Social Security Medical Opinion No Good: Conflict of Interest

Posted on Oct 15, 2015

In this federal court case, the disability claimant filed an application for benefits, alleging that cervical and lumbar degenerative disc disease caused the disability. A neurosurgeon had performed the first of several back surgeries. The disability claimant treated with another surgeon for the remaining surgeries.

Years later, the same doctor who performed the initial surgery performed a consultive examination on behalf of the state agency that evaluated the Social Security Disability claim. After the first hearing, benefits were denied, and the ALJ relied heavily upon the reports of the disability claimant's prior doctor.

The Claimant appealed the case to the Appeals Council. It recognized this conflict of interest, and sent the case back for another hearing. However, the ALJ did not comply with the Appeal Council’s instructions.  The case went up again on appeal.

At the federal court level, the court found that the ALJ’s Decision lacked "substantial evidence," and awarded benefits.

It is not common for a federal court to award benefits at the federal court level.  Usually, the federal judge will "remand" or send the case back to the ALJ for another hearing.  This time, however, the court seemed to have no choice because the ALJ would not comply with the federal court order.  It happens.

Read this article about remand hearings, or check out our free Social Security book.