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Enforcing Guiding Principles in The Face of Changing Regulation

Sometimes the Social Security Administration seeks to change the rules to reduce the number of cases for which it must pay benefits. For example, the Administration has questioned the need for a doctor’s opinion when determining whether or not one can do work. This question arises especially in cases where the claimant is young or has a condition that a lay person finds difficult to understand (or even to accept as real). However, even with changing regulations, a claimant’s lawyer will hold the Administration to the timeless principle that diagnoses and determination of the impairing effects of those diagnoses are best handled by physicians—specifically, physicians that examine you and know your medical history.

The process of applying for disability begins with the initial level, where the Administration reviews your application and evidence, and it makes an initial decision (and sometimes a second opinion called a reconsideration decision). Next there is the hearing stage, during which an Administrative Law Judge (ALJ) will determine whether or not you are disabled based upon: i) your application, ii) the opinions of the Administration at the initial level, iii) your medical record and professional opinions, and iv) your testimony. Also, there is often testimony from a vocational expert that discusses what jobs might be available based on the limitations the ALJ finds after considering the evidence. However, sometimes (actually quite often) the ALJ will overstep his or her bounds and try to make a decision against the advice of medical professionals. This is an error that is often rubber-stamped by the Appeals Council after the hearing decision.

When this happens, it is time to consider taking the Administration to federal court. If the attorneys at Olinsky Law Group find that the ALJ has made an error in applying the law and regulations, we can sue the Social Security Administration. This means that a United States District Court will consider your case, and, if appropriate, the Court will order the Social Security Administration to rehear your case and to follow the District Court’s instructions when doing so.

Recently, the Administration has sought to repeal the regulations requiring ALJ’s to afford more weight to the physicians who treat you on a regular basis, instead allowing the ALJ to rely on the opinions of doctors who review your record on paper or who conduct a single consultation exam. However, despite this repeal of regulations, the District Courts understand that the principles behind the old regulations favoring treating doctors are as applicable today as they were years ago. The Administration must defend their decision by doing more than merely stating that they do not have to follow the old regulations.

Now, does this mean that if your doctor says you are sick or injured that the Administration must provide benefits? No. However, your doctor’s opinion is important, and it must not be taken lightly. A suit in federal court is meant to compel the Administration to afford your case the consideration that the law demands it be shown. In addition to providing professional service in helping claimants at the initial and hearing levels, Olinsky Law Group has a team of attorneys and staff dedicated solely to bringing cases to the District Court so that you can be sure that your case has been given as much consideration as the laws demand. Note by Andrew Flemming.


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