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January 1, 2024

SSA Says I Have to Go to a Consultative Examination. What Should I Do?

You have likely suffered tremendously to get the disability benefits you rely on, and now the Social Security Administration (SSA) is telling you that you must attend a consultative examination (CE). What does that mean? Does it put your benefits at risk? Is this doctor really on your side? These are common fears, and you are not alone. Many people receiving disability benefits feel anxious when they receive this notice, unsure of what to expect or how the results might affect their future. The good news is that you do not have to go through this alone. 

Understanding what to expect at disability medical exam appointments and having experienced legal guidance from the Law Offices of Jennifer R. Solomon can help you confidently navigate this process. You may wonder why your medical records are insufficient, what the exam entails, and whether it could negatively impact your disability claim. Knowing what to expect can help you feel more prepared and confident going into your CE.

Why Does the SSA Require a Consultative Examination?

If the SSA determines that the medical evidence in your file is insufficient to decide your disability claim, they may request that you undergo a CE. Independent doctors hired by the SSA typically conduct these exams. The primary reasons the SSA may ask you to attend a CE include:

• Your medical records lack recent or objective evidence of your condition;
• Your treating physician did not provide enough detailed information;
• The SSA needs additional testing to verify the severity of your disability; or
• There are inconsistencies in your medical records.

The goal of a CE is not to provide treatment but to evaluate your condition based on Social Security disability criteria.

What to Expect at a Disability Medical Exam

A CE is usually brief, often lasting no more than 20-30 minutes, but it plays a crucial role in determining the outcome of your disability claim. The scope of the exam depends on your medical condition. Some important things to know:

• The doctor conducting the exam is there to evaluate your limitations;
• The SSA will pay for the exam, so there is no cost to you;
• The exam may include physical tests, mental health assessments, imaging, and lab tests; and
• The physician will report their findings to the SSA, which uses them to make the final disability determination.

It is essential to be honest and cooperative during the exam. However, be aware that the SSA hired this doctor, and they do not have the same relationship with you as your treating physician.

What Is an Internist Exam for Disability?

If an internal medical condition such as heart disease, respiratory issues, or digestive disorders is the basis for your disability claim, you may need to see an internist. What is an internist exam for disability? It is a general medical evaluation performed by a specialist in internal medicine. The exam may include:

• Checking vital signs, such as blood pressure and heart rate;
• Assessing organ function, including heart and lung health;
• Testing mobility, endurance, and overall physical condition; and
• Ordering additional diagnostic tests, such as blood work or imaging.

This exam is vital because internal conditions may not always be visible but can significantly impact one’s ability to work.

How to Prepare for Your Consultative Examination

To give yourself the best chance of a fair evaluation, follow these tips:

• Review your medical history—take a moment to review your symptoms, past treatments, and how your condition impacts your daily life;
• Bring a list of medications—be ready to provide information about any prescriptions you take, their dosages, and their effects;
• Arrive on time—being late or missing the appointment can negatively impact your case;
• Describe your symptoms accurately—be clear about your pain levels, limitations, and any difficulties you experience without exaggerating or understating them; and
• Do not downplay your condition—do not try to appear “tough” by minimizing your pain or discomfort, as this could result in an inaccurate evaluation.

After the exam, take notes about what the doctor did, how long the exam lasted, and any concerns you had during the appointment.

How Long After the CE Exam Will I Get a Decision?

A common concern for disability applicants is, How long after the CE exam will I get a decision? After your CE, the Disability Determination Services (DDS) will review the examiner’s report along with your existing medical evidence to decide on your disability claim. The SSA does not provide a fixed timeline for this process, as it can vary based on several factors, including the complexity of your medical condition and the workload of the DDS.

While the DDS may decide some claims within a few weeks, others may take longer. If you experience significant delays, you have the right to check the status of your claim with the SSA. Additionally, if you believe there has been an unreasonable delay, you may want to consult an attorney to help navigate the process and ensure your claim is moving forward.

What Should I Do If I Have Concerns About My Consultative Examination?

If you have concerns about your CE, there are steps you can take to address potential issues and ensure your evaluation is as fair and accurate as possible. 

• Request a copy of the report. If you want to review the examiner’s findings, you can request a copy of the report from the SSA. This can help you understand how the report may impact your disability claim and give you an opportunity to provide additional medical evidence, if necessary.
• Report any issues. If you believe the examiner did not conduct a thorough evaluation, was dismissive, or made incorrect statements in their report, you can contact the Disability Determination Services (DDS) handling your case to express your concerns.
• Consult a disability attorney. A lawyer experienced in Social Security claims can help you understand the role of the CE, ensure your medical evidence is properly presented, and assist with an appeal if an unfair CE report contributes to a denial.

While the CE is an important part of the SSA’s decision-making process, it is not the final say on your disability claim. Taking the steps above with the help of an attorney will help keep you moving forward after a CE. 

What Happens If the CE Report Is Unfavorable?

If the consultative examiner’s report does not support your disability claim, you still have options.

• Request reconsideration or a hearing. If you disagree with the determination based on the CE report, you have the right to request a reconsideration or a hearing before an administrative judge. 
• Submit additional medical evidence. During the reconsideration or hearing process, you can submit new evidence to support your claim. 
• Consult a disability attorney. A lawyer familiar with Social Security claims can help you navigate the appeals process. 

These steps can improve your chances of overturning an unfavorable decision and securing the benefits you need to support your well-being.

Why Choose the Law Offices of Jennifer R. Solomon?

At the Law Offices of Jennifer R. Solomon, we understand how stressful the Social Security Disability process can be. With her background as a former insurance defense attorney and years of experience advocating for clients, Jennifer brings a unique perspective to disability claims. Her in-depth knowledge of how claims are evaluated, combined with her dedication to personalized legal representation, allows her to effectively guide clients through the complexities of this daunting process.

Contact Us Today

If you must attend a consultative examination, we can help you understand what to expect, ensure your medical records are properly documented, and advocate for your rights if you receive an unfavorable decision. Contact us today so we can help you receive the benefits you deserve.

Resources

Code of Federal Regulations Title 20 § 404.908, link

Code of Federal Regulations Title 20 § 404.935, link

Code of Federal Regulations Title 20 § 404.1705, link