When claimants receive a request for a Social Security Disability consultative exam, many do not know what to expect or how to prepare. Claimants applying for both the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs may need to take a Social Security Disability consultative exam. And, while receiving the request may result in temporary concern, rest assured that consultative exams are frequent and normal parts of the Social Security Disability determination process.
When Will Social Security Request a Consultative Exam?
When claimants file an initial application for SSDI or SSI benefits, their claim is assigned to a Disability Determination Services (DDS) caseworker at the state’s agency. Next, that caseworker begins the process of collecting medical records from all your relevant treating medical providers.
Following that step (which usually takes months), a physician who works for the State’s Disability Determination Services Agency reviews these records. After the review, they complete a “Residual Functional Capacity” (RFC) assessment. This assessment takes into account your age, education and past relevant work. It also includes a review of the medical evidence associated with your claim for disability benefits.
Most initial claims are denied. Frequently, the state agency physician determines the medical records are insufficient and requests additional information to craft their RFC assessment. If that’s the case, your DDS caseworker and Social Security may decide to request your participation in a consultative examination (CE). (Important note: The Social Security Administration pays for all consultative examinations.)
What To Expect During a Consultative Exam
First, the Social Security Administration (SSA) is unlikely to use your existing physician for the exam. Instead, they often send claimants to a physician they have on contract to perform these types of exams.
These physicians DO NOT work for the SSA, are impartial and do not have an interest in the outcome of your claim. And, they do not involve specialists in this exam. As an example, SSA won’t contract with a neurologist or rheumatologist for a specific claimant with those problems although the physician may have some background in those areas.
There are two types of exams: 1) the Internal Medicine Examination (Physical) and 2) the Psychological Evaluation (Mental).
Exams are frequently short, 20 minutes or less. The examiner observes you at all times… walking into the room, getting on and getting off the exam table. BE HONEST! Don’t exaggerate your condition(s), but thoroughly answer their questions
In addition to the observation period, the exam may include imaging, often x-rays. It’s not necessary to bring your old medical images or records, but you can bring a current medication list, problem list and imaging report if you have any.
Of note, if you’re called in for a mental consultative exam, don’t discount your health problems. Be sure to talk about how your mental health conditions like depression, anxiety or stress affect your ability to perform routine activities.
What’s Next?
While CE’s rarely make or break a claim, it is important to attend them. If you can’t make your exam, let your disability attorney or DDS know in advance so they can reschedule. Typically, they will only honor one request to reschedule.
Finally, there are many ways a good disability lawyer can help prepare your claim and walk you through a CE if requested. If you or someone you know is filing for or appealing a denied Social Security Disability claim, we’d be happy to help.
