What is the Social Security Disability Consultative Examination?

 

After you apply for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, the Social Security Administration (SSA) may pay for you to visit a doctor for a special medical examination or test. This is called a consultative examination.

 

The consultative examination plays a major role in your disability claim. A favorable report following the medical exam could lead to a quick finding that you’re disabled, whereas an unfavorable report means more months of waiting and additional evidence you have to try to overcome on appeal.

 

This article explains the Social Security Disability consultative exam process and what you can expect. Our hope is that you use this information to give yourself the best chance of winning your claim.

 

If you have questions after reading this article, or would like a free consultation with a Richmond disability lawyer or Newport News disability attorney, call or email Corey Pollard today. We are ready to help.

 

When are Consultative Examinations Ordered by Social Security?

 

The SSA or DDS will order a consultative examination when the medical evidence you have provided is insufficient to determine whether you are disabled.

 

There are several reasons the SSA may ask you to attend a consultative examination:

 

1. You do not have a treating doctor due to lack of transportation or health insurance coverage.

2. You have provided medical records but they are out-of-date because you have been unable to treat for some time.

3. Your SSD application alleges physicial or mental medical impairments that are not referenced in your medical records.

4. Your treating doctor refuses to provide medical records or has retired and is unable to provide them.

5. Your treating doctor’s medical records are handwritten and unreadable.

 

The SSA orders consultative examinations in a significant number of SSDI and SSI claims.

 

Which Doctor Will Perform the Consultative Examination?

 

Social Security prefers that your treating physician perform the consultative examination. But unfortunately many treating physicians would prefer to not address disability or perform the examination. This is because a negative report could affect their relationship with you.

 

If your treating physician refuses to conduct the consultative examination, the SSA will contact an independent doctor to perform the exam. Other situations where the SSA will ask an independent doctor to examine you instead of your treating physician include:

 

  • The SSA has asked your doctor to conduct consultative examinations in other cases and has determined that he or she does not do a good job.

 

  • The SSA has asked your doctor to conduct consultative examinations in other cases but found that it took too long to receive a copy of the report.

 

  • The SSA does not think your treating physician has the equipment or expertise to perform a consultative examination in the specific field requested.

 

  • You or your attorney has asked the SSA to send you to another doctor for the consultative examination and have a legitimate basis for doing so.

 

  • Your doctor’s records contain inconsistencies that are best resolved by an independent physician.

 

What Type of Doctor Can Serve as an Independent Consultative Examiner in My Disability Claim?

 

The SSA will purchase a consultative examination from an acceptable medical source. Acceptable medical sources include: licensed physicians; licensed osteopaths; licensed or certified psychologists; licensed optometrists; licensed podiatrist; speech-language pathologists; and, nurse practitioners.

 

The consultative examiner must have the training and experience to perform the type of examination or test requested by Social Security. If the examiner does not – and this happens sometimes – then your disability lawyer should object to the consultative exam report if it does not help your case. For example, we have seen OB/GYNs give opinions on cases involving back problems. We do not think an opinion from that type of doctor in a case involving degenerative disc disease should be given weight.

 

 

The consultative examiner should also have a good understanding of the SSDI and SSI disability programs and the evidence required to be found disabled.

 

Who Will Pay for the Consultative Examination?

 

The SSA will pay for your consultative examination, even if your own treating physician performs it.

 

What Will the Consultative Exam Report Include?

 

The consultative exam report should include the following:

 

  • Your claim number

 

  • A physical description of how you appeared at the exam, to confirm that the correct person is being examined

 

  • A statement of your chief complaints and symptoms

 

  • A detailed history of your chief complaints, including when they started, their severity, and treatment you have received for them

 

  • Details of important findings on physical examination

 

  • An explanation of results from any laboratory or other tests, such as pulmonary function testing, CT scans, MRIs, or x-rays, that you underwent at the medical exam

 

  • Your diagnosis

 

  • Your prognosis (good, poor, stable, etc)

 

  • A medical source statement that explains what you can do given the limitations caused by your impairments. Depending on the type of medical exam, the report should address either your physical capabilities or your mental abilities.

 

The consultative exam report must be signed by the medical source who performed the exam, otherwise it is invalid.

 

How Much Weight is Given to the Consultative Exam Report?

 

The consultative exam report is another piece of evidence used by the SSA or administrative law judge to decide whether you’re disabled. The consultative exam doctor does not have the “final say” on your claim. Typically opinions from your treating physicians are given greater weight.

 

In our experience, the majority of consultative exam reports are not helpful to applicants. There are several explanations for this. The most important one is that the consultative examination doctor is seeing you just one time for a few hours. It is difficult to get an in-depth look at whether a person can maintain full-time employment (40 days per week) based on such a brief snapshot. For example, maybe you did ok during the medical examination but were sore for the next three days and couldn’t get out of bed. This is information that would not be included in the CE report but that your lawyer can bring out at the disability hearing.

 

What are My Rights Regarding a Consultative Exam?

 

You have the right to receive a professional examination. The room should be clean and equipped. And you should be treated with respect.

 

If you feel that something improper happened during your medical exam, notify your attorney and the SSA immediately. You should send in a written report explaining why you feel the exam was inadequate.

 

What Happens if I Don’t Attend the Consultative Examination?

 

You should attend the consultative exam. If you are unable to make it, either due to another doctor’s appointment or lack of transportation, notify the SSA or your attorney immediately so that it can be rescheduled.

 

Because consultative exams are often ordered when the claimant has not received medical treatment or the treating physician’s opinions are unclear, your claim is likely going to be denied if you miss the exam.

 

In our opinion consultative exams are most helpful for those of you who do not have health insurance coverage or regular medical care. A psychological or psychiatric consultative exam can serve as the basis of a finding that you’re disabled.

 

Have a Question About Your Social Security Disability Medical Exam?

 

We help disabled adults at every level of the Social Security process. If you’re looking for help, or need some advice before undergoing a medical exam with a doctor chosen by the SSA, call, text, or email us today. We are here to help.