THE CONSULTATIVE EXAMINATION AKA SOCIAL SECURITY MEDICAL EXAM

Social Security Disability Definitions

This information may help claimants with representation, as well as claimants who are not represented by an attorney or non attorney representative. Understanding how the Social Security Disability system works can make the difference between winning or not winning the continuing disability benefits and backpay to which a person is entitled. To win a claim for ongoing and past due benefits, claimants should learn about the disability process to improve their chances of winning.

Consultative Examinations are medical examinations that social security disability and ssi claimants are sometimes sent to in the course of processing a claim for disability benefits. Contrary to a fairly common misunderstanding, "social security medical examinations" are not conducted by "SSD doctors". In fact, in this sense, there is no such thing as an SSD doctor, though there are DDS unit physicians who assist DDS disability examiners in their decision making duties. The doctors who perform consultative examinations for the social security administration (which can be physical, psychiatric, or psychological in nature) are actually independent physicians who have contracted to perform such services. Who schedules medical examinations for disability cases and why? The process works like this: after a claimant files for ssi based on disability (title 16), or social security disability (title II), the case is transferred to DDS, or disability determination services, where an examiner will begin gathering records for the purpose of making a decision. In cases where a claimant's medical records are very "thin", or where a claimant has not been seen by a doctor for a considerable amount of time, a CE, or consultative exam will generally be scheduled. As stated, CE's can be mental or physical. They can also include ophtalmological exams, bloodwork, and the taking of xrays. However, whatever happens at a social security medical examination is at the discretion of the disability examiner ordering the exam. In other words, the examiner only obtains what is necessary for a decision to be made. Medical exams conducted for social security objectives are not for the purpose of delivering medical treatment. Instead, their purpose is to provide a recent snapshot of a claimant's conditions and various limitations. However, the inherent weakness of such medical examinations is fairly apparent. For one thing, a doctor who conducts a CE has typically never seen a claimant. And though DDS examiners often send a portion of a claimant's medical records to the physician who will conduct the CE (to appraise the doctor of the client's medical background), this is a poor substitute for an established doctor-patient relationship and only minimally effective if the CE doctor actually reads what he or she has been sent. Additionally, social security medical exams tend to be fairly brief. In fact, it is a common complaint among claimants who have gone to such examinations that the duration of the exam was only 5-10 minutes. Though this may not be true for every CE, it is probably true for a large percentaqe of them. What does it mean for a claimant's disability case when a CE has been scheduled? It can be good or bad. First, the good. Getting an appointment letter for a social security medical examination, or CE, means, at the very least, that a claim is actively being worked on. In some cases, it may be that an examiner who is leaning toward making an approval needs to obtain additional evidence, such as an xray. However (now for the bad), a CE appointment can also mean that a claimant has very little in the way of medical records i.e. has not gone to a doctor in quite a long time, or has only been treated sporadically. In such cases, the scheduling of a consultative examination may simply be a technical necessity (examiners are required to obtain "recent" medical evidence on which to base their decisions) prior to closing a case. Claimants who receive appointment letters for social security medical examinations, though, should not be overly concerned about having to go to an exam since the reason for scheduling an exam may never be known. Claimants who are scheduled for such exams, however, should always attend them since examiners are empowered to close disability claims for "failure to cooperate". However, when a claimant misses a scheduled exam and has a valid reason for this happening, an examiner will usually allow for the examination to be rescheduled.