When seeking Social Security Disability or Supplemental Security Income benefits, in many claims, the Social Security Administration will schedule Consultative Examinations for you. It will then use the results to help them determine the severity of your impairments.
Do I need a consultative exam?
Consultative examinations are conducted at the request and expense of the Social Security Administration, and failure to attend an examination most often results in a denial of an individual’s claim. For this reason, you should attend any consultative examination that Social Security schedules for you. You may also wish to seek the advice of an experienced Social Security Disability attorney to obtain information about how to be certain all of your impairments are thoroughly evaluated in the examination.
Who can request a consultative exam?
Consultative examinations are usually scheduled at the Initial or Reconsideration levels of a claim, though in rare instances a Judge will order an examination before or after a hearing.
The most common reason Social Security schedules these examinations is that their reviewing physicians don’t feel they have enough medical evidence in your case to make a medically supported decision. For example, if you allege depression as a severe impairment in your application, but you have either never been diagnosed with depression or your physician only manages medications for depression, they may want more in depth information regarding the severity of your depression and the impact it has on your ability to work.
Another example is if you have only been diagnosed by a social worker or physician’s assistant. Under Social Security Law, impairments can only be considered severe if they are diagnosed by an acceptable medical source, i.e. an M.D. or a Ph.D..
In any of the above scenarios, Social Security may elect to schedule and pay for a psychological examination to confirm an alleged diagnosis. They will use the results of that examination to help them make a determination in your case.
What is included in a consultative examination?
Consultative examinations can be general or specific in their scope, which again is determined by reviewing physicians or the claims examiner handling your claim. The exams can be orthopedic and include orders for imaging, cognitive, psychiatric, gastric, or any other type, depending on the allegations you made in your claim and the medical evidence available to the people reviewing your case.
Conversely, if a claims examiner or reviewing physicians determine they do have enough evidence to make a decision, Social Security will not schedule or pay for a consultative examination for you.
Can I request a consultative exam?
It is also possible to request a consultative examination if you feel one would be necessary in deciding your claim, but the decision on whether to order an examination is up to the examiner in your claim. A Social Security disability lawyer can help with obtaining the proper examinations.
The examinations are consultative in nature, meaning that the examining physician will typically begin by asking you what impairments keep you from working, what treatment you’ve had for these issues, and will then perform a general examination to determine your level of impairment.
Examining physicians also often test your credibility by administering tests designed for that purpose, and they provide conclusions regarding your level of impairment. They do NOT typically state whether or not they believe you can work, because that determination is outside the scope of the examination. Rather, reviewing physicians (or at the Hearings level a judge) will later use the recommendations of examining physicians to help make a determination in your claim.
It is important to remember that these examinations are only one piece of evidence in your claim. They are not determinative examinations, and the examining physician’s opinion is not always given great weight in making a determination. They do form an important piece of evidence in your claim, so attendance is very important if they are scheduled for you.
