Medical Records & Reports

Friday, August 10th, 2007

Disability claimants frequently express shock and befuddlement that their applications for benefits were denied despite the fact that they submitted records from their doctors who all support the claimant’s inability to work. Many of these claimants’ incomprehension results from their not being aware of the difference between treatment records and medical reports.

A common rationale given for denying a claim is that while it is not disputed that the claimant has the alleged medical condition, the medical evidence fails to show that the condition is serious to prevent the individual from working. The treatment records typically provide a diagnosis identifying the medical condition, and treatment for the condition. Diagnostic tests can corroborate the clinical findings that led to the diagnosis. However, records and tests usually do not address the extent to which the medical condition affects the patient’s ability to function or work because that is not the doctor’s focus.

Yesterday, I received an approval on an LTD claim illustrating the difference between medical records and reports. The claimant had submitted records and confirming tests from five different medical specialists, each of whom supported the claimant’s application for disability benefits, yet the application was denied on the grounds that there was no evidence that the claimant’s back condition was severe enough to prevent him from working. On appeal, without securing any additional treatment records or tests, I obtained reports assessing the claimant’s functional capacity from each of the specialists. The claim was approved after the reports were submitted.

When seeking disability benefits, it is imperative to submit reports addressing functionality. It is the functionality opinions, backed up by the treatment and test records, that reveal the severity of a medical conditio

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