Treating Physicians’ Evidence Diminished by New Rules

In the U.S., less than half of all people who apply for disability benefits — about 45 percent — are ultimately accepted, says Lisa Ekman with the National Organization of Social Security Claimants’ Representatives. Getting a hearing takes an average of nearly 600 days.

“It is not easy to get disability benefits, and it’s a very complicated and difficult process,” she says.

Some disability is difficult to actually see or measure. This spring, the Social Security Administration introduced changes to fight fraud and streamline the application process, including a new rule that removes special consideration given to a person’s longtime doctor. Ekman says this is a mistake.

“Those changes would now put the evidence from a treating physician on the same weight as evidence from a medical consultant employed to do a one-time brief examination, or a medical consultant they had do a review of the paper file — [who] may have never examined the individual,” Ekman says.

She says relying on these examiners who don’t know the patient could lead to more denials for disabled people with complex conditions like lupus, multiple sclerosis or schizophrenia. These illnesses can affect patients in very different ways and may be hard for an unfamiliar doctor or nurse to evaluate.

Social Security added regulatory text for claims filed on or after March 27, 2017, that there is no requirement to for them to articulate how evidence from non-medical sources about an individual’s functional abilities and limitations is considered. The means witness statements or testimony, often a very compelling part of a claim, may be less persuasive.