Elimination of the “Treating Physician Rule”
Earlier this year the Social Security Administration (SSA) revised its rules regarding disability claims. The rule changes went into effect on May 27, 2017, and any claims for disability benefits filed with the SSA on or after that date are affected by the new rules. The article addresses one of the rule changes that has garnered the most attention.
Treating Physician Rule
Since the 1990s, additional weight has been given by administrative law judges, when making disability determinations, to the opinion provided by a disability claimant’s treating physician. This has been often referred to as the “Treating Physician Rule.” The Treating Physician Rule meant that, most of the time, the administrative law judge would go with a treating doctor’s opinion at a disability hearing. The Treating Physician Rule has been eliminated with the SSA’s 2017 disability determination rule changes.
Who are considered treating physicians? Doctors who provide ongoing care to a disability claimant are considered treating physicians, and their opinions with regards to their patient’s claim of a disability were, prior to May 27, 2017, given special weight by the claim adjudicator. The number of visits a claimant had made to a physician and the length of time a claimant had been seeing a physician were considerations that would be taken into account when determining the weight that was given to the physician’s opinion.
The rationale behind the Treating Physician Rule was, of course, that a physician who had seen a patient many times would be quite familiar with the patient’s case and condition.
Claims for Disability Benefits Filed on or After May 27, 2017
Under the new rules, the opinions of treating physicians and those of the SSA’s consultative examiners are treated equally, with medical opinions that are most supported by medical tests (e.g. blood tests, MRIs, and X-Rays) being given the most weight. Another factor that is given heightened importance by a disability claims adjudicator is whether a physician’s opinion is consistent with other evidence in the claimant’s file.
If the medical opinions of more than one doctor are considered equal in consistency and supportability, additional weight will be afforded to the opinion of a physicians who have a long history with the claimant and physicians who are specialists in the field in which they rendered a medical opinion.
With less deference given to the medical opinion of one’s treating physician, it is now more important that a claimant’s doctor provide supportive evidence in the form of lab tests that provide results consistent with the doctor’s stated opinion.
If evidence exists in a claimant’s file that could be considered inconsistent with a physician’s stated medical opinion, it is important that the physician provide an explanation for the apparent inconsistency.
Residual Functional Capacity Form
A claimant’s physician should fill out a Residual Functional Capacity Form (RFC) to help make the case that the claimant should receive disability benefits due an inability or diminished capacity to work based on medical matters within the physician’s purview. A properly completed RFC that is submitted with a disability claim can greatly improve the likelihood of the claim’s approval.
Consult an Experienced Attorney
Navigating a claim for social security disability benefits to a successful conclusion can be a tricky process, and it is advised that one consult an attorney who is experienced in this field.