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Social Security Disability Insurance (SSDI) - New Rulings Issued

The Social Security Administration (SSA) recently released several new Social Security Rulings (SSRs) that apply to both Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) claims. The first two SSRs relate to the establishment of the onset of disability dates and replace SSR 83-20. SSR 18-01p and SSR 18-02p became effective as of October 2, 2018. SSR 18-01p addresses how the SSA determines the Established Onset Date (EOD) in claims involving "traumatic, non-traumatic, and exacerbating and remitting impairments," as well as other EOD related cases involving work activity and previously adjudicated periods. One important issue is that the SSR clarifies that an Administrative Law Judge ("ALJ") is not required to call upon a medical expert ("ME") to assist with inferring the claimant's EOD.

 

  • For impairments that result from a traumatic injury or other traumatic event, SSA begins with the date of the traumatic event as the EOD if the evidence supports a finding that the claimant met the statutory definition of disability on the date of the traumatic event or injury.
  • However, when the claim involves a non-traumatic or exacerbating and remitting impairment, the SSA considers whether the claimant first met the statutory definition of disability at the earliest date within the period under consideration taking into account the date the claimant alleges that his/her disability began (alleged onset date ("AOD")). The SSA is to review relevant evidence and consider:
    • the nature of the claimant's impairment;
    • the severity of the signs, symptoms, laboratory findings;
    • the longitudinal history and treatment course;
    • the length of the impairment's exacerbations and remissions;
    • and any statement by the claimant about new or worsening signs, symptoms, and laboratory findings.
  • The SSA may also consider evidence from non-medical sources if the SSA cannot reasonably infer the date that the claimant first met the statutory definition of disability from the available medical evidence.
  • SSR 18-02p is similar to 18-01p, but addresses how SSA determines the EOD in statutory blindness claims.

SSR 18-3p rescinds and replaces SSR 18-59 - "Failure to Follow Prescribed Treatment." SSR 18-3p provides guidance on how the SSA applies it's "Failure to Follow Prescribed Treatment policy in disability claims under Titles II and XVI" of the Act. This guidance will be applied in the determinations and decisions made on or after October 29, 2018.

SSR 18-3p explains that the SSA will only determine whether a claimant has failed to follow prescribed treatment when all three of the following conditions exists:

1. The individual would otherwise be entitled to benefits based on disability or eligible for blindness benefits under Titles II or XVI of the Act;

2. SSA has evidence that an individual's own medical source has prescribed treatment for the medically determinable impairments upon which the disability finding is based; and

3. SSA has evidence that the individual did not follow the prescribed treatment.

If all three of the conditions exists, then the SSA will make a failure to follow prescribed treatment determination by assessing "whether the prescribed treatment, if followed, would be expected to restore the individual's ability to engage in substantial gainful activity (SGA) and whether the individual has good cause for not following prescribed treatment.

If you need more information about a Social Security Disability/SSI, personal injury, EEOICPA, long or short-term disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611 or through our website.

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