Wednesday, July 5, 2017

Treating Doctor CE

The Social Security Administration (“SSA”) invariably sends notices to applicants seeking Social Security Disability (“SSD”) benefits stating that they to attend a consultative examination ("CE”). In New York, claimants are told they have to be examined by a doctor from Industrial Medical Associates (“IMA”). However, the SSA’s program operations manual system (“POMS”) states that a claimant’s own medical sources should be asked to perform the CE for the back problem. 

When my clients get notices for an IMA CE, I advise the State agency about the relevant POMS, and offer to have the claimant’s doctor perform the CE and provide a detailed written report. To ensure there is no issue regarding the quality of the report, I tell the State agency to specify exactly what they would like the report to include, and to provide me with the same information they send to IMA when asking it to conduct a CE. 

Several disability analysts have recently agreed to allow claimants’ doctors to perform CE in lieu of IMA. In each instance the claim has been approved. One of those cases involved a 49 year old former Director of a State agency whose primary impairments are Lyme disease and fibromyalgia. Both conditions are frowned upon by the State agency, which invariably denies SSD applications based on those conditions. Nonetheless, shortly after the claimant submitted the CE report from her doctor, the SSD application was approved.

1 comment:

Uncertain Times said...

(Repost as I commented on an old blog post.)

Now they decided to switch it up and no longer give controlling weight to the treating physician as of 3/27/17. Will claimants be able to avoid agency or IMA exams despite this?

SSR 96-2p: Titles II and XVI: Giving Controlling Weight to Treating Source Medical Opinions

SSR 96-5p: Titles II and XVI: Medical Source Opinions on Issues Reserved to the Commissioner.

SSR 96-6p: Titles II and XVI: Consideration of Administrative Findings of Fact by State Agency Medical and Psychological Consultants and Other Program Physicians and Psychologists at the Administrative Law Judge and Appeals Council Levels of Administrative Review; Medical Equivalence.

SSR 06-03p: Titles II and XVI: Considering Opinions and Other Evidence from Sources Who Are Not “Acceptable Medical Sources” in Disability Claims; Considering Decisions on Disability by Other Governmental and Non-governmental Agencies.