What are Social Security Disability Consultative Exams?

It is common for those who apply for Social Security disability benefits to get a letter or a phone call from Social Security telling them that they must appear for a “Consultative Examination.” As you would expect, this often prompts some apprehension and raises questions like: What is this? Do have I have to go? How long will it take? At Nash Disability Law, we hear these and many other questions about Consultative Examinations (CEs). So let’s take a few moments to answer some of the most frequently asked questions.

What is the Consultative Examination?

A large percentage of those who file for either Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits will be required to undergo a medical examination arranged and paid for by the Social Security Administration. Depending on your disability CEs can be physical, psychological or psychiatric in nature. They can also include standard medical tests like x-rays. The exam is usually scheduled with an available doctor near your home. It is important to note that the medical professional performing the exam will not offer any medical treatment, but will only examine you and report the findings on your condition to Social Security.

Why am I being examined?

Sometimes Social Security doesn’t think the medical information and documentation you submitted as part of your application fully explains your condition and how it interferes with your ability to function and work. Your doctor’s information and notes about your disability may be incomplete or, even in some cases, impossible to read. In many cases, SSA simply wants its own doctor to evaluate you.

Do I have to go to the examination?

Yes. Consultative Examinations are mandatory. If you don’t appear for a CE, the result can be a decision based on existing evidence, or your case may be flat out denied for failure to comply. However, if you miss a scheduled exam for a valid reason like an illness or a family emergency, Social Security will usually allow for the examination to be rescheduled once.

Who performs the exam?

Healthcare professionals like physicians and psychologists who have contracted with Social Security to examine disability claimants and provide written reports perform the exams. They are not Social Security employees but are independent contractors.

Do these healthcare examiners make a decision on my claim?

No. They are only supposed to provide up-to-date information about your impairments and your limitations. Consulting doctors must include what you say are your symptoms, the objective medical facts, and their observations. Even if the doctor tells you that they believe you are disabled, only Social Security will render a decision on whether or not you qualify for benefits.

How long does the exam take?

Although Social Security Administrations regulations require that a general medical examination should take 30 minutes, often times they are very brief—maybe as short as five to ten minutes. This is why it is important to be prepared for your exam and to make the most of your time with the examiner.

Will the doctor have my medical records?

The doctor performing the CE is supposed to have the records that SSA has obtained up to that point. However, oftentimes, this does not happen. While you do not have to obtain your own records prior to the exam, we encourage you to bring any medical documentation that you may already have to the exam with you, and show it to the doctor.

What should I do at the exam?

Don’t be late. If you are late for your exam, the doctor may refuse to see you and the examination will have to be rescheduled further delaying your claim. Take your photo ID—like a driver’s license or other government-issued identification—with you. We encourage our clients to take a family member with them to observe and to give their perspective on the patient’s impairment. Be prepared to make clear and concise statements about your condition. Take with you your medications; any medical assistance devices you use, like a cane or a hearing aid; and any medical records you have. Most important of all, cooperate with the doctor. What you say or don’t say to the doctor can have a major impact on your case. Don’t exaggerate or minimize your symptoms. Think about how you are really feeling and give the examining doctor honest answers, because your answers will likely become part of your written medical record.

What should I do after the exam?

After your examination, write down the details of the exam: How much time the doctor spent with you, what tests were performed, what the doctor said to you, what the doctor asked you, what the doctor asked you to do, and whether or not you had an opportunity to explain the symptoms of your condition. If we represent you, you can send this information to us here at Nash Disability Law for our review. It may make a difference in your case.