Social Security Administration Rescinds Treating Physician Rule

doctor shakes hands with patient

by Andy Jones
April 12, 2017

New regulations went into effect March 27 that disability advocates fear will make it significantly more difficult for people to obtain approvals in Social Security disability benefits proceedings.

Previously, administrative law judges, when making eligibility determinations, were instructed to give additional weight to evidence supplied by the claimant’s treating physician, as opposed to evidence provided by specialists and third-party evaluators. Under the new regulations, crafted by the Obama Administration, treating providers would no longer have such deference.

When the rules were proposed, the Consortium for Citizens with Disabilities, in a letter signed [PDF] by the National Disability Rights Network and 32 other organizations, slammed the proposal in public comments to the Social Security Administration.

They argued that the changes would give judges “excessive discretion” and ignore the inherent reliability created by the “ongoing relationship” between people with disabilities and their treating doctors.

“The relationship between a person and their treating provider is unique and the opinions of treating providers deserve more weight than the opinion of someone who either examines an individual once or only reviews the claims files…,” the CCD wrote in the comments, dated November 6. “Providing effective treatment to a person typically requires a much greater depth of knowledge and information than that relied on by professional merely providing an evaluative function."

The SSA defended the rule as reflecting changes in the structure of the health care system.

“Since we first adopted the current treating source rule in 1991, the healthcare delivery system has changed in significant ways that require us to revise our policies in order to reflect this reality,” the SSA wrote in regulations. “Many individuals receive health care from multiple medical sources, such as from coordinated and managed care organizations, instead of from one treating (acceptable medical source).

“These individuals less frequently develop a sustained relationship with one treating physician… These final rules recognize these fundamental changes in healthcare delivery and revise our rules accordingly.”

Evidence supplied by other governmental agencies, such as the Department of Veterans Affairs, will no longer be given additional weight either.

Disability Rights Washington is the protection and advocacy system in Washington state and a member of the National Disability Rights Network.