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Treating Physician’s Opinion Admissible in Workers' Compensation Hearings

The U.S. District Court for the Eastern District of Pennsylvania ruled that an Administrative Law Judge misapplied the "treating physician rule" when he concluded that a doctor's objectivity was undermined because he was an advocate for the claimant in his workers' compensation litigation. Somenski v. Barnhart, 109 Soc. Sec. Rep. Service 143 (E.D. Pa. 2006).

The claimant, Frances Somenski, a longshoreman, sought disability benefits alleging he became disabled due to anxiety and post traumatic stress disorder resulting from a work accident when he was exposed to oxygen deprivation and where two of his co-workers died. He also alleged disability due to injuries to his legs. His claim was initially denied after which he requested a hearing before an Administrative Law Judge ("ALJ"). The ALJ denied the claim but an Appeals Counsel vacated the decision and a new hearing before an ALJ was held. The ALJ denied the claim a second time and the Appeals Counsel affirmed. Claimant thereafter sought a judicial determination from the appealed to the United States District Court.

The claimant asserted that the ALJ discounted the opinions of several of the his treating physicians, one of whom had treated the claimant for ten years, and instead relied upon the opinions of state agency psychologists who had never examined the claimant. The U.S. District Judge Michael Baylson agreed and found that the ALJ violated the "treating physician rule." This rule, as articulated by the Third Circuit Court of Appeals in Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000), provides that the primary principle behind determining eligibility for benefits is that the ALJ "accords treating physicians' reports great weight, especially when their opinions reflect expert judgment based on a continuing observation of the patient's condition over a prolonged period of time." Id.

Judge Baylson held that in Mr. Somenski's case, it was "error to disregard medical findings of examining physicians offered as part of a workers' compensation hearing even though it may be adversarial in nature, because this does not affect the reliability of the testimony."

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