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Three New Rules from the Social Security Administration You Should Know About

In October of 2018, the Social Security Administration (SSA) introduced three new Social Security Rulings (SSR), each applying to Title II and Title XVI claims. The new SSR 18-01p and SSR 18-02p rescind and replace the preexisting SSR 83-20, and SSR 18-3p rescinds and replaces SSR 82-59.

Changes Created by SSR 18-01p

SSR 18-01p involves the SSA’s determination of established onset date (EOD) for claims involving “traumatic, non-traumatic, and exacerbating and remitting impairments.” The rule also states an Administrative Law Judge (ALJ) does not need to consult with a medical expert (ME) when determining the EOD of a claimant in such cases. Perhaps surprisingly, a claimant’s EOD could be deemed later than the first date they met the definition of their disability under the new rule.

Continuing, SSR 18-01p lists what the SSA will review when attempting to determine a claimant’s EOD, including symptom severity, laboratory findings and medical tests, duration of impairment, occurrences of remission, and more. If the SSA is dissatisfied with those traditional information sources and does not find an EOD using them, it can then review information provided by “nonmedical sources,” such as friends, family members, and employers who know of the claimant’s disability.

SSR 18-02p & Statutory Blindness Claims

The focus of SSR 18-02p is explaining how the SSA can determine EOD in statutory blindness claims, putting attention on how blindness differs from other forms of disability. Under SSR 18-02p, the SSA may establish disability in a blind claimant, even if they continued to work to some extent while blind. The SSA can halt the blind claimant’s earnings for the overlapping period and exclude them from cash benefit calculations, assuming that would prove beneficial for the claimant.

When a claimant is performing Substantial Gainful Activity (SGA) while also meeting all definitions of statutory blindness, the SSA will need to establish when the claimant initially met the definitions of blindness, which will act as the freeze date. Should the blind claimant ever lose SGA, the SSA will choose an “adjusted blind onset date” (ABOD), which would mark when the claimant became eligible for Title II benefits. Although, SSR 18-02o allows for a different interpretation of these dates if the claimant is aged 55 or older, or if the claimant is seeking only Social Security Income (SSI) payments.

SSR 18-03p: Failing to Follow Prescribed Treatments

Disabled or statutorily blind claimants can have their benefits removed for failing to follow prescribed treatments, as described in SSR 18-03p. In order to disqualify a claimant under this rule, it must be shown that the claimant was eligible for Title II or XVI benefits, the claimant was prescribed treatments based on the disability findings, and the claimant did not follow that treatment. Given all of these conditions are proven, the SSA will review the prescribed treatments that were not followed. The goal is to determine if the treatments would have helped the claimant regain SGA, and if the claimant had “good cause” for abandoning the prescribed treatments.

There are a few prelisted “acceptable good cause” reasons for not following treatment:

  • Religious beliefs
  • Cost
  • Incapacity
  • Disagreement among treating medical providers
  • Phobia of surgery
  • Similar treatment failures in the past
  • High risk of serious injury or death due to treatment
  • Risk of opiate addiction

The SSA holds the authority to determine other “acceptable good causes” based on each case’s specifics. No consultative examination or ME testimony is needed for the SSA to reach this determination. It noted that “good cause” cannot be based on a claimant stating they were unaware they were supposed to follow the treatment. It cannot be based on the claimant’s general complaints of the treatment’s effectiveness, either.

Social Security Disability Attorneys in Multiple States

At Rubin & Badame, Attorneys at Law, P.C., we are adamant about providing excellent legal services to men and women in need of Social Security benefits. Our Social Security Disability attorneys can help clients in Pennsylvania, New Jersey, Delaware, and Maryland. If you have any issues or concerns about your Social Security Disability case, benefits, or filing, call (610) 595-4917. We can help you in any step of the process, from initial questions about benefits eligibility to challenging unfavorable decisions with appeals.

Learn more about our law firm and your options during a free consultation with our firm.