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What is a Consultative Examination?
Consultative Examinations for SSD Claims are generally ordered by the Social Security Administration when it is determined that the applicant’s own medical sources are inadequate to accurately determine a disability. Roughly half of all initial applications can require a consultative examination before making a determination.
There are two types of consultative examinations—physical and mental. A physical consultative examination can take twenty minutes or so, while a mental CE exam can take up to 45 minutes. If the SSA wants you to undergo a consultative examination, they will send you a letter (from Disability Determination Services) asking you to see a specific doctor, along with the date, time, and location of the examination.
It’s important to be aware that a consultative examination is not a sign that the SSA is assuming responsibility for securing the medical evidence required for your claim. In other words, you still have the burden of proof to provide strong medical evidence of your disability. Depending on your disability, you may be asked to see a general practitioner for your consultative examination or a specialist. For example, if your claimed disability is Lupus, you may be asked to see a specialist like a rheumatologist, but this is more the exception rather than the rule.
In any case, the consultative examination is a very important piece of information that can carry weight and may be referred to many times throughout the SSD process. Having a strong SSD attorney from Carmichael Law Group, LLC is an important step to take in this process. Hiring a nationwide disability lawyer from Carmichael Law Group can help ensure your application is submitted in a complete, professional manner. If your initial application is denied, our attorneys will ensure your appeals are filed in a timely manner, always advocating zealously on your behalf.
Are Consultative Examinations for SSD Claims Mandatory?
The answer to this question is a resounding “yes.” If the SSA sends you a letter, asking that you attend a consultative examination, failure to show up without an explanation will likely be seen as a lack of cooperation. As such, this lack of cooperation could be grounds for denying your SSD claim. The exam is usually scheduled with a doctor in your area, so you won’t have to travel far.
If your consultative examination is with a doctor an hour or more away—and you don’t think you can make the appointment—contact your attorney as well as your DDS specialist as soon as possible. It may be possible to find a doctor closer or re-schedule your examination. If you are unable to make the appointment for any reason, contact your DDS specialist and your attorney.
Who Pays for My SSD Consultative Examination?
If you are disabled and unable to work, you may be under significant financial pressure. The SSA understands this, and covers the entire cost of the consultative examination. The amount Social Security pays for these consultative exams is regulated at the state level but is typically fairly low (about $200).
It is normal that you may be both relieved and concerned when you receive a letter asking you to attend a consultative examination. You may be relieved that your SSD claim is progressing yet concerned that your medical records may not have provided sufficient medical evidence. The one thing you don’t have to worry about is paying for the examination.
The Downside of a Consultative Examination
In truth, complaints from disability applicants regarding the overall quality of their exams are fairly widespread. Doctors with a thriving private practice generally do not perform consultative examinations for SSD. Doctors who do these exams are paid significantly less than what practicing physicians earn and may not be very happy about the fact they are forced to perform CEs.
You have no prior doctor-patient relationship with a CE doctor, and the doctor is essentially working for the government. Your consultative examination is also limited to what SS has ordered—usually no more and no less.
What Should I Bring to My SSD Consultative Examination?
You need to bring a photo ID (driver’s license or another form of photo ID) to your consultative examination. Arrive a few minutes early, so you are ready and available at your scheduled time. Physicians who perform SSD consultative examinations are required to spend a minimum amount of time with you.
It can be helpful for your SSD attorney to have your written notes about the amount of time the doctor spent with you and what occurred during the examination. (This is not something you would discuss with the SSD doctor, simply something you would do once the appointment is over). You should also bring the following to your examination:
- Information regarding the medical conditions that prevent you from working
- A list of current medications
- Your medical treatments to date
Be sure to put your best foot forward, answering questions accurately, and concisely. After your consultative exam, it can take a few weeks before your disability examiner receives your results and can make a determination regarding your application.
What Do I Need to Know Before I Attend My SSD Consultative Examination?
Perhaps even more important than what you bring to the consultative examination is what you do and say during the examination. Your goal is for this consultative examination to be helpful to your SSD application for benefits. When you file an application for SSD benefits, you are, in effect, saying that your medical condition prevents you from doing any type of job for eight hours a day, five days a week. This means you are having adverse medical symptoms every day and/or frequent ‘bad days’ where your functioning is significantly limited – i.e., bed bound days. It’s important that you express all your medical problems and symptoms to the consultative examination doctor. Remember the following:
- If pain is a part of your disabling medical condition—and it usually is—you need to authentically describe, in your own words, how your pain feels. Simply saying you have “bad” pain, or your pain is a “level 8” is not enough. If your pain makes you feel as though your legs are on fire, relay that to the doctor. In other words, let the doctor know how your pain feels to you on a daily basis.
- Explain to the doctor how your pain places limitations on your life—on your work, on how you care for your children or home, on your work, and even on your social life. For some, the pain they experience can be so severe that it keeps them from even being able to focus or concentrate. That’s a big thing that the doctor needs to know.
