December 12, 2014

Consultative Exams: What Are They And Should You Go?

Many disability claimants are caught off guard when they receive a notice from the Social Security Administration (SSA) for a scheduled doctor’s appointment.   These doctor appointments are called consultative examinations (CE’s).  The SSA will sometimes send SSDI and/or SSI claimants to these examinations if they feel like more information is needed to determine a disabling condition.  It is important that the claimants attend these CE’s.  Failure to appear at a CE may result in the SSA denying the claim.

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Who are the doctors?

The doctors that perform the CE’s are not employed directly by Social Security, but are private doctors that are contracted out by the SSA.  In my experience, this can be good and bad.  The good part is that since the doctors are independent physicians, they should be evaluating the claimant’s condition objectively.  The flip side of this is that since these physicians only see the claimants for a single short visit, (usually around 15 minutes) a thorough evaluation may not be performed.

What is the purpose of these exams?

The most likely purpose that a claimant is sent to a consultative examination is because of a lack of medical records.  If a claimant is claiming a disability, but there are not any or enough medical records to back it up, or the records are from a long time ago, the claimant’s case reviewer will most likely send the claimant out for a CE.  Hopefully the SSA will attempt to give the claimant a fair shot despite the lack of medical records, but it is usually best not to rely on a consultative examination to prove your disability.  Another scenario that my office sees is when the case reviewer or the judge wants a specific test done that they think could prove or disprove the claimant’s case.  For instance, if a claimant/representative are claiming that the claimant has a low IQ but has never received an IQ test, the judge may send them out to get a full picture of the claimant’s condition.

Complaints about these exams:

Many of my clients express frustration after consultative examinations.  Most of the time the CE’s only last a few minutes (may range from 5-20 minutes).   With a short examination, some claimants feel like the doctor does not have an accurate picture of the claimant’s condition.  My clients also have expressed that the consultative examiners can be rude and seem like they want to rush through the examination.

Many times my clients state that the examiner said they were disabled, but instead the paperwork they completed in fact stated just the opposite.

Do not be afraid to express all the details of your condition with the examiner.  I have seen many CE’s where the doctor wrote things like “patient did not express that he was in pain” or “patient was able to get on the exam table without pain.”  If you are having trouble doing something the examiner asks, express it.

Remember, while the CE may be a necessary part of the disability process, a judge at your hearing can make an independent decision regardless of the outcome of a consultative examination.

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