Monday, December 14, 2015

Medical Expert Testimony in Social Security Disability Hearings

In certain cases, a medical expert (ME) is asked to testify during a Social Security Disability hearing. This testimony should not be confused with the written medical opinions provided by treating physicians or, confused with the written opinion of doctors hired by the agency to make a paper review of the claim file or conduct a consultative examination of the claimant.  ME's are different in that their testimony is provided during the hearing stage of a case and at the request of an administrative law judge (ALJ).
ME testimony is governed by Hallex I-2-6-70, I-5-34 and I-2-5-39.  ME's are seldomly used by ALJ's in hearing offices in Hartford, Springfield, MA (which includes Worcester) or New Haven. I am aware of an ALJ in Providence who uses ME's on a frequent basis. 
ALJ's may elect to ask an ME to testify under the following circumstances: 
  • In order to determine whether a claimant meets or equals a listing
  • Determining side effects of medication
  • Determining whether a claimant is following prescribed treatment
  • Determining a claimant's functional capacity
  • Determining the onset of an impairment 

 In the following instances, ALJ's are required to obtain an ME opinion:
  • When the Appeals Council or the Federal Court orders it
  • To evaluate or interpret a medical test
  • In order to consider if a claimant medically equals a listing 
Prior to the hearing, the ALJ must request the ME to examine all the pertinent evidence in the case in which he or she is going to testify.  Moreover, the ALJ must notify the claimant and his or her lawyer of the ME's testimony and provide them with copies of all relevant correspondence.
Section A of Hallex I-2-5-39 requires that the ALJ make a specific opening statement prior to any hearing in which a ME will testify.  The ALJ must explain to the claimant and his or her lawyer why ME testimony is necessary.  The ALJ must also ensure that: the ME has reviewed all the medical evidence, that the ME's professional qualifications are on the record and, must also provide a summary of the the testimony to the ME, if the ME was not able to hear it in person.
During the hearing, claimants or their lawyers can cross examine the ME.  ME's are specifically forbidden from making any physical or mental status examinations during hearings.  Moreover, ME's cannot provide testimony or answer questions on nonmedical matters or make statements outside of their medical and scientific expertise.