What is a Consultative Examination?

Sep 10, 2020 | Sara Khaki

When a person applies for Social Security Disability Insurance, also known as SSDI benefits, the examiners responsible for making a decision on their disability claim may schedule a consultative examination. Even though the examination is very important to the process of an SSDI claim, it can cause frustration or confusion for some.

For those applying for SSDI or another form of disability benefits, they may not understand why a consultative examination is necessary. While the consultative exam is typically requested when you submit insufficient medical evidence, this doesn’t mean that you’re facing an unfavorable decision.

Rather, it means that you must add a little more information for the Social Security Administration (SSA) to make a determination on the existence or severity of your disability. Our Social Security disability representatives possess a thorough understanding of consultative examinations and can give you the peace of mind you need to complete this step in the SSDI claims process.

Purpose of a Consultative Exam

During a consultative examination, you can expect a series of medical examinations designed to help the SSA and other agencies gather more information about your level of impairment. For example, the SSA usually sends disability claims to the federally funded state agency, Disability Determination Services, or DDS. This agency is responsible for gathering medical evidence and giving an initial decision on whether a person’s condition warrants disability benefits from the SSA.

If your medical records do not contain enough evidence about your impairment and capacity for employment, or if you have not been seen by a doctor for a considerable amount of time, DDS may schedule a consultative exam for clarity. This appointment is scheduled by the DDS office, and they will pay all of the costs associated with medical exams, which means anyone pursuing disability benefits will not have to pay out of pocket for this examination.

The medical exams in this process aren’t for the purpose of giving medical treatment, but rather to provide an up-to-date file on your condition and various disabilities. These tests can examine physical, psychiatric, and psychological conditions that may relate to a disability claim.

Who Can Perform the Exam?

Consultative exams are not conducted by doctors who work for the SSA or DDS. Instead, these exams are typically performed by independent physicians who have been contracted to perform this service for the SSA. DDS will elect your own medical provider to perform the exam. However, if your doctor is not qualified to do this type of exam, you may have to visit a new physician.

In many cases, the medical professional who conducts the consultative examination will do tests requested by the disability examiner who first ordered the exams. It’s important to note that the examiner will only obtain what is necessary for an SSDI decision, so you will not be subjected to arbitrary or invasive testing if it is not strictly necessary to assess your disability claim.

How do I Prepare for a Consultative Examination?

You can prepare for a consultative examination just like you would for any other medical appointment. Arriving a few minutes early and coming prepared with a list of conditions, current treatments, and medications can help make the consultative examination process run smoothly.

During the appointment, do your best to give comprehensive and accurate answers to any of the questions the physician asks. Don’t exaggerate your limitations or disabilities. Let your medical results speak for themselves.

A doctor who performs this consultative exam is required to spend a minimum amount of time with a patient, depending on the specific nature of the tests being conducted. For this reason, it is helpful to document what happened during the appointment, what tests were requested, and how much time the doctor spent with you in case you need to contest any issues with the examination.

Working with an Attorney throughout the SSDI Process

The process for receiving a favorable SSDI decision can be long and stressful for first time and repeat applicants alike. Having to appear for a consultative examination may not automatically mean trouble for your case, but if this is your first time having a disability claim questioned, it can still add confusion to an already complicated process.

At the Khaki Law Firm, our team has dealt with a multitude of SSDI claims. It is a multifaceted process, and you can benefit from having an experienced Social Security disability lawyer by your side to ensure that your rights are respected during a consultative examination.

Whether you are just beginning your path to disability benefits, or you are at advanced stage in the SSDI appellate process, our Social Security advocates for the disabled can help. We understand the process and want to help you achieve a favorable outcome in your case. Contact our firm today to learn more about what an SSD appeals lawyer can do for you.

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