Saturday, January 19, 2013

Treating Physician Rule

Treating physician rule (“TPR”) is a principle that when assessing the medical evidence of a Social Security Disability claimant, the administrative law judge (“ALJ”) should give greater weight to the opinions of treating physicians than to the opinions of non-treating physicians. The TPR seems simple enough, yet ALJ’s fail to follow it countless times in order to erroneously deny SSD benefits.
If the TPR rationale were understood, then there should be far fewer instances where ALJ’s erroneously fail to give proper weight to the opinions of treating physicians. I represent a marketing manager who received a fully favorable decision from ALJ Mark Hecht yesterday. The decision contained a through and comprehensible explanation for giving greater weight to the opinions of treating physicians: 

Generally, SSA gives more weight to the opinion of a source who has examined the individual than to the opinion of a source who has not examined you. Further, more weight is usually given to opinions from the individual's treating sources, since those sources are likely to be the medical professionals most able to provide a detailed, longitudinal picture of the person's medical impairment(s) and may bring a unique perspective to the medical evidence that cannot be obtained from the objective medical findings alone or from reports of individual examinations, such as a consultative examinations or brief hospitalizations. Generally the longer a treating source has treated the person and the more times the person has been seen by a treating source, the more weight SSA will give to the source's medical opinion. When the treating source has seen the individual a number of times and long enough to have obtained a longitudinal picture of the person's impairment, SSA will give the source's opinion more weight than we would give it if it were from a nontreating source. Other relevant factors which will be considered in assessing the opinions of treating sources are the nature and extent of the treatment relationship; supportability of the opinion; consistency with the medical findings; and, the specialization of the treating source. 

The decision followed a partially favorable decision that a different ALJ had issued. The result is that the claimant will receive an additional 15 months of SSD benefits. Any SSD claim that is denied in whole or part when the treating doctors support should be appealed.

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