Complex Conditions

The likely impact of this rule change will depend heavily on the disabling condition/illness upon which an SSDI claim is based. For those with conditions that can be confirmed by objective diagnostic testing, such as congestive heart failure or acute kidney disease, the impact should be less since the presence of the disease is understood to lead to the disability and is easily verifiable. However, for those suffering from conditions without a straightforward method of diagnosis that often require meeting with several specialists before a determination is made, such as fibromyalgia, chronic pain, PTSD or anxiety, the road to approval will probably be harder. Since ALJs will no longer be obligated to give additional weight to the opinion of a treating physician, it will be easier for them to deny a claim if other medical consultants, including those that did not perform their own examination of the claimant, have differing opinions. If the totality of the medical evidence does not appear consistent and/or persuasive enough in the eyes of the ALJ, this would be sufficient grounds to deny the claim. Common sense should allow one to realize that a doctor who treated a person for years is in a much better position to produce an informed opinion over a consultant who spent 30 minutes reviewing a file, but unfortunately, the new medical evidence rule seems to discount this factor.

Adding to the Backlog

Since the new rule on medical evidence could lead to the denial of an even greater number of disability claims, more disabled individuals will have to appeal farther into the SSDI determination process. These additional appeals will only add to an overwhelming backlog of claimants waiting to have their claim reconsidered by another evaluator or ALJ. Currently, more than one million people across the country are waiting for a disability hearing in front of an ALJ, a number which will increase if the budget proposed by the Trump Administration is enacted. Consequently, under the new rules, claimants with less easily-diagnosed conditions will need to exhaust all established methods of treatment and present even more evidence of the debilitating effects before approval will be granted. In light of this situation, working with an experienced disability insurance attorney from the beginning is even more necessary to getting the needed benefits.

Get Help

If you are trying to get approval for disability insurance benefits, do not wait until you receive multiple denials to seek the assistance of a disability insurance attorney. An attorney will know who to present your case most effectively, including the types of evidence most likely to convince a judge or examiner a disability exists. Farrell Disability Law understands how overwhelming the disability process can be, and will work to get the benefits you deserve. If you live in Jacksonville, Orange Park, Callahan or the surrounding area, contact the office for a free consultation.

Resource:

ssa.gov/disability/professionals/bluebook/revisions-rules.html

Previous Rule on Treating Physician Medical Evidence

As the new rule is limited to new claims, the previous regulation will still apply to pending SSDI applications, and is worth a review. Until the change, medical evidence from a doctor the SSA considered a “treating physician” was typically given more weight in the final determination of disability. This evidence was especially important at the administrative law judge (ALJ) appeal stage, and often had a substantial effect on the outcome. A treating physician is a doctor an SSDI claimant saw on a consistent basis so that an ongoing history of treatment is formed. Thus, a doctor a claimant saw once or twice would not be viewed as a treating physician. Greater weight was accorded to the opinions of treating physicians because the SSA believed these doctors were in the best position to evaluate a claimant’s prognosis and functional limitations. However, ALJs do not always put greater emphasis on the evidence from a treating physician, and sometimes completely disregard the information if the ALJ thinks it conflicts with the opinions of SSA medical consultant or diagnostic testing. Note that strong grounds for a successful appeal of an ALJ’s rejection of a disability claim exists if the judge does not offer a good reason for rejecting evidence from a treating physician.

New SSA Rule on Medical Evidence

Going forward, medical evidence submitted with new SSDI claims will be weighted equally, regardless of the source, and the most important factors in the determination of disability will be supportability and consistency. The SSA examiners will now look at how persuasive a medical source is based on how well the medical evidence supports the provider’s medical opinion. In addition, the more consistent a medical source’s opinion is, in relation to the opinion of a claimant’s other providers, the more persuasive it will be viewed. Further, an SSA examiner will look at the medical source’s relationship with a claimant according to the following factors:

• how long treatment was provided;
• how often examinations took place;
• the purpose of the treatment;
• the extent of the relationship, e., the types of examinations and testing ordered; and
• if the medical source is a specialist.

Talk to a Disability Insurance Attorney

The award of disability benefits can make a huge difference in a person’s life, and filing a claim should be approached with considerable care and knowledge. A disability insurance attorney brings the necessary background to give your claim the best possibility of success. Farrell Disability Law helps disabled clients throughout Florida and South Georgia file claims and/or appeal denials of benefits, and can assist you with getting the money you need and deserve. Contact the office today for a free consultation.

Resource:

federalregister.gov/documents/2017/01/18/2017-00455/revisions-to-rules-regarding-the-evaluation-of-medical-evidence