What's happening
This bill requires that an applicant's treating health care practitioner's opinion on disability is generally controlling, with certain factors considered, when there are differing medical opinions.
Why it matters
Empowers patients and their treating health care practitioners. By making the treating practitioner's opinion generally controlling in disability determinations, the bill increases the weight of the provider who knows the applicant best, potentially leading to more accurate and individualized decisions.
Reduces the risk of arbitrary denials. When applicants are sent to a different practitioner for evaluation, this bill helps prevent those short-term or one-time assessments from outweighing the ongoing provider's insights, unless specific factors clearly justify it.
Establishes clear evaluation criteria. The bill lists factors—such as treatment history, consistency with overall records, evidentiary support, and practitioner specialty—bringing greater transparency and predictability to how conflicting medical opinions are resolved.
Could streamline the appeals process. By clarifying which opinion takes precedence and under what circumstances, the bill may reduce disputes and appeals over disability determinations, benefiting both applicants and the social services system.
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Who cares
Headline styles
Treating Doctor Opinion Prevails
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- 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.
Treating Doctor's Opinion Prevails
In Senate Committee · Social Services · Sponsor Andrew Hevesi
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
7207
IN SENATE
January 10, 2020
Introduced by Sen. PERSAUD -- 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.
LBD01067-02-0
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 examina- tion 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.
Prior legislative history
2019:54641(Veto 179) 2017-2018:S4195 2015-2016:S1840 2013-2014:S428 2011-2012:S1326 2009-2010:55547 2007-2008:S1509
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.