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Consultative Examination

A consultative examination is a medical examination scheduled by the Social Security Administration (SSA) with examining physicians of its choosing. If you apply for Social Security Disability benefits, it is not uncommon for you to receive a letter from Social Security requiring a consultative examination. Often your first indication that you will be required to take a consultative exam is the notice letter you receive in the mail.

Social Security explains that it requires these examinations when it believes it does not have sufficient evidence for the disability examiner to determine the existence and/or the severity of a disability in order to approve or deny an application for Social Security Disability benefits. The examination is usually requested if your doctor has not responded to Social Security’s requests for medical records or if you have not provided records from the proper specialist. The goal of this exam is for a third party doctor (not known to you and not an employee of Social Security) to render an objective opinion with respect to your medical condition. Testing is meant to determine your residual functional capacity, that is, what you can do in spite of your disabling condition.

It is best if you can avoid a consultative examination, since such examinations are by their nature superficial. If your condition is obvious or can be evaluated in one visit, then a consultative exam may not harm your case. But if your condition has a history that informs your treatment and your prognosis, no consulting physician will be able to judge your condition accurately in a single visit.

Your notice of a consultative examination will probably not tell you that you have the right to have your own physician perform the examination. Check with your doctor to make sure that he or she is willing to conduct a Social Security Disability examination. Some doctors are reluctant to do so, because of the paperwork and the minimal reimbursement. If your doctor is willing, inform the disability analyst listed on your notice so that he or she will send your doctor the paperwork to fill out. If you meet any resistance on the part of the disability analyst, quote the Social Security regulations which state that when at all possible your treating physician should perform this examination. These regulations are found online at the Medical/Professional Relations page of the SSA website.

If your physician refuses to perform the Social Security Disability examination, doesn’t have the right equipment, or for any other reason does not perform the exam, it is highly advisable to take the following steps when you are examined by Social Security physicians:

  1. Take a friend who can witness to the length of time it took for the examination
  2. Write down all you can remember about the examination, including questions you were asked, answers you gave, and tests performed by the doctor
  3. Ask for permission to record the examination on a tape recorder, and if your request is refused be sure to note that you asked and were refused

Taking these precautionary steps will help substantiate your case if you believe your Social Security Disability examination was cursory or inadequate in any way, and will help the case analyst put more credence on your own doctor’s reports. In many cases, it is extremely advisable to consider hiring a qualified Social Security Disability attorney or advocate to prepare and advise you in the case of a consultative exam.