When an applicant for Social Security Disability (SSD) is found ineligible for benefits, they must file an appeal if they intend to continue pursuing benefits. Filing an appeal means the applicant must eventually appear before an administrative law judge (ALJ) whose job it is to evaluate the claim and make a final determination on the applicant’s eligibility to receive SSD benefits.
Medical Experts or MEs are commonly called to testify at appeal hearings. They may be called by the ALJ to evaluate medical records and explain the details of applicants’ medical conditions, or they can be called by the Social Security attorney of the individual applying for SSD benefits.
In either case, the medical expert who’s called is not the treating physician or the physician of record from any of the documentation in the applicant’s claim for disability benefits. Instead, the medical expert is a third party with no interest or connection to the claim or the applicant.
Medical experts who are called to testify by the ALJ in an appeal are tasked with evaluating medical documentation and testimony. A medical expert helps the ALJ determine the degree of impairment from which an applicant suffers and whether or not his or her medical condition meet SSD eligibility requirements.
When a medical expert is called by the applicant or their attorney, the role of the expert is to testify to the severity of the applicant’s medical condition, supporting the claimant’s argument that they have a qualifying disability and are therefore eligible for SSD benefits.
Medical experts can establish a claimant’s condition meets the guidelines of a listed impairment in the Social Security Administration’s (SSA) Bluebook, which is the manual utilized for evaluating medical records for SSD eligibility with specific diagnoses.
Additionally, a medical expert can help establish the date of onset of the claimant’s medical condition. This is crucial in determining when benefits should have commenced. The date the disability began will determine the amount of retroactive SSD benefits the applicant should receive if the ALJ finds them eligible for SSD following the appeal hearing.