Do CE exams usually result in denials for disability?
Social Security Disability examiners like to have a twelve month longitudinal medical treatment history from your treating physician to process their disability determinations. Often disability applicants have been out of work and have not been able to pay for medical treatment, consequently they do not have the current medical evidence (medical records less than 90 days old) needed for a disability determination.
If you apply for disability but have not been seen by a doctor in the last 90 days, you will most likely be sent to a CE, or consultative exam, in order to gather recent evidence. Usually, this involves a general physical exam, or a short mental status exam. Disability examiners sometimes use special CE examinations (i.e. neurological, orthopedic, psychological, or psychiatric, etc.) to clarify medical treatment evidence they already have in your disability claim file.
If you have no treatment for your disabling condition, a CE may show that you do have a severe disabling condition and most certainly the medical information provided is better than none.
However, your disability claim has a better chance of being approved if you have had medical treatment over a period of time with a doctor who is familiar with your medical conditions. They can also offer information that CEs cannot provide, such as treatment, medications, and response to treatment, prognosis, and an opinion with regard to your limitations.
It is important to remember CE examinations are not meant to be a medical treatment and often they are not very thorough. CE physicians are paid by Social Security to give them enough information for them to make a medical determination. Often these examinations do not lead to an approval of benefits.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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