Acting on ACUS Recommendations, SSA Implements Major Overhaul of Disability Claim Regulations Governing Medical Evidence

Who

The Social Security Administration (SSA) recently made changes to its disability claims program based upon ACUS’s recommendation regarding medical evidence and the treating physician’s rule.

What

The new rule implements two important revisions to account for changes in how healthcare is administered.

First, it expands the class of healthcare professionals whose opinions can be considered in deciding whether a claimant is disabled to include not only physicians, but also nurse practitioners, physician assistants, and other licensed providers.

Second, it eliminates the so-called “treating physician rule” under which the SSA must give “controlling weight” to the opinion of a claimant’s treating physician even in the face of conflicting evidence from other—sometimes more qualified—medical professionals familiar with the claimant’s condition. The treating physician rule has spawned unnecessary litigation—both in proceedings before SSA and in appeals of SSA decisions to the federal courts—in large part because it is often difficult to determine who qualifies as a “treating physician.” 

When

January 18, 2017 – SSA announced the implementation of major changes to the rules governing administrative litigation in its multi-billion dollar a year disability claims program, as recommended by the ACUS.

Why

SSA valued the expertise and advice the Conference provided. The changes are expected to improve the consistency and accuracy of disability decisions, resulting in greater fairness to claimants and the reduction of litigation costs paid by taxpayers.

How

The changes appear in a final regulation published in the Federal Register.