Strict requirements for certain IV reports
Published: Wednesday, Mar 6th 2024, 12:11
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The Federal Supreme Court draws the consequences of the IV's decision to no longer commission expert opinions from the private company PMEDA. Examinations that have already been ordered must be subject to strict requirements regarding their probative value. Relatively minor doubts justify a new assessment.
In October 2023, the Federal Social Insurance Office (FSIO) announced that the Disability Insurance (IV) would no longer be awarding bi- and polydisciplinary reports to the Zurich-based company PMEDA. An expert commission had previously identified formal and substantive deficiencies in their medical reports.
In a ruling published on Wednesday, the Federal Supreme Court partially upheld the appeal of an insured person whose pension application had been rejected by the IV office of the Canton of Zurich on the basis of a PMEDA report.
External expert opinions permitted
The 4th Public Law Division of the Federal Supreme Court, based in Lucerne, points out that the courts can rely on expert opinions ordered by the insurers and prepared by external specialists. However, there must be no concrete evidence to cast doubt on their accuracy.
According to the FSIO's decision, it is justified to impose stricter requirements on the assessment of the probative value of PMEDA reports that have already been ordered in ongoing proceedings. Even relatively minor doubts are sufficient to order a re-examination.
In the present case, the Lucerne judges find that the contested expert opinion of February 2022 is contradictory and inconclusive on key points regarding the complainant's health impairment and ability to work. The case is therefore referred back to the lower court, which must order a court expert opinion and make a new decision.
In October 2023, the FSIO announced that PMEDA still had several dozen expert opinions in progress. It had pointed out that these reports would be subject to quality control after submission. However, the definitive pension decisions based on these reports remained valid. (Judgment 8C_122/2023 of February 26, 2024)
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