SSDI: Treating doctor opinions get less weight starting March 27, 2017

New rules taking effect March 27, 2017, will do away with the long-standing treating source rule that recognizes the special importance of an SSDI applicant’s treating doctor’s opinion.

Social Security Disability Insurance or SSDI law will undergo a major change on March 27, 2017, when complex new regulations issued by the Social Security Administration or SSA will take effect. For new SSDI applications filed that day or after, when deciding whether a claimant is disabled, the agency will no longer apply the longstanding treating source rule.

Treating source rule

Since 1991, the SSA has had an important regulation called "Evaluating opinion evidence" that establishes the treating source rule. Because in a given claim the agency may need to weigh medical evidence from a variety of medical providers, the rule says that the SSA will give "controlling weight" to the claimant's treating doctor's opinion on the "nature and severity" of the patient's impairments, so long as both of these are true:

  • The opinion is supported well by "medically acceptable clinical and laboratory diagnostic techniques."
  • The opinion is "not inconsistent" with other "substantial evidence" in the record.

The rule gives a treating doctor's opinion more weight because he or she is most likely to have a "detailed, longitudinal picture" of the claimant's medical conditions. The treating physician may also "bring a unique perspective to the medical evidence" that is not present in objective medical evidence standing alone or from one-time examinations.

The treating source rule is deeply embedded in the way SSDI eligibility is determined, so many people involved in the claims process, including many claimant's attorneys, objected when the SSA formally proposed eliminating the rule in September 2016.

The amended regulations

After considering public comments on the proposed changes, the SSA issued final rules in January 2017 to take effect on March 27, 2017. The new regulation states that claims filed before the effective date will be processed under the old rule, but those filed on or after the effective date under the new one.

Based on an agency finding that ongoing treatment relationships with doctors are becoming less common, the new regulation states that the SSA will not give controlling or specific weight to any medical opinion or "prior administrative medical finding," including those from the claimant's "medical sources" - the new way the rule refers to the claimant's treating doctors or other treating professionals.

Instead, "supportability and consistency" will be the most important things considered in deciding how persuasive a medical opinion is. Supportability looks at how "relevant the objective medical evidence and supporting explanations" are to the persuasiveness of a medical opinion. The more relevant the evidence and explanations are, the more persuasive the opinion.

Consistency looks at how consistent a medical opinion is with other medical and nonmedical sources. The more consistent the opinion is with the other sources, the more persuasive.

In addition to the most important factors of supportability and consistency, the SSA will also consider when deciding weight of a medical opinion:

  • The claimant's relationship with the medical source, including the length of the "treatment relationship," frequency of medical exams, reason for treatment with this source, extent of the treatment relationship and whether the source examined the claimant
  • Whether the medical source is a specialist
  • Other factors like whether the medical source is familiar with other medical evidence in the SSDI application and more

Anyone considering applying for SSDI should speak with a lawyer immediately about whether it could be beneficial to file before the controversial March 27 rule changes.

Attorney Robert Whitlow of Ayers, Whitlow & Dressler in Charlotte, North Carolina, has advised SSDI clients for over three decades from the surrounding area and across the state. He can be reached for appointments at 704-594-4317.