Background

This transmittal updates Chapter I-2-1 to memorialize existing hearings level guidance and procedures for adjudication of cases involving allegations of consultative examination (CE) provider and other expert misconduct, fraud or similar fault, or lack of qualifications.

Explanation of Content and Changes

I-2-1-24 – In subsection C., we added language indicating that a claimant or appointed representative may intentionally submit information from a person who is not a party to the hearing as support for an allegation that fraud or similar fault was involved in providing evidence related to the claim. We added case processing instructions for the administrative law judge (ALJ) in this situation. We added sample language for ALJs to use in correspondence and hearing decisions when responding to the claimant's or the appointed representative's submission of information related to a non-party. In addition, we made minor editorial changes.

I-2-1-32 – In subsection B, we added cross-references I-2-1-30 and I-2-1-33 to instructions for processing allegations of a CE provider disqualification. We also added a cross-reference to I-2-1-24 in the NOTE. We made minor editorial changes throughout to improve clarity.

I-2-1-33 – We created a new section titled “Allegations of Improperly Completed or Deficient Consultative Examination Reports and Misconduct by Consultative Examination Providers.” This new section provides instructions to Office of Hearing Operations staff and adjudicators for processing and evaluating allegations concerning consultative examination reports or providers.

Date: March 3, 2025