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Sunday, January 21st, 2018

WC Medical Opinions

Many people file both Workers Compensation (“WC”) and Social Security Disability (“SSD”) claims. During the SSD application process, the Social Security Administration (“SSA”) frequently obtains the records and reports of the WC doctors. How much weight does the SSA give to the opinion of a WC doctor?

Last year, in an SSD appeal, a federal district court judge rejected the opinion of a WC doctor because he failed to specify if the claimant could sit for 6 hours a day. The district court judge reasoned that the SSA administrative law judge (“ALJ”) was not permitted to speculate about the claimant’s capacity to remain seated based on the WC medical reports, and had a duty to procure medical evidence that specifically discussed the claimant’s capacity to sit for six hours and to stand and walk for two hours.

What happens if a WC doctor addressed whether or not a claimant could sit for 6 hours a day? In New York, it has long been recognized that when reviewing a SSD claim, the opinions of WC doctors are entitled to little weight. Federal court judges have discounted reports from WC doctors on the grounds that self-interest may well have dictated their contents, and they should not be permitted to constitute substantial evidence.

Despite the aforementioned, ALJs frequently seek to deny SSD benefits by elevating the opinions of WC doctors over the opinions of treating doctors.

I represent a 46 year old former cement truck driver whose SSD application was approved today. Despite the fact that two treating orthopedists and a treating pain management specialist specified that the claimant lacked the ability to perform sedentary, the ALJ insisted that the claimant provide the report from the WC doctor.

The claimant’s WC case was closed a few years ago after he received a lump sum settlement. However, I was able to obtain, and submit, the WC doctor’s report to the ALJ a couple of weeks after the hearing. I enclosed the report with a cover letter that included the citations and greater explanation concerning the relevant case law briefly mentioned above. I contended that there was no reason to defer to the opinion of the WC doctor because the ALJ already had medical evidence from the treating doctors that specifically discussed the claimant’s inability to sit for 6 hours a day.

The ALJ, who was from the Virginia hearing office, approves as many SSD claims as he denies. Regardless of where the ALJ is located, because the claimant resides and would appeal to federal court in New York, New York case law would apply to the appeal. Considering that my client was under 50 years of age, I suspect that the ALJ would have denied the SSD application based on the WC doctor’s opinion if I had not provided the cover letter explaining how New York courts have treated WC medical opinions.

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