Questão jurídica principal
Whether reliance on an undisclosed RAD medical report violated the right to be heard
Decisão extraída
Yes. Because the insured was not informed of the medical report on which the office's reasoning substantially relied, he was unable to comment or respond with further medical evidence.
Fundamentação extraída
The report was not disclosed before or with the decision, yet its reasoning was largely copied into the decision. It mattered for the defense to know whether the rebuttal to the insured's submissions was based on medical expertise, so he had to be given a chance to comment.