What Are the Major Changes in SSDI Regulations for 2019?
Disability benefits are paid based on a medical record review and other formalities. Here are some changes in SSDI regulations to note for 2019.
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The SSA (Social Security Administration) introduces changes in its rules and regulations from time to time, which social security attorneys have to keep in touch with. To evaluate the potential medical feasibility of a case, attorneys utilize medical record review services. To determine the legal validity of the case, attorneys have to be knowledgeable in all the applicable regulations. Only then can they provide the required counsel to their clients and direct them properly. What are the recent significant changes in social security regulations?
The 5-day rule, which became effective in May 2017, requires all evidence to be submitted at least 5 business days before the hearing. Or, the judge must be informed about the evidence. According to the rule, the administrative law judge (ALJ) may refuse to consider any evidence that is submitted after the deadline. Attorneys consider this challenging when they represent clients whose disability may prevent them from providing clear details regarding their medical providers in a timely manner. Besides, disability claimants may have additional medical records since their treatment is ongoing. Those medical records may be disregarded by the ALJ according to the rule, which can prove detrimental to the applicant.
Since March 2017, there is a significant change in how the SSA considers medical opinions. Earlier, the SSA had given substantial deference to a treating doctor’s opinion regarding a patient’s limitations. If the doctor’s opinion was consistent with the bulk of medical evidence available, the ALJ was required to give it considerable deference. If it was not consistent, the ALJ could decide how much weight a medical opinion in the file was worth. The new rule neither gives any deference to the treating physician’s opinions nor any specific evidentiary weight to it. Now the rule uses terms such as “consistency” and “supportability” and thereby weakens the treating doctor’s opinion on his/her patient’s limitations and abilities. As a result, ALJs could dismiss these opinions right away.
Since August 2018, the rule regarding withdrawal of representation came into effect. According to this, once a hearing is scheduled, an attorney can withdraw representation only in “extraordinary circumstances.” Why is this problematic for attorneys? The SSDI representation is contingent-fee based, and the rule could prevent an attorney from withdrawing from representation if he/she has received information regarding the
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strength of the case that may not have been available earlier. Attorneys representing problematic clients or those whom they cannot contact could find themselves in a very difficult situation. ALJs may refuse to allow attorneys to withdraw from representation once a hearing is scheduled and could even issue sanctions with the authority they have. Major concerns are: o The scheduling of hearings could vary considerably – from 12 months to 24 months after a request for hearing is submitted. Attorneys representing claimants who are non-responsive or who have disappeared can find it highly challenging to prepare the case. o Another problem with regard to the new rule is that “extraordinary circumstances” have not yet been defined. The definition could vary significantly among different ALJs.
Now, attorneys must disclose if they have referred a claimant to a doctor who gave an opinion on the claimant’s limitations and capabilities. This includes a client referral made by a firm to a doctor for a different matter such as a personal injury or workers’ compensation case. This kind of disclosure could cast the shadow of doubt on the legality of the treatment provided and opinions offered. Typically, claimants rely on their attorneys to find good doctors to treat their conditions. Social security disability attorneys can indeed provide the required assistance in this regard. Therefore, referrals such as these should not be used against claimants because they are part of the overall service the attorney provides.
The All-Evidence rule requires claimants and their attorneys to submit or make the ALJ aware of all the evidence they have relating to the disability claim including adverse evidence. Earlier, attorneys only had to submit evidence to the issue of whether the claimant is disabled. Now attorneys have to submit residual functional capacity evaluations or RFCs (crafted by themselves) and completed by the claimant’s doctors.
A comprehensive chart review can establish a claimant’s disability and limitations and with the appropriate medical evidence, attorneys can work to ensure that their clients receive the due compensation. However, the new rules that have been introduced over the last 2 years or so, could make the entire claim filing process challenging for claimants and attorneys. One of the greatest concerns is the restriction the rules impose on the manner in which evidence is www.mosmedicalrecordreview.com
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submitted and the importance it is given. While the process has become difficult for claimants’ attorneys to steer through, it has become even more challenging for disability claimants navigating the system on their own.
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