What is a Consultative Examination for Social Security Disability?

Submitted by Deanna on

Claimants who apply for financial assistance from the Social Security Administration (SSA) due to a disability may receive a notice to appear at a consultative exam, or CE. A consultative exam is typically requested when there is insufficient medical evidence in your file to determine the existence or severity of a disability. A CE might be required if your treating physician has not thoroughly documented your health condition, if your doctor has not responded to information requests, or if you have not been seen by a medical provider for a considerable amount of time.

Who Requests the Consultative Exam?

When a person applies for Social Security Disability Insurance (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 (DDS). The DDS is responsible for gathering medical evidence and rendering an initial decision as to whether or a not a claimant is disabled.

If the DDS determines that additional medical information is needed to make a disability determination, a consultative exam may be requested.

what is a consultative exam?

What Is a Consultative Exam?

Unlike the medical examinations that you have likely received in the past, a consultative exam is not conducted for the purpose of providing medical advice or treatment. Rather, this medical exam is meant to assess your current medical condition, as well as your limitations. 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 exams, as well as what must be included in each report. If you have been called to attend a CE, you might want to review what will likely be included in your exam here.

Who Performs the Consultative Exam?

As a typical rule, the DDS attempts to obtain medical evidence from a claimant’s own medical provider first. In fact, the SSA will offer to purchase a consultative exam from your own physician, provided that he or she is qualified and willing to perform the additional examination for the fee outlined by the SSA.

However, if your medical documentation is lacking for whatever reason, the DDS will arrange for a consultative exam to be performed by an independent medical professional. 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. The report must be personally signed and reviewed by the doctor performing the medical or psychological exam.

As a general rule, you will be assigned a medical examiner who lives as close to your home as possible and who has availability in their schedule.

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.

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.

How Do I Prepare for the Consultative Exam?

Prepare for your consultative examination as you would for any important medical appointment. 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, put sure your best foot forward. Be certain to 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.

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 a written note that reflects what occurred during the appointment, as well as how many minutes the doctor spent on your appointment.

Can a Disability Lawyer Be Helpful During the Consultative Exam Process?

As you can see, there is a lot that goes into the consultative exam process. An experienced Social Security disability advocate or attorney can help you navigate the process, educating you on your rights and responsibilities during the SSDI application process.

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