Claimants who apply for SSDI or SSI from the Social Security Administration (SSA) due to disabilities may receive a notice for a consultative exam, or CE. A consultative exam is typically requested when there is insufficient medical evidence in your file to determine the restrictions the underlying disability may cause. A CE might be required if your treating physician has not thoroughly documented your restrictions from your disabilities, if your doctor has not responded to information requests, or if you have not been seen by a medical provider recently.
Who Requests the Consultative Exam?
When a person applies SSDI benefits, they file their application with the local Social Security field office. Decisions are not made by local Social Security office personnel. Instead, the claim is sent to a federally-funded state agency called the Disability Determination Services or (DDS). DDS is responsible for gathering medical evidence and rendering initial and reconsideration decisions as to whether or a not a claimant is disabled. DDS vary widely by state with their approval percentages on initial and reconsideration claims. If DDS determines that additional medical information is needed to make a disability determination, a consultative exam may be requested.What is a Consultative Examination?
A consultative exam is not conducted for the purpose of providing medical advice or treatment but to establish restrictions based off of your medical records, appearance potentially varying degrees of diagnostic testing for purposes of ascertaining restrictions related to work. The exam can be physical or psychological in nature. Further, the CE might include additional tests such as blood work, x-rays, or EKGs.
The SSA has carefully outlined the content requirements for consultative examinations. If you have received a letter to attend a CE, you might want to review what will likely be included in your exam by clicking the link above.
Who Performs the Consultative Exam?
As a typical rule, the DDS attempts to obtain medical evidence from a claimant's own medical provider first. We always want to get these reports from treating physicians because they know your conditions better than anyone else. If you want someone to look at you for 5 minutes and make a determination on your restrictions which maybe used to award or deny you benefits than the doctor that is intimately familiar with your circumstances then be ready to be disappointed most times when the CE comes back with far fewer restrictions than your treating physician has told you.
The doctors or psychologists contracted to perform the CEs are not employees of the SSA. Instead, they are independent contractors who are paid for their impartial services. In addition to performing the exam, they are required to submit comprehensive reports that follow a specific format to make things easier for the ALJ when reading such examinations. The report must be personally signed and reviewed by the doctor performing the medical or psychological exam if it is not you can oppose the exam to becoming part of the record. In those instances SSA will have to send you back for another CE or determine they have enough information to make an informed decision.
Do I Have to Pay for the Consultative Exam?
No, you will not be required to pay for your consultative exam. The DDS office that schedules your CE will be responsible for all the costs associated with the medical exam whether you win or lose.
Am I Required to Go to the Consultative Exam?
Should you want to obtain disability benefits, attending a CE exam is not optional. If you miss your scheduled appointment without valid cause, it is possible for a decision to be made without all the facts at hand. In most cases, if you do not attend your consultative examination, your application to be denied. Think about it if the DDS worker needs more documentation and you refuse to go the outcome is not going to be favorable in almost all instances.
How Do I Prepare for the Consultative Exam?
First, arrive at your appointment a few minutes early so that you are ready and available at the scheduled time. Come prepared with a list of your medical conditions, as well as all of your treatments and medications. During your appointment, give concise and accurate answers to questions, perform what is asked of you to the best of your ability. Do not exaggerate your limitations but be sure to communicate them clearly and direct.
By law, consulting doctors who perform consultative exams are required to spend a minimum amount of time with you, depending on the nature of the exam. While you should not discuss this with the physician, when you leave document everything that has happened while you were at that office. Manny times these doctors spend less than two minutes with patients and check very little. These notes you take will be crucial to the weight the ALJ may or may not give the physician.
Can a Disability Lawyer Be Helpful During the Consultative Exam Process?
There is a lot that goes into the consultative exam process and this is just one step in the process. We would love to have you as a client but if you do not hire us hire someone else. We only get paid if we help our clients, those that we do not help never pay us a dime. An experienced Social Security disability advocate or attorney can help you navigate the SSDI application process, CE and appeals processes.