“It is not easy to get disability benefits, and it’s a very complicated and difficult process.” That’s the assessment of Lisa Ekman, who is the Director of Government Affairs for the National Organization of Social Security Claimants’ Representatives. If you are unable to work and you need to receive Social Security disability benefits in Southern California, the place to start is a consultation with an experienced Los Angeles Social Security disability lawyer.
Why is it difficult and complicated to obtain disability benefits? If your first application for disability benefits is denied – and most first applications, in fact, are denied – you’ll need to appeal that decision, and the average wait time for a first appeal hearing is six hundred days.
And earlier this year, the Social Security Administration (SSA), in a well-intentioned but possibly misguided effort to fight fraud and to expedite the application process, established new rules. These new rules prevent the statements and conclusions of an applicant’s longtime personal physician from receiving any particular special consideration.
Until March of this year, benefits adjudicators for the SSA were required to give greater weight in the disability evaluation process to the opinion of a claimant’s treating physician about the disability claimant’s work-related limitations.
A “treating physician” is a medical doctor (M.D.), osteopath (D.O.), or Ph.D.-level psychologist who has an ongoing relationship caring for the claimant as a patient, as opposed to a doctor who may have seen the claimant briefly or not at all.
WHAT WAS REQUIRED UNDER THE OLD RULES?
Under the old rules, if a treating physician had stated that a claimant can only lift five pounds, but a consultant had opined that the claimant can lift 20 pounds, the SSA had to evaluate the claim on the basis of the treating doctor’s opinion rather than the consultant’s opinion. The new change now makes a huge difference and means that thousands who might have received disability benefits will now be denied those benefits.
The new rules are a mistake, according to Lisa Ekman, who explained why to KCUR Radio in Kansas City: “Those changes would now put the evidence from a treating physician on the same weight as evidence from a medical consultant employed to do a one-time brief examination or a medical consultant they had do a review of the paper file and may have never examined the individual.”
The Social Security Administration has said that the new rules preventing a personal physician’s statement from receiving special consideration are designed to “reflect modern healthcare delivery.” The new rules will no longer give added weight to disability determinations by other agencies such as the Department of Veteran’s Affairs.
While the SSA can look at the medical reports that another agency’s decision is based on, the SSA is no longer compelled to consider another program’s requirements when making its own decision about an applicant’s disability.
However, one of the new changes may be helpful to disability applicants. The Social Security Administration will now consider the opinions submitted by physician assistants and nurse practitioners in the same manner as opinions from doctors. This new rule recognizes recent changes in medical practice that means most hands-on care is now provided by physician assistants and nurse practitioners.
WHO MIGHT BE DENIED BENEFITS UNDER THE NEW RULES?
Ms. Ekman also said the new rules could mean more benefit denials for applicants with complex disability conditions such as multiple sclerosis, schizophrenia, and lupus – conditions that a physician unfamiliar with a patient may have difficulty evaluating.
More benefit denials mean that more appeal hearings have to be scheduled, adding to an appeals backlog that is already staggering. It all adds up to additional and needless suffering for struggling disabled persons who have already earned and deserve to be receiving their disability benefits.
Take Stephenie Hashmi, for example. Her career as a nurse in Kansas City was cut short six years ago by systemic lupus, which causes the immune system to attack the body’s organs and tissues. Despite surgery and other treatments, Ms. Hashmi, now 41, is usually bedridden.
When she first applied six years ago for Social Security disability benefits, she was denied. Her appeal hearing is scheduled for November – not this November, but November 2018.
WHY THE BACKLOG?
The long waits for appeal hearings started about a decade ago. That’s according to Jason Fichtner, a former acting deputy commissioner of the Social Security Administration who is now a senior research fellow in public policy at George Mason University’s Mercatus Center. The recession of 2007-2008, Fichtner said, compelled thousands of partially-disabled people who had been working to apply for disability benefits.
Even though partially disabled persons are able to do at least some limited amount and kinds of work, Fichtner explained, in a tight economy, they are typically the first people to lose their jobs. Thus, today, more than a million disability applicants are waiting for appeal hearings. At the same time, the Social Security Administration’s core operating budget has been slashed by about ten percent since 2010.
Fichtner also explained that the Social Security Administration is committed to weeding out fraud – including cases where a patient’s personal doctor might exaggerate his or her conclusions to help a patient obtain disability benefits. “For patients that are really in dire condition and really have major disabilities, I don’t think they have to worry about these rule changes,” he concluded.
The disability benefits application process is lengthy, complex, and often just baffling. Even when an applicant is approved to receive disability benefits, it can take up to six months to receive the first payment.
While there’s nothing spelled out that a Social Security disability attorney can do to expedite the process, an experienced Los Angeles Social Security disability lawyer can help an applicant to complete applications, write additional letters, gather the necessary paperwork, and help an applicant to be prepared for an appeal hearing.
A Social Security disability attorney can also ensure that no mistakes or misunderstandings lead to any unnecessary delays. If you are disabled, you are entitled by law to disability benefits – that’s why the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs were created. Congress – or the Social Security Administration itself – should find a way to speed up the benefit approval process.