Magazine article Developments in Mental Health Law

Psychiatrist as HMO Team Leader May Be "Treating Source" Whose Opinion Is Entitled to Greater Weight in Social Security Disability Determination Even Though Psychiatrist Has Minimal Patient Contact

Magazine article Developments in Mental Health Law

Psychiatrist as HMO Team Leader May Be "Treating Source" Whose Opinion Is Entitled to Greater Weight in Social Security Disability Determination Even Though Psychiatrist Has Minimal Patient Contact

Article excerpt

The Ninth Circuit held that the lead psychiatrist on a patient's managed care treatment team may be considered a "treating" source whose opinions are entitled to greater weight in Social Security disability proceedings even though the psychiatrist has minimal contact with the patient and most of the direct patient contact is provided by others on the managed care treatment team.

The individual seeking Social Security disability benefits had quit working because of asserted chronic pain stemming from a knee injury incurred 25 years earlier that persisted despite seven subsequent surgeries. She was a member of a health maintenance organization (HMO) and had consulted an HMO psychiatrist. The psychiatrist diagnosed her with major depression, an unspecified personality disorder, and chronic pain. The psychiatrist prescribed medications, first Elavil and then Paxil, consulted regularly with her treating therapists, and concluded on the claimant's social security disability application that her prognosis was very poor.

The agency processing the application asked for an independent psychiatric evaluation. An agency psychiatrist who examined the claimant concluded the claimant did not have a severe mental impairment. A vocational expert testified that the absence or presence of a mental disability was the difference between the claimant being able to perform her past relevant work or not. An Administrative Law Judge (ALJ) hearing the matter did not credit the opinion of the HMO psychiatrist, asserting that there was no evidence that he was the claimant's treating physician and gave greater weight to the reviewing psychiatrist.

The Ninth Circuit reversed. Under Social Security regulations, a "treating source" is to be given greater weight than those of examining but non-treating physicians or physicians who only review the record. However, to be a "treating source" requires an "ongoing relationship. …

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