Admissibility of Social Security Disability Determination as Evidence of Causation in a Civil Suit


[author: Joseph Falgiani]

Counsel defending serious toxic exposure or personal injury claims are often faced with a determination by the Social Security Administration (SSA) that the plaintiff is disabled.  More importantly, the finding will often reference the plaintiff’s injury from the exposure or accident as a cause of the disability.  The plaintiff’s counsel will then seek to admit the SSA determination as a public record or will have the plaintiff or an expert discuss the finding.  However, recent decisions from different federal district courts provide sound reasons for prohibiting such testimony as unduly prejudicial and redundant.


In Orber v. Jain, Civ. No. 10-1674 (RMB), U.S. District Court for the District of New Jersey (May 2, 2012), the plaintiff alleged malpractice against her surgeon who performed knee replacement that allegedly left her unable to work.  She testified at trial that SSA had granted her disability benefits, a fact reiterated in testimony by her damages expert.  The court allowed the testimony with a limiting instruction that the jury was not bound by the SSA determination, that it may not consider the SSA report as evidence of causation of the plaintiff’s injuries, and that it may consider the report in determining the extent that the disability benefits may offset the plaintiff’s lost wages claims. (New Jersey permits collateral source payments to be deducted from jury awards.)  The court reasoned that the SSA finding on disability was “relevant and relatively reliable” because the central purpose of the SSA hearing is to determine disability, and the SSA has expertise in determining disability.  The plaintiff then sought to introduce the SSA report itself as a public record under Federal Rule of Evidence 803(8).  Without deciding whether the report was admissible under Rule 803(8), the court held that any probative value it may have was substantially outweighed by the danger of unfair prejudice to the defendants under Rule 403.


The court offered several reasons for excluding the report.  First, it found that the probative value of the report was minimal and cumulative, as the plaintiff had already testified about the SSA determination, and her experts had already opined that she was disabled.  To the extent that the report linked the plaintiff’s disability to the knee replacement surgery, the court denied its admissibility because (a) the SSA hearing was not “a meaningful adversarial process” on the issue of causation because it has no “institutional interest” in determining causation (i.e., there was no party to the SSA hearing that had an interest in causation except the plaintiff, and no one represented the defendants’ interests), and (b) the administrative law judge’s (ALJ) qualifications to render an opinion on medical causation could not  be assessed. The court then concluded that the defendants may suffer significant prejudice from admission of the report because the jury could give inappropriate weight to a causation finding by a government agency.


A similar issue arose in Johnson v. American Honda Motor Company, Civ. No. 19-126-M-JCL, U.S. District Court for the District of Montana (March 28, 2010), where the plaintiff was injured while operating an allegedly defective ATV manufactured and sold by the defendants. The SSA made a determination that the plaintiff had suffered numerous significant injuries that entitled him to disability benefits.  It is not clear from the opinion if SSA expressly made a causation finding, but that was at least implicit, as the plaintiff’s injuries were primarily related to his accident.  The plaintiff moved to admit the SSA report under the business record and public record exceptions to the hearsay rule.  The court ruled that, even if the report fell within the exceptions, its probative value was outweighed by the risk of unfair prejudice to the defendant.  Thus, the report was excluded.


The plaintiff then argued that his expert should be allowed to testify about the ALJ report because it was probative of damages. The court again rejected the argument on grounds of unfair prejudice, noting that, under Rule 703, the facts and data on which an expert relies may not be disclosed to the jury if their probative value is outweighed by their prejudicial effect.  The plaintiff’s experts could give their opinions regarding the plaintiff’s disability without the SSA determination.  The court then rejected the plaintiff’s final argument that the SSA determination was res judicata on disability. The court held that res judicata does not apply because the parties in both proceedings must be the same, and the defendants were not parties to the SSA hearing.


Although the SSA may have expertise in determining disability under specific facts, it should remain  the providence of the jury to evaluate causation evidence independently without the shadow of an administrative finding that was not seriously contested.  At the very least, the courts’ decisions in Orber and Johnson indicate that the prejudicial effect of the SSA’s findings should render the results inadmissible in subsequent civil actions against defendants who were not parties to the administrative proceedings.


DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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