The Consultative Examination

Clients often call us with questions concerning a letter they receive indicating that they have been scheduled for a “Consultative Examination”. Most clients want to know what the exam is and if they have to attend. Clients are also curious as to who has scheduled this exam and what doctor they will be seeing. Here is some basic information and insight about Social Security medical exams.

What is the Consultative Examination?

A fairly high percentage of individuals who file for either Social Security Disability benefits or Supplemental Security Income benefits will be required to go to a medical examination by the Social Security Administration. Social Security Disability exams are called Consultative Examinations (“CE exam”). CE exams can be physical in nature, psychological (IQ testing), or psychiatric in nature. They can also include ophthalmological exams, blood work, and the taking of x-rays. The Disability Office that schedules your exam also pays for the CE exam and any necessary tests. The exam is scheduled with a doctor closest to your home zip code, so it is important that you always notify your attorney when you move or change addresses.

Why is a Consultative Examination being scheduled in my case?

Sometimes your medical records don’t say as much about your condition as you might think they should. For example, your doctor’s notes might only say that you complained of low back pain and you were prescribed a pain medication. In other instances, your medical records are hand written and impossible to read, or information from your doctor may be incomplete. In some cases, clients have not been to see a doctor recently. Limited documentation such as this does not give the disability examiner reviewing your case sufficient information about how your condition limits your ability to function and work.

CE exams are requested by disability examiners (examiners handle initial disability applications) and also by Administrative Law Judges at the disability hearing level. The purpose of these exams is to obtain additional medical information and documentation for an adjudicator (a disability examiner or a judge) to arrive at a decision. Disability examinations that are scheduled by a disability examiner or a disability judge are mandatory and failure to attend can result in a decision based on existing evidence, or the closure of a case for failure to comply. However, if you miss a scheduled exam and have a valid reason for this happening, an examiner will usually allow for the examination to be rescheduled.

 Who performs the exam?

CE examinations are performed by independent physicians and psychologists who have contracted to examine disability claimants and provide written reports afterwards. The doctors who perform these exams are not Social Security doctors. They are not employed by the Social Security Administration, rather they are independent contractors who are paid for their services. In addition to performing an examination, physicians and psychologists who perform CE exams are required to submit the written results of an examination. Please keep in mind that Social Security CE exams are not for the purpose of rendering medical treatment or making the decision on your claim. The purpose of these exams is to provide a recent snapshot of your conditions and various limitations.

How long does the exam take?

One of the most common complaints among our clients who have gone to CE examinations is that the duration of the exam was only 5-10 minutes. The length of the exam will vary depending on the type of exam a claimant is sent to. Examinations for physical allegations can be relatively brief (10-15 minutes is not abnormal), while a mental exam can take considerably longer due to the nature of psychological or psychiatric testing.

 What should I do to prepare for the exam?

Being required to go to a medical exam by Social Security is no cause for alarm. Getting an appointment letter for a CE examination means, at the very least, that your claim is actively being worked on.  

 Here are some important tips to keep in mind when attending your CE examination:

1. Arrive a few minutes early for the exam. If you show up late, the doctor may refuse to see you, and the exam would have to be rescheduled. This can add further delay to the processing of your claim.
2. If you have children, leave them with someone during your exam so that you will be able to give the doctor your full attention.
3. When you go to the exam, always bring a government issued picture ID, like a driver’s license.
4. Take any medications or pill bottles with you to the exam, and any necessary braces, canes, eyeglasses, or hearings aids that you use.
5. Have someone go with you to the examination and observe.
6. Takes notes during and after the examination. How long did the doctor see you? What questions were asked? Were any tests performed?
7. Cooperate to the best of your ability during the exam. The doctor may ask you to do something that is uncomfortable. Not trying or refusing to do something the doctor asks, can make a difference in how your disability is viewed.
8. Be honest and don’t pretend to be better or worse than you are.

Got a question that you need answered? Please check out our website at www.westcoastdisability.com . We try to provide you with valuable information on our website that may help you navigate the Social Security Disability process. Also, feel free to shoot us an email at info@westcoastdisability.com or call us at (800) 459-3017.