NEW NINTH CIRCUIT CASE AFFIRMS GREAT WEIGHT OF TREATING PHYSICIAN OPINION AND AFFIRMS SUBJECTIVE PATIENT SYMPTOMS

In a case involving denial of social security disability benefits, the Ninth Circuit Court of Appeals held on July 10, 2017 that a district court and an administrative law judge should be reversed because they did not provide sufficient weight to the treating physician’s opinion and to the claimant’s own subjective testimony as to her symptoms. This case can be helpful precedent by analogy in group and individual health insurance cases as well. The Ninth Circuit Court cases are precedent in California, Nevada, Oregon, Washington, Idaho, Montana, Alaska, Guam and Hawaii.

Trevizo v. Berryhill, WL2925434 (9th Cir. 2017) involved a 65-year old woman who had formerly worked as a security guard and who appealed a denial of the date of her onset of disability. She wanted an onset of two years before the Social Security Administration had set.

On appeal Ms. Trevizo argued the administrative law judge (ALJ) improperly rejected the medical opinion of her treating physician and erroneously discounted her symptom testimony. She testified at length about how her impairments affected her daily activities and limited her ability to perform work. The ALJ found claimant was not disabled and denied the claim in its entirety. Claimant then sought judicial review of the ALJ decision in the district court of Arizona who affirmed the ALJ decision. The Ninth Circuit Court reversed and remanded the case back to the ALJ for a calculation and award of benefits.

In a very detailed 13-page opinion, which spends an entire three pages just examining the medical record, the Ninth Circuit held that the ALJ committed legal error by not applying the appropriate factors to determine how much evidentiary weight to give to the opinion of a treating physician, and did not offer “specific and legitimate” reasons for rejecting the treating physician’s opinion. Citing federal regulations, the Court stated the ALJ should have considered the following factors to give the treating physician’s opinion great weight:

  • the length of the treating physician relationship;
  • the frequency of examination of the patient;
  • the nature and extent of the treatment relationship; and
  • the supportability of the opinion.

The Court found that claimant had presented objective medical evidence of an underlying impairment which could reasonably be expected to produce the pain and other symptoms alleged. It held that the claimant did not have to prove that her symptoms could be as severe as she stated, only that they could reasonably have caused some degree of symptom. The Court stated:

“The ALJ failed to provide legally sufficient reasons for rejecting the informed medical opinion of Trevizo’s primary treating physician and instead improperly substituted her judgment for that of the doctor.” Providers and payors alike will be well informed by reading and using this case. The full opinion is posted at www.amadorlawcorp.com.