A remarkable change in the way disability claimants are evaluated will likely have a significant impact on a large number of Social Security Disability claims that are filed each year. Effective as of 03/16/2016, a disabled worker’s credibility is no longer to be considered when evaluating the claimant’s symptoms. While the change may not initially appear to be significant, it is important for disabled individuals to realize that when a claim is denied at the hearing level, the standard decision by an administrative law judge (ALJ) is almost always based on the credibility of the claimant.

Nationwide, only about 50 percent of disability claims are approved at the hearing level. In Illinois, an alarming 44 percent of claimants are denied benefits at this stage. Before the new ruling took effect, a claimant’s credibility generally played a central role in the evaluation of the individual’s symptoms. Unfortunately, many symptoms that are associated with a disability cannot be medically measured (pain, fatigue, anxiety, inability to focus). Therefore, the ALJ had to rely on his or her own opinion about the severity of the subjective symptoms reported by the claimant as well as the effects these symptoms had on the person’s ability to perform substantial gainful activity (work). Individuals who suffered from symptoms that were difficult to document with medical evidence were frequently denied benefits.

According to the new ruling, if an individual alleges symptoms related to his or her impairment, those symptoms must now be evaluated using a two-step process.

  1. First, it must be determined whether the individual suffers from mental or physical impairment(s) that could reasonably be expected to result in the alleged symptoms.
  2. If it is determined that the individual suffers from underlying mental or physical impairments that could produce the symptoms in question, the intensity, functionally limiting effects and persistence of those symptoms must be evaluated. The symptoms are to be evaluated by considering all available evidence in the individual’s record. This includes medical evidence, statements from the individual himself as well as information provided by others (previous employers, friends, public and private agency personnel, etc.).

Since judges will no longer be able to use the standard “lack of credibility” reason for rejecting a claim, they will be forced to either base their denial on more substantial evidence or approve the claim, which could potentially lead to an increase in the number of claims approved.