Why Your Doctor, the Treating Physician, Is Important for Social Security Disability

Social Security has changed it rule on medical opinions, but your treating doctor's support can still help you get disabililty benefits.

In the past, Social Security gave a good deal of weight to the medical opinion of a treating physician (a doctor who provides you with medical treatment on an ongoing basis) about your medical conditions and the limitations it caused you. For Social Security disability claims filed before March 27, 2017, a disability claims examiner or an administrative law judge at a Social Security disability or SSI disability hearing had to go along with the doctor's opinion in most cases.

But in 2017, Social Security enacted a new rule that says an examiner or judge no longer needs to give special weight to the opinions of a disability applicant's treating physician.

Treating Physician Rule Prior to March 27, 2017

To benefit from the special consideration given to treating physicians, you had to have an ongoing relationship with the doctor. A specialist you had seen once probably wouldn't count as a treating physician. Generally, the longer a doctor treated you, and the more times you saw the doctor, the more weight Social Security gave to that doctor's medical opinion. More than one of your doctors could be considered a treating physician. For instance, your primary care physician could be a treating physician because you saw the doctor a number of times over a period of months or years and your oncologist and neurologist could be treating physicians if you've seen them on a number of occasions and they are very familiar with your case.

Even prior to the law change, however, examiners and judges were allowed to discount a treating doctor's opinion in certain circumstances. For example, in one disability claim that made it to federal court, the judge found that the treating physician's opinion was in conflict with his own clinical notes and with the opinion of Social Security's medical consultant, and so did not deserve great weight. Other times, a judge would reject a doctor's opinion even though the treating physician's notes and recommendations provided evidence of disability. When this happened, it could be used on appeal to possibly overturn the judge's decision.

New Rule for Claims Filed On or After March 27, 2017

Under the new rule on medical opinions, Social Security no longer gives special consideration to the opinion of a treating doctor. A disability examiner or judge will evaluate all medical opinions on the same basis, whether they are from treating doctors or Social Security's consultative examiners (doctors paid by Social Security).

The new rule says that the most weight should be given to the most persuasive opinion, and that the most important factors that should be considered in evaluating the persuasiveness of an opinion are "supportability" and "consistency."

The first factor, supportability, means that a medical opinion should well-supported by medical tests, such as x-rays or blood tests, symptoms, and a doctor's clinical notes. The second factor, consistency, refers to whether the medical opinion is consistent with the rest of the evidence in the file (for instance, the applicant's statements and other doctors' opinions).

The new rule also says that if there are opinions from two or more doctors (for instance, the treating doctor and the Social Security doctor) that are equally well-supported and consistent with the applicant's file, Social Security will then consider the length of the patient's relationship with the doctor and whether the doctor is a specialist. So an applicant's treating doctor can still be very important to a disability claim, as long as his or her medical opinion is supported by and consistent with the evidence. However, the doctors' familiarity with Social Security rules and with the applicant's disability file will also be considered, and this factor tends to be in favor of Social Security's consultative doctors.

For more details, see our article on when Social Security can ignore your medical provider's opinion.

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