What's happening
This bill requires that, when doctors disagree on an applicant's disability, the treating doctor's opinion usually prevails, considering specific factors.
Why it matters
Strengthens the role of treating doctors. By generally favoring the opinion of the applicant’s own doctor, the bill increases the weight of continuity and firsthand knowledge in disability determinations, potentially reducing the impact of one-time, state-ordered examinations.
Promotes fairer disability assessments. The requirement to consider factors such as treatment length, evidence support, and medical specialty pushes agencies to make more nuanced and individualized decisions, rather than defaulting to administrative convenience.
Could lead to higher approval rates for applicants. Applicants whose treating doctors support their claims may have a better chance of being approved for disability-related benefits, which could affect access to necessary support for vulnerable populations.
Limits arbitrary overruling by outside practitioners. By codifying a preference for treating doctors—unless strong, specific factors suggest otherwise—the bill aims to prevent situations where applicants are denied based on less-informed or potentially biased secondary evaluations.
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Who cares
Headline styles
Treating Doctor's Opinion Prevails
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Recommit, enacting clause stricken
- Referred to social services
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Prioritize Treating Doctor’s Opinion
Assembly Floor Calendar · Sponsor Andrew Hevesi
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4584
2019-2020 Regular Sessions
IN SENATE
March 15, 2019
Introduced by Sen. SANDERS -- read twice and ordered printed, and when printed to be committed to the Committee on Social Services
AN ACT to amend the social services law, in relation to establishing factors to be considered when a health care practitioner upon examination has a different opinion from an applicant's treating health care practitioner's opinion as to an applicant's disability
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 332-b of the social services law is amended by adding a new subdivision 4-b to read as follows:
4-b. In the event the practitioner to whom the individual is referred pursuant to subdivision four or paragraph (b) of subdivision two of this section issues an opinion that differs from the applicant's treating health care practitioner's opinion, the applicant's treating health care practitioner's opinion is generally controlling, subject to, but not limited to, the following factors:
(a) the length and frequency of the treatment provided,
(b) consistency of the opinion with the record as a whole,
(c) the degree to which the opinion is supported by concrete evidence, and
(d) the practitioner's specialty.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01067-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to establishing factors to be considered when a health care practitioner upon examination has a different opinion from an applicant's treating health care practitioner's opinion as to an applicant's disability
Purpose or general idea of bill
To ensure that the opinions and determinations of a public assistance applicant's treating health care practitioner are given sufficient weight when making disability determinations.
Summary of specific provisions
Section 1 amends subdivision 4 of section 332-b of the social services law, by adding a new subdivision 4-b.
Section 2 is the effective date.
Existing law
Currently it is within the evaluating practitioner's discretion what, if any, weight is given to the treating health care practitioner's opinion.
Justification
If an individual applying for public assistance has work limitations, disabilities, or health issues which have been identified by their treating health care practitioner, their diagnosis and recommendations should be considered to be accurate, in the absence of any contradictory findings. As the current law is written, there is little weight given to the treating health care practitioner's opinion, and if not supplied in a very timely fashion, is not even considered in making a determination on work limitations.
The social services appointed examining practitioner only sees the applicant for one short assessment, which is not always sufficient in exploring many complicated issues related to work limitations. If the applicant's treating health care practitioner has been following him or her for a long period of time, they most likely have established enough of a relationship with their patient which would allow for the discovery of hidden disabilities that the examiner may never find. It is for this reason that, under current law, if the examiner makes any findings contrary to the treating health care practitioner's diagnosis, the reasons for the differing diagnosis should have to be defended and explicitly stated in writing.
The federal government recognizes the importance of giving sufficient consideration to a physician's medical opinion, and they follow this practice explicitly in their Supplemental Security Income determination procedure, detailed in 20 CFR 416.927. (evaluating opinion evidence). This bill is modeled after this federal regulation. This section of federal regulation outlines Evaluating Opinion Evidence, and it is after this federal regulation that this bill has been modeled after.
Prior legislative history
2015-2016: A3450 (Wright M-S); 2013-2014: A2960; 2011-2012: A2957; 2010: A1417; 2009: A1417; 2008: A7946; 2007: A7946
Fiscal implications
None.
Effective date
This act shall take effect on the ninetieth day after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.