Denial of claims can happen if there is “insufficient medical evidence to demonstrate a disability.” This can include incomplete medical statements, missing medical records, and/or a medical statement completed by a doctor that was not approved by the Social Security Administration.
In 2015, a class action was filed against the Social Security Administration over the Administration’s reliance on medical reports from a doctor that was technically disqualified. According to the allegations, after the plaintiffs were specifically sent to this doctor, the doctor performed cursory examinations, referencing laboratory tests that were never done, and making medical statements that were inconsistent with the plaintiffs’ previous medical records. Plaintiffs were then notified that their benefits were being terminated and/or their applications outright denied because they were no/longer disabled, a prognosis that was based on the medical records associated with the doctor’s findings. At no point were the plaintiffs notified that the doctor had been disqualified.
The main plaintiff, Kevin Hart, suffered from limited mobility, emphysema, and diabetes following a car accident and attack. He was found to be disabled by an administrative law judge five years prior and yet, due to the examination of the disqualified doctor, the Administration terminated his benefits.
Following years of complaints about his practices, the doctor was removed from the consultative examination panel. The plaintiffs—as well as countless others who depended upon the SSDI program—were never notified. In 2016, Kevin was awarded a settlement by the court.
This Class Action Lawsuit raises important questions about the Social Security Administration’s oversight of its own program, as well as its obligation to ensure that people are provided with quality disability determinations instead of being penalized for medical record issues that aren’t their fault.