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New Rules May Make the Backlog of Disability Claims Even Worse

July 12, 2017

Let’s start with this: the backlog of Social Security disability cases is a national disgrace. According to the latest statistics (updated monthly with the most current data available from the Social Security Administration (SSA) and the Office of Disability Adjudication and Review (ODAR) on the website disabilityjudges.com), the national average case processing time is 573 days, and in Illinois it is even worse—588 days. This is just from the time a hearing is requested (much later than the date a person applied for benefits). It is an agonizing wait for disabled Americans, especially since the financial well-being of many of these families is hanging by a thread.

As bad as these case processing times are, new regulations out of Washington which affect disability claims will likely make the wait times even longer. The new regulations, which went into effect earlier this spring, eliminated the so-called “treating-physician rule.” Under this rule, the Social Security Administration (SSA) was required to give significant weight to a physician’s report supporting an applicant’s claim for benefits, but the new rules remove that special consideration given to a claimant’s longtime doctor.

Lisa Ekman, a policy specialist with the National Organization of Social Security Claimants’ Representatives, told National Public Radio that this is a mistake. “[These] changes…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 [the SSA] had do a review of the paper file — [who] may have never examined the individual,” Ekman says. The new rules also give even less weight to disability determinations by other agencies such as the Department of Veterans Affairs. For example, a Veteran who receives 100% service-connected disability benefits from the Veterans’ Administration may not be deemed “disabled” by the Social Security Administration.

The Social Security Administration says the new rules are designed to “reflect modern healthcare delivery,” but their real goal is to root out fraud—regardless of how remote that possibility is. Jason Fichtner, a former acting deputy commissioner of the SSA, told NPR that “the agency is obligated to weed out any and all fraud that it can — including the rare cases in which a patient’s personal physician might be trying to tip the scale to get a patient benefits.”However, those who advocate for the disabled say this will make it harder for people to prove they’re entitled to disability payments. This rule change will most likely lead to more denials of benefits, especially for those with complex medical conditions resulting in chronic pain or mental illnesses (to name just a few). It is not hard to see that more denials will result in more appeals, which will increase the backlog.

NPR reports, “There are now more than a million people across the country waiting for hearings, and, adding to the strain, the SSA’s core operating budget has shrunk by 10 percent since 2010.”