When applying for Social Security Disability Insurance (SSDI), it is important to provide comprehensive medical evidence that shows the severity of your disability and that it is expected to last at least 12 months or end in death. This evidence must prove that your disability prevents you from working.
As part of the application process, every claimant will be asked to provide documentation of their medical condition. However, if the evidence provided is not sufficient, the SSA may schedule you for a consultative examination (CE).
What is a consultative exam?
A consultative exam is a medical examination that may be required by the Social Security Administration (SSA) to help evaluate your disability claim. The exam may be physical, mental, or a simple procedure like a blood test or X-ray. It is free of charge and paid for by the SSA. If you are asked to undergo a consultative exam, it is important to attend, as it could help complete your application and increase your chances of receiving benefits.
After you file a claim for SSD benefits, a disability examiner will review your application and determine if additional information is needed. If so, they will order the exam that is most appropriate for your situation.
Do I need a consultative examination?
Not all SSD benefit claimants will need a consultative exam. It will only be required if their initial medical history lacks specific details or is insufficient. The Disability Determination Service (DDS) will request it only when they need more information.
When you receive notice of the exam, it’s important to review your medical records beforehand to ensure no important details were missed. If you have any additional medical documentation, you may be able to forward it to DDS and avoid the consultative exam. However, in most cases, attending the exam will be necessary.
Who performs the consultative exam?
Consultative exams are performed by an independent physician who has contracted with the SSA but is not employed by them. In some cases, you may be able to have your current medical provider perform the exam or test, but this will need to be approved ahead of time. However, if you are asked to have a mental health exam, it must be done by a psychologist or psychiatrist and cannot be a therapist or counselor.
What role does the consultative examiner play in the SSDI claims process?
The consultative examiner is responsible for conducting the specific test or exam that has been ordered and producing a consultative exam report for the Disability Determination Service (DDS). However, they do not determine whether the claimant is eligible for disability benefits, nor do they provide any advice or treatment recommendations. The DDS will use both the information provided in the claimant’s application and the results of the consultative exam to determine eligibility for benefits.
Can I request a different consultative exam doctor?
Yes, you can request a different consultative exam doctor if you have a valid reason. The SSA has a network of medical providers who perform these exams, and they will try to choose one who is nearby and convenient for you. However, if you have an issue with the provider they selected, you may request a new doctor. Keep in mind that this request could cause a delay in your claim.
Can I ask my own doctor to perform the CE?
In some cases, the SSA may allow your personal doctor to perform the consultative exam (CE), but some factors could prevent this. Your doctor may not be qualified or licensed to perform the specific type of exam required, or the SSA may want an independent assessment to confirm or clarify existing medical information.
If the exam is a simple procedure like a blood test or X-ray, you may be able to schedule it with your personal doctor and send the results to Disability Determination Services (DDS) directly. For more comprehensive physical or mental exams, the SSA may require you to see a different doctor.
However, you can request that your doctor perform the exam and submit a report to the SSA. Your doctor must be willing to accept payment from the SSA, and their report must meet the requirements for a CE report. Making your request in writing and following up with a phone call can increase your chances of approval.
What is included in the final consultative exam report?
After the consultative examination, the independent physician will prepare a report with their findings and test results and send it to the SSA.
The report should only cover the exam that was performed but may include a diagnosis based on their findings and a general statement about how your disability can impact your daily life. This can involve an analysis of your ability to work, stand, or sit, or any restrictions caused by your condition.
The report will also consider any information you provided during the exam, including previous treatments, medications, or how your disability has affected your life.
What if I’m unable to travel to the doctor’s office?
If you are unable to travel to your consultative exam, you should contact your disability examiner as soon as possible to make alternative arrangements. Often, the exam can be scheduled with a nearby provider.
If your disability prevents you from traveling to the exam, federal law requires the SSA to make arrangements for the physician to come to you. It’s important to be proactive and file a written request explaining why you are physically unable to travel.
What should I do if I miss my consultative exam?
If you miss your consultative exam and fail to reschedule it, it could result in your claim being denied due to a lack of evidence. It’s important to be proactive and contact your disability examiner as soon as possible to explain the reason for the missed exam.
Typically, the SSA will only excuse the missed exam if it was unavoidable, such as due to an illness, a death in the family, or an unexpected loss of transportation. If your reason is deemed valid, you may be able to reschedule your exam, but be aware that this could further delay your claim.
How To Prepare for Your Consultative Exam
Double Check Time and Place
To ensure a smooth consultative exam process, make every effort to arrive on time for your scheduled appointment. If you anticipate any issues that may prevent you from being able to make it, contact your disability examiner as soon as possible to reschedule or arrange for transportation. Delays can cause your claim to take longer than expected, so it’s important to avoid them whenever possible.
Bring Documentation
While it’s ideal for your medical records to be transferred to the CE physician, this is not always the case. To provide the doctor with as much information as possible, bring documentation of any past diagnoses or tests, especially objective ones such as x-rays, MRIs, EMGs, or blood tests. Don’t forget to include any prescription medications you are currently taking.
Prepare to Share Your Story
During your consultative exam, you will be meeting with a new healthcare provider who has no prior knowledge of your medical history. It’s important to be ready to explain your condition and how it affects your daily life. When did your symptoms start? Was it gradual or sudden? Describe your physical and mental limitations, and any help you need with daily activities like bathing, dressing, or using the restroom.
Provide your treatment history, including medications, procedures, and hospital visits. Be honest and specific but avoid exaggeration or downplaying your disability.
Bring a Support Person
Consultative exams can be stressful, and it can be helpful to have someone you trust accompany you, like a family member or friend. Before the appointment, discuss the details of your story with them so they can help fill in any gaps or clarify information if needed.
Consultative Exams for SSDI Benefits
Social Security disability benefits are a financial lifeline for those whose disabilities prevent them from working at full capacity. Applying for these benefits can be a lengthy process, and requires you to provide detailed information about your personal finances and medical treatment.
In some cases, you may be asked to attend a consultative examination, which is scheduled by your disability examiner. These exams are provided at no cost to you and are nothing to be anxious about. However, it’s important to be prepared.
Consultative exams are typically ordered when there isn’t enough evidence in your Social Security disability application or when the medical information you provided is insufficient. To process your application and confirm your condition, one or more tests or exams may be necessary.