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4 Things A Disability Administrative Law Judge Looks For When Making A Benefit Decision

Posted on March 16, 2016Posted By Russell & Hill, PLLCPosted In SSD

Since many claimants are denied at the Application and Reconsideration levels of the disability process, it is important to know what the administrative law judge (ALJ) is looking for when making a decision at the Hearing level.

Generally speaking, ALJs look for:

  1. Credible claimant testimony
  2. Sufficient medical records
  3. The claimant’s efforts throughout the process and treatment, and
  4. Opinion evidence from a treating provider. Let’s look at these in more depth

Credible Claimant Testimony

Claimants are sworn under oath when giving testimony, so honesty is imperative. Inconsistent or exaggerated statements can lead an ALJ to find the claimant not credible.

Other issues may influence a judge’s perspective on a claimant’s credibility as well, such as a claimant’s work history prior to her disability, activities of daily living, compliance with medical treatment, substance abuse and criminal history. If a claimant’s impairments are largely subjective in nature, credible testimony is even more important.

Sufficient Medical Records

The primary source of evidence in a disability claim is the claimant’s medical records. The Social Security Administration (SSA) orders a claimant’s medical records at the Application and Reconsideration levels. The claimant and her Social Security and Disability attorney develop the medical record at the Hearing level.

Judges like to see consistent medical treatment from the start of a claimant’s disability. If a claimant does not talk openly with her doctors about her symptoms, pain, and limitations, then the medical records will not include this information. Any complaint a claimant makes on testimony should be corroborated by her medical records. This means a claimant must get regular medical treatment and she needs to discuss her problems with her doctor so there is documentation of her limitations.

Effort from the Claimant

Judges expect effort from the claimant. They expect a claimant to cooperate with the system. Seeking disability is a long and difficult process, but a claimant’s failure to cooperate (e.g., does not fill out necessary paperwork or does not go to a consultative examination), can cause problems for the claimant.

Judges also like to see claimants making efforts to get the treatment they need to improve. If a claimant is not following a doctor’s recommendation, it is important to have a good reason why. Judges often want to see more than conservative treatment. For instance, if a claimant’s case focuses on her mental health, and she is receiving medication for her impairment from her primary care doctor, the judge may wonder why the claimant is not also involved in regular mental health counseling.

Opinion from Treating Doctor

Opinion evidence is very important in a disability case. Medical records provide information regarding claimant’s symptom complaints, examination findings, treatments, and recommendations for future treatment, but they typically do not include a doctor’s opinion regarding a claimant’s functional limitations.

Judges like to see opinions from medical providers who are treating the claimant regularly and know the claimant well. It is important for a claimant to build a good relationship with her medical provider(s) so hopefully, the provider will support the claimant in her disability claim.

Help From Social Security and Disability Attorneys in Spokane

At Russell and Hill, our Social Security and Disability attorneys in Spokane can assist a claimant by providing an effective questionnaire for her doctor that will ask specific questions relevant to the claimant’s disability claim. This will help develop the type of opinion evidence judges like to see.

Our team of attorneys in Snohomish County would love to help you obtain Social Security and Disability benefits. If you’re looking for qualified, experienced legal assistance, we’re your reliable team. Give us a call at 888-399-0921 or fill out our contact form.

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