The 2007 COLA
The Cost of Living Adjustment (COLA) for 2007, released by the Social Security Administration (SSA), is be 3.3 percent. This means that for the more than 53 million Americans who receive monthly benefits from the SSA, benefits have increased 3.3 percent in 2007.
By the Numbers
In 2007, the 3.3 percent COLA increase means that:
· Supplemental Security Income (SSI) benefits have increased $623/month for individuals, while the average Social Security Disability Insurance (SSDI) benefit amount for a disabled worker, spouse and one or more children is $1,646/ month. Remember, SSI benefits are for a disabled individual only, whereas SSDI benefits may also apply to the spouse and children of a disabled worker.
· The Substantial Gainful Activity (SGA) amount will increase from $860 to $900 gross earnings per month. Earning over this amount may prevent one from filing for disability benefits or result in a loss of some or all benefits.
· The Trial Work Period (TWP) amount will increase from $620 to $640 gross earnings per month. During a TWP, a person receiving SSDI benefits is able to return to work, to test their ability to do work, on a trial basis for nine months.
New Social Security Ruling Means More Emphasis Will be Placed on Medical Providers
Introduction
By far, the most important evidence that SSA examines in a disability claim is the medical evidence. This is somewhat obvious, because the definition of disability requires that there exist a “medically determinable impairment.”
Medical evidence not only includes objective medical evidence, such as medical signs and laboratory findings, but also other evidence from medical sources, such as the medical history, opinions, and statements about treatment received.
Statements that a disabled individual makes about his or her impairments are also considered, but they must be corroborated by the medical evidence in order for them to be found credible and be given weight.
To help interpret the medical evidence, and to give binding guidance on disability and other benefit programs, SSA publishes several Rulings each year. In 2006, SSA published a Ruling entitled, “Considering Opinions and Other Evidence From Sources Who Are Not 'Acceptable Medical Sources' in Disability Claims; Considering Decisions on Disability by Other Governmental and Nongovernmental Agencies.”
In part, this Ruling clarifies how SSA considers opinions from sources who are not considered "acceptable medical sources." The Ruling recognizes that with the growth of managed health care and the emphasis on containing medical costs, many people get much of their care from health care practitioners who are not doctors. These sources include nurse practitioners, physician assistants and licensed clinical social workers. This Ruling gives guidance on how much weight SSA will give to their opinions.
Q & A
Question: Who does SSA consider to be an “acceptable medical source”?
Answer: In general, “acceptable medical sources” include, for example, licensed physicians (medical or osteopathic doctors); licensed or certified psychologists (including school psychologists); and licensed optometrists, although SSA may need a report from a physician to determine other aspects of eye diseases.
Question: What categories of non-acceptable medical sources are there?
Answer: There are three categories of sources besides "acceptable medical sources" considered under the new Ruling:
1. "Medical sources who are not acceptable medical sources" (for example, nurse practitioners, physicians' assistants, therapists, psychiatric social workers and chiropractors);
2. "Non-medical sources" such as teachers, counselors and social welfare agency staff acting in their professional capacity. These sources often have close contact with the individual and personal knowledge and expertise to make judgments about the impairment, activities, and level of functioning over a period of time.
3. “Non-medical sources” such as spouses, other relatives, friends, employers, and neighbors.
Question: Why does SSA draw a distinction between and “acceptable medical sources” and other health care providers who are not “acceptable medical sources”?
Answer: One reason is that only “acceptable medical sources” can give “medical opinions,” a judgment about the nature and severity of the impairments and the mental and physical restrictions they cause. In addition, if a patient has had an ongoing treating relationship with a medical doctor, for example, that doctor’s medical opinion can be given “controlling weight,” which can result in a favorable disability determination by SSA.
Question: What factors does SSA consider in deciding how much weight to give the opinions of medical sources who are not “acceptable medical sources”?
Answer: The same factors that are used to evaluate the medical opinions of “acceptable medical sources” can be applied to consider other opinions.
As stated in the Ruling, “These factors include:
· How long the source has known the individual and how frequently the source has seen the individual;
· How consistent the opinion is with other evidence;
· The degree to which the source presents relevant evidence to support an opinion;
· How well the source explains the opinion;
· Whether the source has a specialty or area of expertise related to the individual's impairment(s), and
· Any other factors that tend to support or refute the opinion.”
Question: Is there ever a situation where the opinion of a nurse practitioner or licensed clinical social worker could outweigh the opinion of a medical doctor?
Answer: It is important to keep in mind that although information from these “other sources” cannot establish the existence of a medical disease or illness, the information may be based on special knowledge and provide insight into the impairment’s severity and how it affects an individual's ability to function.
Under the new Ruling, it is possible for the opinion from a medical source who is not an “acceptable medical source” to outweigh the opinion of an “acceptable medical source,” if, for example, he or she has had greater contact with the patient and can provide better supporting evidence and an explanation of the opinion. This can be a great boon to patients who have limited contact with a medical doctor.
Bio:
Since 1986, Richard Feingold has been representing disabled persons in their Social Security disability claims throughout the United States. He a sustaining member of the National Organization of Social Security Claimants' Representatives (NOSSCR) as well as past Chair of the Chicago Bar Association's Social Security Law Committee. He can be contacted by email at Rich@FeingoldLawOffices.com, through his website at www.FeingoldLawOffices.com, or by phone at 773.989.9899.
Disclaimer:
The information contained in this article is provided as a public service, is general in nature, and does not constitute the rendering of legal advice or legal services. One should consult an attorney before making any decision involving a legal matter, such as a Social Security disability claim. |
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