- If your pain is so severe that you must lie down during the day to get some measure of relief—say so.
- If your disabling condition is mental, clearly detail how your anxiety, depression, PTSD, or other mental disability affects your everyday life. If your anxiety is so bad you are unable to leave your home, state that fact. If you are unable to concentrate or focus for extended periods of time due to nervousness or depression, overt tell such to the consultative examiner.
- While you can’t control what’s in the consultative examination report, you can be very assertive when highlighting your disabling symptoms and problems. If you feel like the doctor is rushing you, be even more overt about your disabling condition—do your best to make sure the doctor really hears you.
- If you feel like a specific test would clearly support your disabling condition, don’t be afraid to ask the doctor. While the doctor does not have to agree to a test, it might prod them into asking DDS to also order an x-ray, CT scan, or another type of test done.
- Ask the consultative examination doctor whether he or she reviewed your medical records. The doctor must mention in the report which medical records (sent by your DDS specialist) were reviewed prior to your examination. In some cases, however, the doctor may fail to do this.
- Even if the doctor did review your medical records, be thorough in your descriptions of your disabling condition.
- If there is important medical information you believe is critical to proving your disabling condition, bring a copy of that information with you, whether it’s a doctor’s report, a test result, or any other medical information. While sometimes the consultative examiner may not review such information, sometimes they will.
- Even if the doctor is rushing you or otherwise angering you, make sure your responses are polite. Annoying the doctor—even when deserved—can cause the doctor to be less than forthcoming about your disabling condition in the report.
- While you should always clearly detail all your disabling symptoms, don’t over-exaggerate—and don’t assume no one is watching you before you see the doctor. Perhaps a staff member saw you walking across the parking lot with no assistance, yet once you were inside, you hobbled around with a cane. Such a tactic can definitely backfire—you never want the doctor to put in your report that you are “faking” your disability.
What If I Feel the Results of My SSD Consultative Examination Are Inaccurate?
If you feel as though your consultative examination doctor did not do a thorough examination, rushed you through the exam quickly, or just didn’t listen to you, make a note of this following your exam. Write down every detail and relay those details to your SSD attorney.
The report from the doctor is meant to be fairly detailed. If the doctor was in the room for five minutes or less, did not perform a basic physical examination, failed to do range of motion testing, or simply refused to listen to your account of your disabling condition, you need to immediately let your attorney know.
When a consultative examination is simply not what it should be, your attorney may use your notes to discredit the opinion in court. If the doctor failed to review your medical records or made assumptions regarding your abilities without reviewing your medical records, this can establish a clear inconsistency. Your doctor may be able to show that the consultative examination doctor’s report is simply not credible.
If My SSD Consultative Examination is Favorable Does This Mean I’ll Be Awarded SSD Benefits?
Perhaps your consultative report comes back exactly as you had hoped. It clearly details your disability, showing that you are unable to work and make a living. Before you celebrate, thinking you will definitely receive SSD benefits, consider this. Your consultative examination doctor may have gone too far in the other direction with your report. If the DDS specialist thinks your disability has been significantly overstated, it could be afforded less weight than other medical reports in the file.
The DDS specialist might determine that the doctor was just agreeing with you, or that the report simply doesn’t correspond to your other medical records. While you want your report to convince SSA that you do have a disabling condition and should receive SSD benefits, you don’t want the report to be over the top. Tell the doctor the full extent of your disability and the resulting disabling symptoms and problems, but don’t over-exaggerate your symptoms.
Could a Consultative Examination Be Requested by the Administrative Law Judge?
Suppose you are not asked to undergo a consultative examination and your application is denied. Once your claim goes before an Administrative Law Judge (ALJ), the judge can request a consultative examination prior to making his or her decision. The judge may order a consultative examination if he or she believes the information is necessary to make an informed decision.
While many judges hesitate to do this because they don’t want to hold up the case following a court hearing, others may order the CE. If a consultative examination is necessary to adequately show your disabling condition, your attorney can make the argument as to why a CE is necessary. If the judge refuses, this may provide grounds for appeal to the next level.
How an Attorney from Carmichael Law Group Can Help with the Consultative Examinations for SSD Claims
Consultative examinations for SSD claims can be nerve-wracking. You may feel as though your future hinges on this one twenty-minute examination. It’s hard not to be anxious about the exam—which is why you should speak to an experienced SSD attorney from Carmichael Law Group. Social Security Disability is a federal program, so Carmichael Law Group can help you—no matter where you live.
While our offices are in Alabama and Georgia, we are ready to help anyone in any state. We will aggressively pursue the disability benefits you need and deserve, always working toward a positive outcome. Whether you are just beginning the process, or your initial application for benefits was denied, we can help. Contact Carmichael Law Group today—we will ensure your disability is presented in the very best light.