Medical Evidence and Exams for Child Disability Benefits

Child Social Security Disability

• Child SSDI Overview
• Qualifying for Child SSDI
• Child Disability Medical Exams
• Eligible Child Disabilities
• Child Disability Claim Evaluations
• Approved Child Disability Claims
• Denied Child SSDI Claims and Appeals
• Special Circumstances for Child SSI and SSDI

One of the most important elements of your SSDI/SSI application is relevant medical evidence. The most common reason for a denial of an application for benefits is the failure to provide accurate and adequate medical information.

Child Medical Records and Laws for Disability Benefits

The Privacy Act requires that Social Security cannot release or obtain your child’s medical records without your consent. You will be asked to sign medical release forms as part of the application packet. Information you submit to Social Security can only be released for referring you to community or other agencies for services they cannot provide

Medical Providers that are Acceptable and Approved by the SSA

• Licensed physicians; Licensed or certified psychologists for purposes of establishing mental retardation, learning disabilities, and borderline intellectual functioning only;
• Licensed optometrists, Licensed podiatrists; and
• Qualified speech-language pathologists, for purposes of establishing speech or language impairments only.
• Other medical sources, such as physical, occupational, and rehabilitation therapists; and nonmedical sources, such as parents, teachers, and other people who know your child.

Obtaining evidence from your doctor and the hospital-- If you do not have the evidence, you need from your doctor or hospital, Social Security will assist you in getting that evidence. Social Security will pay for the cost of obtaining medical records from hospitals, doctors or other medical providers

Medical records – It is important to keep medical records up to date in child cases because of the length of time it takes to get benefits. It is likely that a hearing maybe necessary to have a successful claim. That may take up to three years with the current backlog. Records need to be recent and thorough to the better your chance if a favourable decision.

What does the SSA look for in children’s medical records?

• Medical evidence—General. Medical evidence of your impairment(s) must describe symptoms, signs, and laboratory findings.
• Formal testing that provides information about the development or functioning in terms of standard deviations, percentiles, percentages of delay, or age or grade equivalents. It may also include opinions from medical sources about the nature and severity of the child’s impairments.
• Test scores. Social Security considers all of the relevant information in the child’s case record. They do not rely on test scores alone in deciding disability.
• Medical sources – should report findings and observations on clinical examination and the results of any formal testing. Interpretations should also be based on information from parents or other people who know the child, including teachers and therapists.
• Information from other people – impairments will not affect all children the same way. Information about how the child functions with the impairment will be gathered from your activities and how you function on a day-to-day basis. These other people may include, but are not limited to Your parents and other caregivers, Early intervention and preschool programs, School faculty members
  

Medical Exams to Determine Disability Conditions  for Children

Who needs a consultative examination? Social Security may need a consultative examination in several situations. Some of them are as follows:

• To gather more evidence because the evidence obtained is not enough to make a disability determination;
• To obtain more detailed medical findings about your impairment(s);
• To obtain technical or specialized medical information;
• To resolve conflicts or differences in medical findings in the evidence already in file; or
• If you are a child under age 18, your ability to function like other children your age who do not have impairments.

Who will perform the child’s consultative examination?

The doctor, hospital or other medical professional or institution is the preferred source for a consultative examination. There are situations where Social Security could send you to someone other than your regular doctor or clinic. Social Security is required to give more weight to a treating physician’s opinion if someone other than treating physicians does the consultative exam.

Who will pay for the consultative examination?

Social Security is responsible for the cost of the consultative examination and any travel related expenses that may be necessary.

Impairments Eligible for Child Disability Benefits

Social Security regulations include a listing of medical impairments organized by body system, that provide a basis for determinations that many individuals are disabled without further evidence of their inability to work or consideration of their age, education, and work experience. A listing of impairments applies to children in instances where a child’s symptoms could be different from those of an adult. Social Security uses either listing where appropriate.

View all Categories and Types of eligibile Child Disability conditions.