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Disclosure of Adverse Medical Reports in a Social Security Disability Case

Adopted: July 26, 1996

Opinion rules that a lawyer representing a client on a good faith claim for social security disability benefits may withhold evidence of an adverse medical report in a hearing before an administrative law judge if not required by law or court order to produce such evidence.

Editor's Note: Compare Rule 3.3(d).

Editor's Note: See also 98 Formal Ethics Opinion 1.

Inquiry #1:

Attorney represents Client L, a claimant for social security disability benefits. Attorney files a request for an administrative hearing before a Social Security Administration administrative law judge ("ALJ"). In administrative hearings before an ALJ, no one advocates or presents evidence in opposition to the claimant's case.

Attorney previously represented Client L on his claim for workers' compensation benefits. During the workers' compensation case, the workers' compensation carrier required Client L to submit to an independent medical examination. The report of the physician performing the examination states that there is little wrong with Client L and he is a malingerer. Attorney considers this report biased and unfair. At the administrative hearing, Attorney submits other medical records for Client L, and withholds the adverse report from the workers' compensation case. Is this ethical?

Opinion #1:

Yes, provided there is no law or court order mandating disclosure and further provided Attorney is advancing Client L's claim in good faith.

The Social Security Independence and Program Improvements Act of 1994, Pub.L.No. 103-296, Sect. 206, 108 Stat. 1464, 1509-16 (1994) provides, in pertinent part:

(a)(1) Any person...who makes, or causes to be made, a statement or representation of a material fact for use in determining any initial or continuing right to or the amount of (A) monthly insurance benefits under title II, or (B) benefits or payments under title XVI, that the person knows or should know is false or misleading or knows or should know omits a material fact or makes such a statement with knowing disregard for the truth shall be subject to, in addition to any other penalties that may be prescribed by law, a civil money penalty of not more than $5,000 for each such statement or representation....

The statute defines "a material fact" as follows:

(2) For purposes of this section, a material fact is one which the secretary may consider in evaluating whether an applicant is entitled to benefits under title II or eligible for benefits or payments under title XVI.

Whether the law requires disclosure of adverse medical opinions or medical reports generated in an unrelated adversarial proceeding is the subject of controversy. See Robert E. Raines, "The Advocate's Conflicting Obligations Vis-a-Vis Adverse Medical Evidence in Social Security Proceedings," 1995 B.Y.U.L. Rev. 99, 133-134. However, if a lawyer reasonably believes that this law or a court order requires the production of such evidence, the lawyer should comply with the law or court order. In so doing, the lawyer is not violating the duty of confidentiality. See Rule 4(c)(3) of the Rules of Professional Conduct.

If the lawyer reasonably believes that there is no law or court order requiring production of the evidence, Rule 4 of the Rules of Professional Conduct requires the lawyer to protect the confidential information of a client. Canon VII also requires the lawyer to represent the client zealously within the bounds of the law. In litigation, a conflict may arise between these duties and a lawyer's duty of candor to the court. See comment to Rule 7.2. In general, there is no ethical duty to volunteer adverse evidence to a tribunal absent a law or court order requiring disclosure. The lawyer must present the evidence that best advances the client's case and should not reveal confidential information if to do so would be detrimental to the client's interest. Rule 4(c)(2). Nevertheless, a lawyer may not knowingly advance a claim, make a false statement of fact, use false evidence, or assist the client in illegal or fraudulent conduct. Rule 7.2(a)(2), (4), (5), and (8).

In light of these conflicting obligations, the following position taken by the Committee on Professional Ethics of the New York County Lawyers Association in its decision of September 9, 1993, is sound:

If a lawyer is able to advance a good faith claim for benefits despite knowledge of contrary medical reports, and if none of the evidence or statements made in support of that claim is known to be false in light of such knowledge, then nothing in the Code [of Professional Conduct] precludes assertion of the claim. If, however, the lawyer's knowledge of the adverse medical information constitutes knowledge that the claim itself is false, then the lawyer is not free to advance the claim and must withdraw from the representation.

Id. at 115 (quoting Comm. On Prof. Ethics of the N.Y. County Lawyers' Ass'n, New York County Lawyers Ethics Opinion, N.Y.L.J., September 9, 1993, at 2).

Thus, if Attorney is not knowingly advancing a false claim on behalf of Client L and Attorney reasonably believes that disclosure is not required by law or court order, he may represent Client L in the social security disability hearing without disclosing the adverse medical evidence.

Inquiry #2:

Attorney A represents a claimant for social security disability benefits. Attorney requests an administrative hearing. In the course of the representation, Attorney writes the claimant's treating physician and asks for a letter stating the physician's opinion about whether the claimant is disabled. In the responsive letter from the physician, the physician indicates that she believes the claimant is not disabled and should not be granted social security disability benefits. Attorney does not submit the adverse letter from the physician to the ALJ at the hearing. Is this unethical?

Opinion #2:

See opinion #1.

Inquiry #3:

In the same situation as inquiry #2, Attorney requests from the treating physician a letter plus the treating physician's office notes. The treating physician sends the office notes which merely describe the course of the claimant's treatment. However, the physician also sends a letter stating her opinion that the claimant is not disabled. Attorney submits only the office notes to the ALJ and withholds the adverse letter. Is this conduct ethical?

Opinion #3:

See opinion #1.

Inquiry #4:

Attorney has concluded that it would be a good litigation strategy to produce all relevant medical evidence at the administrative hearing on the claim for disability benefits of Client X. Attorney believes that if the adverse medical evidence is introduced, it can be explained and will not defeat Client X's claim. If Attorney introduces and explains the evidence, it will avoid any perception that Attorney is hiding relevant evidence and will, thereby, increase the ALJ's confidence in Attorney. It will also avoid the potential harm that might result if the ALJ learns of the evidence from another source. Is Attorney prohibited from introducing the adverse medical evidence?

Opinion #4:

No. The Rules of Professional Conduct do not prohibit a lawyer from presenting to the client the strategic advantage of disclosing adverse evidence and obtaining the client's consent to disclose. Rule 4(c)(1).

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