Monday, February 15, 2016

The ALJ's Duty to Develop the Record in a Social Security Disability Hearing

Because Social Security proceedings are not strictly adversarial in nature, the Secretary of Health and Human Services has a duty to develop an adequate record from which a reasonable conclusion can be drawn. This responsibility increases in cases where the claimant is unrepresented, where the claim itself seems on its face to be substantial, where there are gaps in the evidence necessary to a reasoned evaluation of the claim, and where it is within the power of the administrative law judge (ALJ), without undue effort, to see that the gaps are somewhat filled. The Secretary's duty is even greater when the claimant is obviously mentally impaired. If the ALJ fails to fill those evidentiary gaps, and if they prejudice a plaintiff's claim, remand is appropriate.
In an action for social security benefits, if the evidence does not support a source's opinion and the administrative law judge (ALJ) cannot ascertain the basis for the source's opinion, theALJ has an obligation tomake every reasonable effort to recontact the source for clarification. Specifically, the ALJ must recontact the treating doctor when the doctor's records are inadequate, contain conflict or ambiguity, do not appear to be based on medically acceptable diagnostic techniques, or appear incomplete. The ALJ may carry out this duty by seeking additional evidence or clarification from the source, telephoning the medical provider, or requesting copies of the records, a new report, or more detailed report. In an action for social security benefits, one can demonstrate prejudice by showing that additional evidence would have been produced if the administrative law judge had fully developed the record, and that the additional evidence might.
The Commissioner of Social Security's failure to develop an adequate
record is grounds for reversing theCommissioner's decision pursuant to sentence four of § 205(g) of the Social Security Act, 42 U.S.C.S. § 405(g), and ordering the case remanded for further proceedings have led to a different decision.