Social Security rules changes impact appealed SSDI claims

New Social Security Rules Impact Appealed Disability Claims

Social Security rules updated by the Social Security Administration (SSA) on January 18, 2017 may affect your pending disability claim. Recently, the SSA revised regulations regarding evidence that Administrative Law Judges (ALJ) can use to determine eligibility for disability benefits. The new Social Security rules became effective on March 27, 2017, making it harder for claimants to qualify for SSDI.

Below is an overview of the new Social Security rules and how these changes could affect your own SSDI claim.

The SSA Repeals Its “Physician/Treating Source” Rule

These newest Social Security rules replaced the standard for reviewing evidence during the appeals process, but don’t affect initial claims. If your initial disability claim’s denied (i.e., the SSA rules you don’t have a ‘total disability’ preventing you from working), your next option is to file an appeal. During the appeals process, you can bring your case before an ALJ. That ALJ will then begin a five-step process in order to determine your originally denied disability claim’s eligibility for benefits.

While actual legislation revising Social Security rules may seem complicated, the most significant change affects the previous “Physician/Treating Source” rule. Before January 2017, each ALJ carefully considered the treating physician’s medical opinion about a claimant’s health. Until now, ALJs deemed the treating physician’s report far more important than the SSA doctor’s findings in determining SSDI eligibility. If sound medical diagnostic techniques consistently supported your doctor’s opinion about your claim, the ALJ found that opinion valid. Before these new Social Security rules passed, the ALJ assumed your doctor understood your condition better than the SSA could. All claim appeals filed after March 27, 2017 must follow the new rules regarding acceptable medical sources (AMS). According to the SSA, all AMS providers must give specific evidence proving you meet the qualifying criteria for disability, based on the SSA’s internal definition.

Your Doctor’s Opinion About Your Disability Matters Less Than It Did Before This New Social Security Rule

New Social Security rules mean the SSA will no longer defer to your treating physician’s opinion about your disability status. In fact, the SSA no longer needs to take into account any treating healthcare provider’s statements detailing your:

  • symptoms (both visible and invisible)
  • physical, mental or emotional limitations that impact your ability to complete formerly routine job duties
  • other medical opinions from non-AMS providers that were previously used to establish your disability diagnosis

The most important consideration the ALJ makes now involves a list of factors gleaned from various treating physicians’ opinions. In other words, the ALJ must still review your doctor’s opinion. However, the final decision comes from the SSA physician assigned to your case during the reconsideration. Now, the ALJ has permission to review supporting explanations along with your own doctor’s opinion to determine your disability claim’s consistency. Factors that may help the ALJ in determining your disability claim’s eligibility may include:

  • frequency of treatments needed for your condition
  • whether your doctor is a specialist or not (i.e., qualified to make a professional medical opinion about your disability status)
  • length of relationship with your treating physician as well as the nature of individual visits (treatments, paperwork-only reviews, etc.)

What These New Social Security Rules Mean for Claimants During The Appeals Process

Of course, the SSA healthcare provider’s opinion was always important in reviewing a denied claim’s eligibility during the appeals process. However, these new Social Security rules make the SSA doctor’s opinion for reconsidering appealed claims even more powerful than before. If the SSA’s medical provider determines that you don’t have a qualifying disability, getting your denial reversed is much harder. The ALJ may have to prioritize the SSA provider’s disability determination over an individual’s treating source/physician while reviewing appealed claims. This is true despite the fact that in most cases, your treating physician knows much more about your medical history. If this happens, you may have to provide much more concrete evidence than before to support your appealed SSDI claim. Lengthier ALJ hearings and disability claim denials throughout the appeals process are more likely due to updated Social Security rules.

If your initial claim resulted in denial, speak to a disability advocate or Social Security attorney about filing your appeal. Experienced legal representation can make it easier to prove you’ve got a qualifying disability during an ALJ hearing, even if the SSA provider’s opinion is given deference over that of your treating physician.

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Mandy Voisin

Mandy Voisin is a freelance writer, blogger, and author of Girls of the Ocean and Star of Deliverance. As an accomplished content marketing consultant, mom of four and doctor's wife, Mandy has written hundreds of articles about dangerous drugs and medical devices, medical issues that impact disabled Americans, veterans' healthcare and workers' compensation issues since 2016.