Click To Call The treating physician rule was originally modeled after the social security law, as applied in social security disability cases. The rule was created on the basis that the treating physician, having a physician-patient relationship, providing hands-on medical care, and having first-hand knowledge of the claimant, is in a better and more informed position to render opinions that need to be considered in a disability determination. As a result, deference was given to the treating physician's opinions in making a disability determination. The majority of the US Circuit Courts adhered to the treating physician rule and applied it to ERISA cases. At the same time, however, many Circuit Courts did not. This inconsistency, as it applied to the federal statute, was - unfortunately - ultimately clarified on appeal to the US Supreme Court by Justice Ginsburg on May 27, 2003. In the case of Black & Decker Disability Plan v. Nord , the U.S. Supreme Court held that ERISA does not require plan administrators to accord special deference to the opinions of treating physicians, consequently, ending the use of the treating physician rule in ERISA-governed claims.
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Frequently Asked Questions for Social Security Disability, Veterans Disability Compensation, and Long-Term Disability Claims

 


Q: What is the "treating physician rule" and how will it affect my long-term disability claim?

A:

The "treating physician rule" was originally modeled after the social security law, as applied in social security disability cases. The rule was created on the basis that the "treating physician," having a physician-patient relationship, providing hands-on medical care, and having first-hand knowledge of the claimant, is in a better and more informed position to render opinions that need to be considered in a disability determination. As a result, "deference" was given to the treating physician's opinions in making a disability determination.

The majority of the US Circuit Courts adhered to the treating physician rule and applied it to ERISA cases. At the same time, however, many Circuit Courts did not. This inconsistency, as it applied to the federal statute, was - unfortunately - ultimately clarified on appeal to the US Supreme Court by Justice Ginsburg on May 27, 2003. In the case of Black & Decker Disability Plan v. Nord, the U.S. Supreme Court held that "ERISA does not require plan administrators to accord special deference to the opinions of treating physicians," consequently, ending the use of the treating physician rule in ERISA-governed claims.


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