If you file a Social Security disability claim, the SSA may ask you to participate in a consultative exam. Before you go into your exam, it’s important to know what to expect and how to prepare for it. This can help your exam go smoothly and provide valuable and accurate medical information related to your claim.
Here are some of the most frequently asked questions about the consultative exam for Social Security disability benefits.
A consultative exam helps provide SSA reviewers with important medical information related to your Social Security disability benefits claim. The exam should provide additional information that helps reviewers make a fair and accurate decision about your Social Security disability claim.
Consultative exams come in two types: physical and mental. A physical consultative exam is rather brief – it may last anywhere from 5 to 20 minutes. The examining physician will ask you health-related questions and may perform a few simple tests.
A mental consultative exam takes longer to complete. The mental exam can run between 15 and 45 minutes. You will be asked several questions and may undergo a mental status evaluation.
The consultative exam is an important part of your Social Security disability claim. It is mandatory to attend if you are asked to do so. Failure to attend the exam will almost certainly result in a denial of your claim.
You may be asked to participate in a consultative examination if SSA reviewers determine that the medical documentation included with your disability claim is insufficient. Many times, this occurs because the claimant isn’t currently receiving medical treatment for the disability or hasn’t seen a physician in quite some time. When this happens, the SSA asks the examiner to provide additional information. This helps reviewers make an accurate decision about whether to award SSDI or SSI benefits – including SSI or SSDI back pay.
Ultimately, reviewers need recent medical information about your condition to make an informed decision about your claim. For example, you may be asked to participate in a consultative examination if your submitted medical records are more than 90 days old.
If you are homebound, confined to bed rest, or otherwise unable to travel to your consultative examination for documented medical reasons, the Social Security Administration is required to arrange for your consultative examination to happen at your home.
To request a consultative exam at your home, contact your disability examiner as soon as possible. It’s helpful to have medical documentation that supports your inability to travel. You can submit this documentation along with the written request for an examining physician to come to your home.
If you miss your appointment and don’t immediately reschedule, your claim will likely be denied. The report from your scheduled consultative exam is a key piece of medical evidence the SSA needs to make its disability determination.
Missing your appointment almost guarantees that your claim will be denied since the consultative exam was likely scheduled because of a lack of medical evidence. The very act of missing the appointment can also work against you.
If you have a good reason for missing your appointment and you reach out to your disability examiner immediately to reschedule, you may be able to get an alternative appointment time.
If your claim is denied, you have the option to appeal the decision, with the hope that during the appeals process you could be scheduled for an additional consultative exam. But this is not guaranteed.
In most cases, the consultative exam will be performed by a licensed medical or mental health professional who is under contract with the Disability Determination Service (DDS) for your state. The DDS is the agency that makes disability decisions on behalf of the Social Security Administration. CE physicians do not work directly for the Social Security Administration – they are independent practitioners who are contracted by the SSA to perform these examinations.
Your consultative examiner has two primary duties. The first is carrying out the specific examination requested by the SSA. The second duty is to complete and submit a report to the SSA outlining the examiner’s findings. You must remember that the examining physician is not there to treat your medical condition but to objectively evaluate your alleged disability and report to the SSA.
The examiner will ask you specific questions about your medical condition and carry out any appropriate medical tests that have been requested. Keep in mind that your consultative examiner does not make a recommendation about your Social Security disability claim. The examiner simply provides the specific medical information the SSA has requested. It remains up to the discretion of SSA reviewers whether to award disability benefits based on the information presented in your claim.
If the Social Security Administration assigns your consultative exam to a doctor that you have seen in the past or dislike based on past history, you may be able to object. For example, if this physician has seen you as part of a prior consultative exam or was involved in a previous insurance or legal case that was unfavorable to you, you may be able to get an alternate examiner assigned.
You should put your objection in writing and send it directly to your Social Security disability examiner.
In some cases, you may be able to get the SSA to approve your personal physician to carry out your consultative exam. You have the right to request that your own physician complete the exam. However, please be advised that this may prove difficult.
When you make this request, it must go through your disability examiner, who works at Disability Determination Services. The disability examiner can advise if there are special or particular tests being requested by the SSA as part of your consultative exam. Once you have this information, you can reach out to your doctor to determine whether your doctor is able and willing to provide the type of exam requested.
Keep in mind that your doctor must agree to accept payment from the Social Security Administration, perform the requested exam, and send the SSA a formal report. Your doctor must be determined to be an “acceptable medical source” by the SSA for your request to be approved.
In many cases, it may be more effective to include medical evidence from your doctor in the form of written documentation that can be included with your claim.
The final consultative exam report will include the results from the medical examination. This includes the results of any requested tests and any positive or negative findings from the exam.
If requested, the examiner may include a diagnosis of your condition, along with a professional opinion about what activities you are able to perform. For example, the physician may note how many hours you are capable of standing or walking and how much weight you are able to lift.
The important thing to keep in mind is that the report will be in alignment with what the SSA requested regarding your medical condition and the specifics of your Social Security disability claim.
Here are some helpful tips as you prepare for your consultative exam.
Review your medical history and documentation so that you can speak confidently and accurately about it if you are asked. Some patients find it helpful to make a list in advance of all relevant points they’d like to make. Keep it clear and succinct. Practice your key talking points in advance.
Your examiner is likely to be busy and will want to keep your visit brief. Make sure you can clearly and succinctly describe your medical condition and its effect on your life without getting off-topic or discussing details that aren’t directly related to your claim.
Don’t bring new medical documentation with you for the doctor to review – that isn’t part of your exam. If you have new information that is relevant to your claim, you should formally submit it as part of the claims process.
Bring copies of objective medical tests like MRIs and blood tests. These reports may be helpful to your examiner. Your examiner likely will not have reviewed your medical history before your visit, so selecting the most helpful information from your Social Security disability claim may prove useful. Keep in mind, though, that whether to review or accept the information you’ve brought with you is up to the examiner.
Give an accurate representation of your disability – this is your chance to give a medical professional a clear impression of how your disability affects your life. Don’t downplay symptoms and also don’t exaggerate them. You’ll need to clearly and accurately describe your limitations.
Bring a friend or family member with you to your exam. Many patients report that it’s helpful to have a supportive companion for the exam, and it also helps to have another witness in the room as you answer questions from the examiner. You also may find it helpful for your friend or family member to make notes about the visit and everything that is discussed.
The consultative examination is an important part of the SSDI and SSI disability claims process. If you are asked to participate in a CE, you should take the opportunity very seriously. Make sure you’re able to get to your appointment and that you’re well prepared to clearly and accurately discuss your medical condition with the examiner.
This is your opportunity to give the physician a comprehensive account of how your disability affects your everyday life. This helps the SSA make an appropriate decision regarding your Social Security disability determination. Don’t waste this opportunity – put in the time and effort beforehand to make sure you are sharing the most helpful and applicable information possible.