clinic and immediately be placed in touch with someone who can pull your records from your file. Getting what you need from a huge organization often requires going through multiple employees and making numerous requests.

How a Lawyer Can Help

If you have not done so already, the first thing you should do is sit down with a Social Security disability lawyer to discuss your situation. Even if you are not having issues obtaining your medical records, it is still a good idea to work with a lawyer when applying for SSDI benefits.

No Upfront Fees

Very few disability lawyers charge upfront fees to work on SSDI cases; most work on contingency, which means they do not get paid until you do. So there are no risks and lots of benefits to having a lawyer on your side when applying.

When a medical provider is dragging their feet on releasing your medical records for an SSDI claim, your lawyer can spring into action, putting pressure on them to act quickly. A phone call or certified letter from a lawyer tends to get people’s attention quickly. Often, that is all it takes, and your records miraculously get released the next day. If not, your lawyer can take additional steps.

If a Provider Still Fails to Release Your Medical Records

If the provider continues to drag their feet, or if there is some reason they are intentionally holding onto your records and not releasing them, you have a couple of options. One, your attorney can escalate the situation, potentially by threatening and, if necessary, following through with litigation. Two, you can submit to a medical exam by another physician, one contracted with the SSA.

Both options have pros and cons. Any type of litigation can drag out your claim and delay your benefits. But the SSA-contracted doctor is not likely to know as much about your personal history as your own physician and therefore might not be able to paint as accurate a picture of your condition.

If your lawyer is involved from the beginning, the situation is highly unlikely to get to this point. But if it does, you still have options, and your lawyer can help.


Speak With a Social Security Disability Attorney by Calling 865-566-0800

At the Disability Advantage Group, our attorneys help disabled clients receive SSDI and SSI benefits. We want to put our resources to work for you and help you get the benefits you deserve.

For a free consultation, call us today at 865-566-0800.