Can You Get Disability Without Having Seen a Doctor?

Your medical records are the foundation of your disability claim. Social Security needs to see that you've seen a doctor about the condition that you're saying makes you unable to work. Without documentation of a medical impairment, the agency can't accurately assess several key factors in the disability determination process, such as what your residual functional capacity may be or whether you meet a Blue Book listing.

The strongest disability claims have evidence of consistent doctor's visits appropriate for treatment of the medical condition. If you apply for disability without seeing a doctor, you'll face an uphill battle—but it's not impossible to get benefits with only occasional medical attention.

Is It Possible to Get Disability Without a Doctor?

After you apply for disability, the claims examiner assigned to your case will review your file for information about any medical providers you've seen and request records from those providers. If you don't have enough evidence in your file for the examiner to make a disability determination, you'll likely get a letter in the mail asking you to attend a consultative examination with a doctor paid by Social Security.

While a consultative examination may seem like a good way to get disability without seeing a doctor of your own, keep in mind that the role of a consultative examiner isn't to advocate for you or help you get disability. Often, consultative exams are brief and less than thorough. There's no guarantee that the doctor's report to Social Security will address all your symptoms or limitations.

But in some cases, a consultative examination can be helpful for your claim. For example, if you apply for disability due to back pain and don't have any recent medical treatment, an X-ray showing that you have severe degenerative disc disease may provide the evidence a claims examiner needs to approve your application for benefits—particularly if you're over the age of 50 and fit a certain vocational profile.

Should I Apply for Disability Without First Seeing a Doctor?

Even though a consultative examination might help you get disability if you've had infrequent medical treatment, you shouldn't count on the examining doctor to write a glowing recommendation for your disability claim. Without a history of regular doctor's visits, Social Security will need to rely on the consultative examiner's opinion to determine what your functional limitations are, and that opinion isn't necessarily going to be in your favor.

That's why disability attorneys frequently remind their clients of the importance of obtaining consistent medical treatment. Social Security generally values the opinions of your treating doctors over those of consultative examiners, because your regular doctors can provide more insight into how severe your impairment is and how it might keep you from working. Moreover, disability examiners can assume that because you haven't seen a doctor, your condition isn't that bad.

So it's very much in your best interest to establish an ongoing relationship with a doctor before you apply for disability. Unfortunately, many applicants face financial hurdles keeping them from being able to get regular treatment. Social Security understands that medical care can often be prohibitively expensive and won't necessarily hold it against you if you can't afford a doctor, but you'll have to show that you've exhausted your available options.

What If I Can't Afford Medical Treatment?

If you apply for disability without seeing a doctor because you can't afford one, Social Security won't automatically deny your application. However, the agency will need to see that you've tried to obtain free or reduced cost health care services available in your area.

The burden is on you to prove that you can't pay for a doctor and that there are no affordable alternatives available. Social Security will find your explanation much more persuasive if you can show that you've done the following:

• completed an application for Medicaid
• contacted community organizations for assistance
• applied for subsidized health insurance from the federal marketplace
• sought treatment from emergency rooms or urgent care centers when appropriate, and
• called doctors' offices to ask about low-cost services they can provide, or whether they can arrange a payment plan.

Disability claimants who've struggled to pay for doctors often also find it difficult to afford medication (such as insulin for diabetes). Social Security won't penalize you for failure to take prescribed medication if you can show that the medication is too expensive and you don't have access to low-cost resources.

Can a Lawyer Help You Get Disability Without a Doctor?

Disability attorneys can only do so much for clients with limited medical treatment. If you hire a lawyer before you see a doctor, it's likely that the first thing your lawyer will do is try to get you set up with a doctor. Attorneys can't force you to seek medical treatment, but they can often point you in the direction of an affordable health care provider in your area, and some may be willing to assist you with a Medicaid application. Getting Medicaid benefits early on in the process may allow you to establish treatment well before your disability hearing.

Occasionally, an attorney might pay for you to be examined by a doctor who will then submit a report to Social Security. Because this is a pricey option, however, most lawyers only do this if they think the examination could realistically turn a losing claim into a winning one. If your lawyer sends you to a doctor on the firm's dime, you'll likely have to reimburse them for the costs of the examination if your application is approved (and sometimes even if it's denied).

While your lawyer won't be able to conjure up doctor's records where none exist, having an attorney on your side means that they'll be able to persuasively explain why you have gaps in your medical history and why you're disabled despite these gaps in treatment. Your attorney can also obtain statements from relatives or employers familiar with your condition, and get useful information about your functional limitations from doctors who have seen you only once or twice. You can learn more in our article on when to talk to a Social Security disability lawyer.

_{Updated April 23, 2024}