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Doug Landau
Doug Landau
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DC Social Security Doctor's Fraudulent Exam Leads to Remand

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The Social Security Administration often hires doctors to examine disability claimants, review their medical records and even come and testify against these wage earners who had paid into this system and need benefits before their intended retirement because of serious medical conditions. Leesburg and Manassas area Social Security lawyer Doug Landau has seen reports from these Social Security doctors in spinal cord injury and toxic chemical cases where they are: unsigned, by a physician of the wrong area of medicine; and incomplete. In a recent case, the disabled claimant filed a complaint with the D.C.Board of Medicine against the Social Security Consultative Examining Physician ("CE") while his case was pending at the Federal District Court (because he had lost again at the Hearing level before the Administrative Law Judge).

The D.C.Board of Medicine determined that indeed, a violation of the Health Occupations Revision Act had occurred and that disciplinary action could be warranted. The disabled claimant also filed with the DC Superior Court that the report constitute fraudulent misrepresentation because the doctor hired by the Social Security Administration had performed only a cursory medical examination and used no diagnostic tools to arrive at his medical conclusion. The court concluded that the doctor's report contained a false representation of material fact.

The letter from the D.C. Board of Medicine and the D. C. Superior Court Transcript constituted new and material evidence requiring a remand under the Social Security guidelines. The evidence is new because it was not in existence at the time of the Administrative Law Judge Hearing. So there was good cause for not including it earlier. The evidence is material because it undermines the credibility of the CE's report, and therefore might have changed the outcome of the Social Security judge's Hearing. Although the ALJ did not rely exclusively on this opinion, it was clear that he considered it and he may have given it less weight had he known that it contained a false representation of material fact. In Jones v. Astrue,* the DC Federal Circuit Court of Appeals held that, the decision denying benefits was reversed and the case was remanded. The case was sent back for an explanation of the weight given to the physician's opinion.

*Jones vs, Astrue, 647 F.#rd 350 (D.C.Cir., 2011)

3 Comments

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  1. Tara Mandinec says:
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    Seriously I wonder how many of the doctors that have done these can be charged with the same thing. MY husband had to submit to several different disciplines for review during his claim and not ONE used any diagnostic tools, were about 5 minutes long for a very complicated illness as well, and resulted in TWO denials and caused us to become financially bankrupt. The ALJ for his case blasted the states “evidence” as completely without merit in the end, but way too little way too late. What a disgusting mess the whole system is. People who are in most need, getting the most screwed.

  2. Doug Landau says:
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    While I am sorry to hear about your experience with the Social Security system, you have identified one of the real problems that seems never to be discussed; when there is a delay, the Federal disability benefits that are eventually paid are usually without interest or regard to late fees and penalties working people like you and your husband may have had to pay while waiting for a favorable decision and borrowing money just to survive.

  3. Tara Mandinec says:
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    Exactly. When they were finally received the windfall caused me to lose the state low income health insurance that I was entitled to for me and my children because we were “rich”! Husband had medicare WE had NOTHING. The system doesn’t take into account that the person IF they were able to work would be receiving chances for advancement and raises much more frequently then when the government decides that yes indeed the cost of living has gone up! Those same deciders get a COLA without regard to ACTUAL increase to cost of living. NO ONE who is truly ill would ever want to be on social security 30 years before they are expected to receive it, and those who WOULD prefer it-should get it because they obviously have serious issues with intellect. To be punitive almost from the beginning for applicants across the board is deplorable.