How Your Doctor Can Make or Break Your Disability Case

Apr 8, 2016 | Sara Khaki

“The Treating Physician Rule”

When our office first meets with a new client, one of the main questions we ask is: “Do you have doctor you have been seeing for a while? And what is your relationship like with that doctor?”  The reason this is such an important question is because Social Security has a rule called “The Treating Physician Rule” which basically holds that the medical opinion of your own treating doctor will hold more weight than the opinions of other doctors that Social Security may send you to for a one-time consultative exam.< So when we are pushing our clients to develop a good treating relationship with one of their doctors, what our firm is looking for is a doctor who has been treating our client for a significant period of time (more than two to three visits).  Then we will contact that doctor and ask him/her to write a statement or fill out a form that we have prepared that asks the doctor for his/her opinion about our client's day to day limitations, severity of the disability, symptoms, and diagnosis and prognosis.  If the opinion is favorable to our client's case, we will then use it to help prove our legal case for disability benefits. But there are some legal parameters around the treating physician rule. First, the opinion has to be made by a physician, psychologist, or psychiatrist, or other acceptable medical sources.  The opinion of nurses, counselors, physician's assistants, physical therapist will not receive the same level of legal value as that of the doctor. Next, more evidentiary weight will be given to the opinion of a doctor who is a specialist in the impairment that you are alleging.  For instance, Social Security will not give much weight to the opinion of a primary care physician who is making a medical opinion about their patient's mental health.  However, if that same client is able to get their psychiatrist to write an opinion about their patient's mental health then that will be an opinion that will get substantial weight from Social Security. Social Security will also examine the duration of your relationship with your doctor and how frequently you see your doctor.  The longer a doctor has seen you and the more often a doctor has seen you, then the more likely that the doctor has a better understanding of your medical impairments. Probably one of the most important aspects of the "Treating Physician Rule" is that the opinions that your doctor makes about your medical condition is supported by the doctor's treatment notes.  There is no use in a doctor writing a statement that claims their patient is completely bed ridden and unable to work if that doctor's own treating notes does not contain any information that would support such an opinion. If your long treating doctor is willing to make a statement on behalf of your disability case and he/she specializes in your medical condition, then you will have the advantage of Social Security basing their decision on your own doctor's medical opinion of your disability case rather than the opinion of a doctor you have never met.  That is an advantage that every Social Security claimant should strive for.

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