The gap between medical expertise and treating physicians’ reports in Brazilian social security: a scenario of legal insecurity and social exclusion

Abstract

This article examines the gap between treating physicians’ reports and medical expert opinions issued in administrative and judicial proceedings within the Brazilian Social Security system, focusing on how this divergence affects the effectiveness of disability benefits. The research is guided by the following problem: Does the uncritical prevalence of official medical expertise, to the detriment of treating physicians’ reports, undermine due process and violate the fundamental rights of insured workers? The hypothesis is that this technical-legal asymmetry not only leads to unfair decisions but also perpetuates the social exclusion of vulnerable individuals. The general objective is to critically analyze this evidentiary dysfunction, while specific goals include identifying its causes, evaluating its practical consequences, and proposing structural solutions. The research adopts a qualitative methodology based on bibliographic review, documentary analysis, and case law research. The methodological procedures involved the study of specialized doctrine, legal norms, and precedents from Brazilian higher courts. The findings show that the lack of dialogue between clinical and expert knowledge, along with the resistance to applying the biopsychosocial model, contributes to the systemic denial of rights. The study concludes that urgent reforms in the disability assessment model are needed to ensure fairness and social justice in the Brazilian welfare system.